Obamacare is Dying. Should We Save It?
Protestors rally in favor of a public option outside the offices of Anthem Blue Cross in San Francisco. Photo courtesy of Steve Rhodes.
When President Barack Obama signed the Affordable Care Act (ACA), informally known as “Obamacare,” into law in 2010, it was poised to become the most impactful healthcare reform act since Medicare and Medicaid’s passage in 1965. However, challenges have arisen throughout its implementation. With public opinion divided over Obamacare’s policies, the fight for universal coverage is an uphill battle.
The ACA’s protection of people with pre-existing conditions from exorbitant insurance premium prices and coverage denial has been crucial, especially during the pandemic. However, without an individual mandate to incentivize healthy people to get insurance, Obamacare is creating an insurance pool of mostly unhealthy people, leading to rising premiums and less affordable care for those who need it. To restore Obamacare’s longevity and effectiveness, the federal government should implement reforms to improve its accessibility and lower premium costs.
One of Obamacare’s novel aspects was its policy regarding coverage of individuals with pre-existing medical conditions. Under Obamacare, insurance companies cannot deny coverage or raise premiums—the monthly cost of insurance—based on pre-existing conditions. While there are a few exceptions, this policy still benefits over 100 million patients by offering more comprehensive coverage. The problem is that this system removes the incentive for healthy people to purchase insurance. Healthy individuals have no incentive to pay premiums when they can wait to enroll in a plan that classifies their sickness as a pre-existing condition. This loophole drives up premium costs for a disproportionately unhealthy pool of insured people. Obamacare solved this problem by establishing an individual mandate.
The individual mandate was a policy that penalized people without health insurance. The rationale behind it was simple: the more people with health insurance, the cheaper premiums would be. Think tanks on both sides argued the individual mandate violated the free market and people’s freedom to not have insurance, with the negative impacts often disproportionately affecting immigrants. They also claimed the mandate overstepped the powers granted by the Constitution, specifically citing the Commerce Clause and saying Congress should not penalize economic inactivity. Using these arguments as a springboard, Republicans in Congress repealed the individual mandate in 2017, and states with their own mandates slowly dissolved their policies through 2019. Admittedly, the original individual mandate policy had its flaws. To name a few, it was unconstitutionally implemented; it penalized individuals who didn’t carry insurance for personal financial or health reasons; and it did relatively little to solve the loophole issue. However, it has become clear that incentivizing healthy people to pay for insurance is necessary, especially given the results of the repeal after 2017. With the individual mandate gone, the loophole situation from earlier has returned where individuals are locked into a spiral of rising costs that jeopardizes Obamacare’s entire goal.
Republicans have argued that scrapping Obamacare is the best solution, but that fix has proven to be false, as it would lead to nearly 30 million people losing their insurance, impacting the working class the most. In just the first two years of open enrollment, over 14 million people gained insurance due to Obamacare. As of 2017, nearly 12 million people saved over $26 billion on prescription drugs thanks to Obamacare’s dramatic expansion of Medicare. Obamacare was also crucial during the COVID-19 pandemic. As a result of Obamacare, millions of people who gained insurance could now access testing and previously unavailable treatments due to cost barriers and inaccessibility. This impact was even more significant among marginalized communities, with uninsured rates for Latino and Black people being halved. Even before COVID, Obamacare saved lives, but its value to society during public health crises cannot be overstated. Restoring Obamacare’s affordability after the individual mandate repeal is key to preserving its positive impact.
Fortunately, several potential solutions have already been proposed and even implemented in some states. These solutions include perpetuating premium tax credits that reduce premiums for low-income individuals before they expire in 2025. Another strategy would be to remove deductibles, which deter people from getting insured by requiring a certain amount of money to be paid before coverage is given. In California, this approach successfully reduced medical deductibles from $5,400 to $0. From another perspective, offering more providers under Obamacare would allow for competition and potentially reduce prices by targeting market power. Implementing price cap policies, promoting price transparency, or reducing administrative costs could also help mitigate rising premium costs by reducing the price of services covered under healthcare.
In recent years, Obamacare’s opponents have been more vocal, many of whom highlight valid flaws in the system. The United States spends nearly $4.5 trillion on healthcare—about $14,000 per person—which is dramatically higher than the cost of healthcare in most other wealthy countries. Despite this, Americans are more likely to die younger from preventable causes, bringing the quality of this expensive healthcare into question. While there are efforts to ensure at least 80% of the revenue from premiums goes toward making healthcare better for consumers, out-of-pocket costs are unrelenting, especially for the middle class. For people making over 400% of the federal poverty line—roughly 40% of the population—Obamacare provides no benefit and creates barriers to healthcare accessibility. Thankfully, several of Obamacare’s flaws can be addressed by proposed reforms to the program such as expanding the premium tax credit system to encompass the middle class or offering more public options in addition to private plans.
Many misinformed arguments against Obamacare have recently contributed to public perception of the program as far more disastrous than it is. For instance, the Heritage Foundation claims that “Obamacare does not allow patients to buy insurance across state lines, which would dramatically increase competition and lower costs.” Obamacare allows sales across state lines, but states simply don’t tend to take advantage of that option since it could undercut insurers’ ability to provide coverage since not all policies would be subject to the laws of a buyer’s state. A quick Google search can often debunk the sensationalized claims against Obamacare.
Unfortunately, most Americans don’t even know why they don’t support Obamacare. 60% reported getting their information on it from watching TV, and a near majority disapproved of it even though they approved of its features. Recently, President-elect Donald Trump called the program “a horrendous disaster” but offered only “concepts of a plan” during his debate with Vice President Kamala Harris. At his rally in Madison Square Garden, he shared his intention to put Robert F Kennedy Jr. in charge of healthcare if he won the election, saying “I’m gonna let him go wild on health. I’m gonna let him go wild on the food. I’m gonna let him go wild on medicines.” (Trump made good on his promise, nominating RFK Jr. to be the secretary of health and human services 11 days after his election victory.) Similarly, Republicans who oppose Obamacare do so primarily for the sake of disparaging Democrats and the left, loudly promising to solve a problem that doesn’t exist. Just like 12 years ago, Obamacare and healthcare as a whole have become issues centered around politics rather than Americans’ best interests, and that is the largest obstacle facing healthcare reform.
Obamacare has offered numerous lessons to future generations regarding healthcare policy. First, it showed that expanding access to healthcare is a crucial first step to protecting citizens, but there needs to be an incentive to keep healthy people enrolled and prevent premium costs from exploding. This can include providers offering additional services that benefit healthy people such as screenings, wellness programs, or discounts based on healthy lifestyle choices. Second, Obamacare has exposed gaps in the healthcare system, as selling plans over state lines has created problems in coverage and enforcement of state regulations. Lastly, public health is very much a public issue. Information on policy can quickly become overshadowed by politically charged rhetoric, leading to misconceptions. In the future, more transparency regarding pricing, where the money goes, and what government officials are doing to ensure more accessibility will make healthcare reform a far more feasible possibility. Obamacare may not be the final healthcare solution, but if the US government is willing to invest in improving it, it has the potential to do a lot more good for society.
Nathan Shurts (CC ’28) is a staff writer at the Columbia Political Review. He is a freshman studying political science and statistics.