Background
The Affordable Care Act (nicknamed Obamacare) is the central statue of the United States approved by the 111th United States Congress, and was incorporated into law by President Barack Obama on March 23, 2010.’ The act was then modified by the health care and education reconciliation act on March 30th, 2010, where it changed how health care was viewed in the US significantly. Obamacare provided Americans with better health well-being, and putting in place a widespread a reform for health insurance that will try to increase Medicaid coverage, drop the cost of health care, which will guarantee more choices Americans can make in choosing an insurance plan and help enhance the value of care that Americans receive. With Obamacare, the objective of the law that’s been put into place is to reduce the amount of uncompensated care that the average family in America pays for by compelling everyone to have health insurance and those without it for the year, to pay a tax penalty for either the months they were not covered by insurance.
Obamacare was aimed to cover middle- and lower-income families in making health insurance a lot more reasonable for them. (Obamacare, 2020, February 13) Obamacare usually refers to the two separate pieces of legislation, which are; the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010. Together, the pieces of legislation has played an important role in expanding Medicaid coverage to millions of Americans who are considered low-income and make an abundant if improvements to both Medicare and Children’s Health Insurance Programs other known as CHIP. With Obamacare, this law also provides a tax credit that can be used when choosing a health insurance plan. For example, the way the tax credit works is if you fall under the 400% poverty level than you can qualify for the tax credit. For the individual their income has to be less than $51,040. For 2 person per household their income has to be $68,960 combined and 3 person per household is $86,880 combined and so on and so on. (Federal Poverty Level FPL) The poverty level line limits the out of pockets cost to $7,150 for the individual plan and $14,300 for the family plan.
Proposal
Some of the proposals that can be taken into consideration for Obamacare would be a budget resolution. With this process we would start of by repealing Obamacare, which will then lay out the groundwork for the budget reconciliation bill to surround the legislative language that repeals a portion of the Obamacare Act. According to the article “3 Ways the Senate Budget Reopens the Door for the ACA repeal” it states that every dollar the funding committee decreases from health care could be used to compensate for tax cuts for the rich that would be on top of the $1.5 trillion tax cut funded by the insufficiencies. This type of resolution could let congress pass a huge deficit-financed tax cut for the rich and businesses, combined with general components of Obamacare. (Stein, H. 2017, September 29)
Another proposal for Obamacare would be to replace this health care bill with the Graham-Cassidy legislation bill which would be executed by a block grant program that gives funding to states. This would then have an extensive flexibility on how the state wants to spend that money in regards to health care market for individuals to purchase health insurance. The Graham Cassidy bill was created by Senator Bill Cassidy, Lindsay O. Graham, Dean Heller, and Ron Johnson with the vision of turning jurisdiction of the health care markets over to the states and rather than financing Medicaid. That money would be put into what are called block grants that a state could use to develop any health care system it wants. This also allows each state to elect out of many of the regulations that Obamacare has. For example, if some of the states opt in favor for Obamacare, they can keep it as is, but if some of the states aren’t in favor of Obamacare then they can replace it with the bill that was created by the senators. (Analysis | Will Republicans have enough votes to repeal Obamacare?) Another proposal would be to restore Americans’ Healthcare Freedom Reconciliation Act of 2015 which was traditionally used by lawmakers to reduce the shortfalls through income increase and cuts to powers.
An example would be Medicare and Medicaid, but not Social Security which cannot be changed under a reconciliation bill. The process has been used in the past to enact both tax cuts and tax increases, reforms to student loan programs, and even some minor pieces of Obamacare. (H.R. 3762, Veto Override) The last proposal that I have in mind that can be used would be to eliminate pre-existing condition as a barrier to converge which will allow more people to purchase health insurance. States would be allowed to scale back conditions that they require insurers to cover. Because of the way the law is designed, that could allow insurers to re-impose annual and lifetime limits on some coverage, which would not allow insures to charge sick people more.
Reasons to Address the Issue
Reasons to address the issues with the Obamacare are that this type of act has high deductibles for insurance plans that individuals purchase and other cost sharing problems with it as well. Also, not many people would fall under the 400% poverty line that the state has put into place and I believe that this poverty line should be lowered a lot more. Another reason this issue should be addressed is because of impractical subsidies. (Goodman, J. C. (2015, June 25) Obamacare isn’t just unfair, it also has different subsidies that will disturb our economy greatly in the long road. Another issue with Obamacare that needs to be addressed is that in its first year, there has not been an outpouring of doctor’s visits from patients.
Three to five million people have lost their health insurance through employment because it didn’t cover Obamacare’s ten crucial benefits. For those who were without health insurance they got a tax penalty at the end of the year by Obamacare and for some reason some of the individuals actually preferred to just pay the tax penalty. If we repeal Obamacare, this would reduce the discrepancy over time and have it declared unconstitutional. If this happened than the federal discrepancy would surge by a relativity small amount which would then have a small impact on the economy. Back in 2013, medical device productions and importers paid a 2.3% expunge tax, this type of tax was suspended from 2016-2018. For example, indoor tanning services paid a 10% excise tax and this type of taxing would discourage those business from hiring new employees. Obamacare does not just impact individuals, it impacts small business as well. Also, in 2013 families could reserve medical expenses that exceeded 10% of their income. Before this, they could withhold any expenses that exceeded 7.5% of the income. (Amadeo, K. n.d.) Repealing Obamacare will have a great impact on even the small stuff as you can see.
Key Arguments for and Against
A main argument for the Graham Cassidy bill is that people who are born with pre-existing conditions, for example congenital heart failure, are not eligible for this type of law. The individual with these pre-existing conditions will not benefit from this and will find themselves going back to square one in attempting to purchase health insurance again. Another argument against Obamacare would be, because many people received preventative care and testing for the first time, it would then become very expensive to treat these illnesses that have been ignored for decades. In the end when Obamacare was implemented, its vision was to make Medicaid more available but it failed at making it affordable and appealing to all of the states.
Out of the 50 states only 38 of them have chosen to adopt the Medicaid expansion plan. However Obamacare, which was enacted on March 2010, made a substantial change in federal programs and tax policies regarding health care including changes affecting insurance coverage, affordability and accessibility, financing of medical care, and the operation of the Medicare program. All in all, with Obamacare in place it has caused an intense increase in the debt that the government is in and has made the word Medicaid Expansion less appealing to some of the states. Some states even went as far as suing the federal government stating that Medicaid expansion was very unconstitutional. According to “A Guide to the Supreme Court’s Decision on the ACA’s Medicaid Expansion” a majority of the Court found that Medicaid expansion was unconstitutional, because states did not have suitable notice to willingly consent to this change in the Medicaid program, and all of a state’s existing federal Medicaid funds potentially were at risk for non-compliance.
Plan to Engage With Stakeholders
Stakeholders that are for supporting the Graham Cassidy-bill are Chuck Grassley, Jim Inhofe and Pat Roberts. The senators who support this bill, I plan on speaking with each of them and taking into consideration any new ideas that can be added to the bill and pass it by congress to see if they get approved. Also, I would find new ways to get those who are oppose of the bill to get on board. I also plan on letting those who are not onboard with the Graham Cassidy bill, that patients that are born with pre-existing conditions are eligible and will not be automatically disqualified. The groups that oppose the Graham Cassidy bill include blue cross blue shield association, Americas health insurance plans, American medical association, American hospital association and AARP.
To start off, AARP is a United Sates membership group that was founded in 1958 by Ethel Percy Andrus who was a retired educator from California. The American Hospital Association is a professional association that seeks to promote quality care by hospitals and health care networks through public policy providing information to health administration to health care providers and public. The purpose of the Graham Cassidy bill is so that the federal government does not make any problematic policy judgement concerning how health insurance is supported and regulated within the state. Stakeholders that see eye to eye with making Obamacare and Medicaid expansion more affordable and appealing to others are the Republican and Democratic parties. The Medicaid and CHIP Program, and all those who fall under the qualification of the program are stakeholders that see eye to eye with this. One of the main goals of health reforms is to expand insurance coverage and ultimately to increase access of care as well as lowering the government expense.
Timeline
The timeline for this to go into effect would be immediately. First and foremost, we would have to talk to those who are not in favor of repealing Obamacare and make them see the benefits that can come with repealing it. We would also have them see how the changes made to new ideas like the Graham Cassidy bill would benefit patients with pre-existing conditions. With the block grant, each state will have a fixed amount of money each year which will have a great effect in low income American families. The main payers for the block grant will be the federal government. With the block grant, the cost to the government would be a moderate amount and the political feasibility would be at a medium. This will increase access to lower income population.
Also, with eliminating pre-existing conditions, this will require insurance companies to cover but not charge more to patients with this type of issue. The population that would be affected by this would be disabled and of course patients with pre-existing conditions. The main payer for this will also be by the federal government and this will cost them a moderate amount. The feasibility would be at a medium and this type of access will be increased to those who are disabled as well as low income American families. When less people are uninsured, it would mean that less people would need to be on Medicaid. This could possibly allow states to be more inclined in adopting the Medicaid expansion because less people would need to be on Medicaid and in all it will decrease federal spending. All in all, this type of repealing will subsequentially take a little bit of time to go into effect because we would have to get everyone on board with it and still have some tweaks to fix as well.
