OBAMACARE ABLE TO INSURE 35 MILLION PEOPLE SO FAR

The Affordable Care Act was a very controversial plan at the time of its launching. Today, it provides health insurance to 358 million Americans

BY DEBORAH JEANNE SERGEANT

Since its passing in 2010, the Affordable Care Act, informally known as “Obamacare,” has helped people get health insurance by mandating coverage and eliminating insurer exemptions related to consumers’ pre-existing conditions.

Younger and typically healthier consumers would help mitigate the higher costs of older and typically sicker older consumers.

As of early 2022, about 35.8 million people were enrolled in ACA plans, Medicaid expansion and Basic Health Plan policies, an increase from 27.1 million in 2020.

In 2008, before the ACA, 255.1 million Americans had health insurance, or

83.45% of the population. As of 2022, about 302.1 million have health insurance, or 90% of the population. That represents a solid increase in the number of insured people. Experts say that part of the reason for this success is that no one is arbitrarily excluded.

“The marketplace offers the expectation that you can get health insurance, removal of preexisting coverage, removed limitations on treatment for chronic conditions and expanded Medicare and Medicaid,” said Lisa Olson-Gugerty, who holds a master’s degree in public health, and works as associate teaching professor at Syracuse University David B. Falk College of Sport and Human Dynamics.

The ACA has created a more level playing field as far as eligibility for acceptance by insurer. However, it also has a few drawbacks.

“The plans may still be too expensive for some, they may not offer adequate coverage and where to find them varies,” Olson-Gugerty said. “The ACA did not mandate that all states expand Medicaid and Medicare, 14 states did not. We are not any closer to creating a universal access health system.”

She sees healthcare as further away from existing as a human right to serve humanity and closer to becoming more like a service industry dictated by business guidelines and through patients “who may or may not have any understanding of evidence-based medicine,” she said.

Although anyone can obtain insurance through the Marketplace, that does not necessarily mean everyone can easily afford insurance, she said. The website healthcare.gov states the primary goals of the ACA are to make affordable healthcare available to more people, expand Medicaid to cover all adults below 138% of the federal poverty level and support healthcare delivery that lowers the overall cost of care.

Physician Hemant Kalia, interventional pain and cancer rehabilitation specialist and president-elect of the Monroe County Medical Society, calls the ACA “definitely a success” for the number of people now able to access health insurance. “But it does come with some challenges. The biggest was that unfortunately, the legislation itself was not able to curtail the cost of healthcare.”

A fair number of people still fall through the cracks and are unable to obtain affordable insurance. This includes people who perform all gig work, work two part-time jobs, work as sole proprietors or for companies of fewer than 50. They still don’t have employer issued health insurance because they’re either 1099 workers or their employers are not required to in- sure them.

Of course, these people can buy policies through the exchange, but it’s not easily affordable for people of modest income and they don’t qualify for lower cost insurance because they make too much income.

“That’s one of the cons of Obamacare which has manifested itself,” Kalia said. “Businesses with 50-plus employees are required to provide it, but by reducing hours, some have 30 hours a week as a definition. Those are the employees falling through the cracks. Businesses are sometimes cutting hours to avoid covering employees and people have to go on the marketplace, which is challenging financially.”

In a measure effective in 2019, The Trump Administration lifted the former tax penalty levied for non-coverage. Those who choose not to have coverage can do so without a penalty.

Mary Dahl Maher, nursing department chairwoman and director of the public health program at Nazareth College in Rochester, views the ACA as a compromise between 100% patient-paid premiums and universal healthcare.

“What we have to find in this coun- try — and we’re capable, with the brilliant minds we have — is a different look at our healthcare system,” Maher said. “We don’t want a single payer and we can’t cover everyone’s healthcare needs, but we need preventive healthcare for every single person. Basic healthcare is a human right. I think that’s something we need to do.”

Pushing preventive care can help reduce healthcare expenses overall. For example, a colonoscopy could discover a polyp and prompt its removal before it becomes cancerous and more difficult and expensive to treat.

Maher wishes that current healthcare plans offered better plans at more affordable rates, as currently the least expensive plans operate like catastrophic plans with high deductibles and co-pays.

“The cost of any insurance is still higher,” Maher said. “I teach about the ACA in undergraduate classes. It didn’t solve all the problems.”

Although she does not believe the ACA turned out as well as it could have, she lauds it for helping more healthcare consumers understand how the system works and exposing the need for more coverage for everyone.