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 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.

“The ACA has been toward reforming our vastly unjust health system,” said Terence D. Gipson, Ph.D., master’s in public health and assistant professor of public health at St. John Fisher University in Rochester. “Millions of Americans now have health coverage via the ACA marketplace and Medicaid expansion who otherwise would remain uninsured or underinsured. Considering the state of our healthcare system pre-ACA, this is a monumental triumph for health equity.”

The website healthcare.gov states that 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 managing director for InvisionHealth in the greater Rochester region, 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,” Kalia said. At the time of this interview in December 2022 he was the president-elect of the Monroe County Medical Society.

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 insure 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 may 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.

Gipson said that in addition to not covering 1099 workers or those who work for small employers, the ACA also does not cover people living in “the 11 states that have not expanded their Medicaid programs, undocumented immigrants, or young adults without employer-sponsored plans,” Gipson said. “Many still report that the premium tax credits are not enough to cover the high costs of quality insurance plans.”

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

“What we have to find in this country — 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.