The U.S. Affordable Care Act (ACA) on March 23 turned five years old. The landmark healthcare law, derided as "Obamacare" by its opposition (a nickname that stuck and was taken up by proponents as well) aimed toward covering the estimated 47 million Americans who lacked health insurance, reducing healthcare costs and improving health services. Critics said it couldn't be done, but a check-up on the bill shows modest, solid improvements that should make President Obama very happy.
It is well known that the United States spends more money than any other country on healthcare, despite lower outcomes and the highest or near-highest prevalence of obesity, car accidents, infant mortality, heart and lung disease, sexually transmitted infections, adolescent pregnancies, injuries, homicides and disabilities. The United States is among the few industrialized nations in the world that does not guarantee access to healthcare for its entire population. In many countries, healthcare is a right--a public service like the police force or fire department. In the United States, it is Big Business.
Therefore, healthcare reform has long been a hot topic among the political leadership. Republicans generally resist what they consider a socialist-style approach to government-regulated healthcare, while Democrats support a stronger federal role in the matter. Fresh off a sweeping electoral success for the Democrats in 2010, President Barack Obama passed the landmark bill that represented the most significant regulatory overhaul of the U.S. healthcare system since the passage of Medicare and Medicaid in 1965.
An additional 11 million Americans have gained health insurance coverage under Obamacare, and the percentage of uninsured Americans dropped from 18 percent in 2013 to 11.9 percent this year. Health and Human Services Secretary Sylvia Burwell announced in March that hospitals saved an estimated $7.4 billion in uncompensated care costs last year as a result of patient enrollment. Public hospitals in the United States follow a "treat now, pay later" system for the ill, and no one can be turned away from an emergency room for lacking payment, so patients who are not able to pay are considered "uncompensated care costs."
While much has been made of the bill's mandate that all Americans enroll in an insurance program or face a fine, the greatest driver of the reduction in uninsured Americans has been the expansion of Medicaid. Under the ACA, states can expand Medicaid to include those who make 133 percent of the federal poverty level ($16,243 a year for an individual or $33,465 a year for a family of four). So far, 29 states have expanded Medicaid, and another six states are considering the expansion.
Though the federal government has pledged to cover 100 percent of expansion costs, many Republican-controlled states have refused based on their opposition to the bill. These states are forgoing an estimated $88 billion in federal funding, and reducing the country's economic output by $66 billion through 2017, according to the president's Council of Economic Advisers.
To make the bill's anniversary even sweeter, the non-partisan Congressional Budget Office just lowered its estimated price tag of implementing Obamacare. It projected the program would cost 11 percent less than previous estimated. Healthcare costs are also growing at a slower rate than they have in recent years.
One would think even the staunchest critics of Obamacare would be impressed by these numbers, but the vitriol aimed at the ACA has not diminished, and every Republican candidate has vowed to repeal the bill since it was passed. There have been 56 unsuccessful votes in Congress to undermine or repeal the law, and opponents are now focused on a strategy of "repeal and replace" that does not threaten aspects of the bill that are extremely popular with the public--namely, allowing young people to stay on their parents' insurance plans until age 26 and banning insurance companies from refusing patients with pre-existing conditions.
Republican critics have long predicted the bill would wreak havoc on the federal budget and the U.S. economy. The way they talk, healthcare reform would send the country's economy spiraling into a deep, irreversible depression. They call it a "disaster," a "train wreck" and "un-American."
While Obamacare certainly has not turned out to be a disaster, there are still some problems and growing pains for the program. Some consumers still pay high out-of-pocket costs with their low-premium plans, the government still has a challenge in encouraging young and healthy singles to sign up for insurance policies, and employers have resisted new regulations that require them to provide healthcare coverage for their employees.
Perhaps the biggest failing of Obamacare is that it didn't go far enough. Unlike the universal healthcare systems of countries like France--number one in providing high-quality, low cost healthcare according to the World Health Organization--or a single-payer system like that of Canada or the UK, Obamacare still relies on a web of insurance companies to issue policies. Healthcare is still a business in America, not a right.
There's much that still needs to be done to make healthcare affordable and accessible to all Americans, but critics and proponents alike should work on ways of improving the bill, instead of fighting over its very existence. Five years later, we can see that Obamacare works even with its flaws. It's time to take the next steps and build up the most successful parts of the ACA. Until we can take the debate out of the political realm and into the practical, America will never be number one in healthcare no matter how much it spends.
The author is a contributing writer to Beijing Review, living in New York City