The Patient Protection and Affordable Care Act (Public Law 111-148, also known as “Obamacare”) is so voluminous and addresses so many issues within the realm of health care, that students of this enormous effort at reforming the nation’s health care system are still analyzing the law’s provisions and effects. The Affordable Care Act was politically contentious upon conception, and remains controversial six years after its passage—despite the well-founded assumption that few of the lawmakers who supported or opposed it really understood what was in it. Having spent 20 years as a congressional staffer familiar with the reading habits of many members of Congress, I would personally be very surprised if more than a dozen of the 535 members of the House of Representatives and Senate had actually invested the time and energy into reading and analyzing the legislation needed to fully understand its many provisions. While it is true that all members of Congress have aides who are supposed to read and analyze legislation for their employers, it is the members of Congress themselves elected to represent their constituents who have a responsibility to seriously understand the legislation on which they vote—especially when that legislation affects every citizen of the country.
The purpose of the above is to emphasize that debates over the Affordable Care Act that occur as part of the ongoing presidential campaign will rarely, if ever, touch on concrete issues of concern to the public. Rather, the partisan divide surrounding the Affordable Care Act can best be explained in the basest terms as the distinction between those who support a large government role in the provision and administration of medical care and those who just as fervently believe that the private sector is best able to provide such care. The role of the federal government in our daily lives is, in fact, a defining characteristic of both major political parties in the United States, and the fight over passage and implementation of the Affordable Act reflects those political distinctions. Consequently, the pros and cons of “Obamacare,” as they will be discussed among most politicians running for office are largely boiled down to perceptions of the proper role of government in administering health care, with Democrats supporting the enormous increase in the government’s role mandated in the 2010 law and Republicans continuing to argue that the law imposed costly and inefficient mandates on medical practitioners while increasing the costs of health care to the middle class through the imposition of higher taxes to subsidize the provision of medical insurance and care to the millions of Americans who were previously un- or underinsured.
Among the more highly-publicized issues surrounding the Affordable Care Act is the difficulties many individual states as well as the U.S. Department of Health and Human Services experienced establishing and operating so-called insurance exchanges, centralized databases that are supposed to provide members of the public with health care options at varying prices. Construction of such centralized databases proved every bit as unwieldy as the law’s critics predicted, but the fact that any such program was certain to experience growing pains does help place those difficulties into a proper context. Additionally, there is no denying the fact that millions of previously uninsured Americans have benefited being added to the existing Medicaid system, which is good, I suppose, for previously uninsured low-income citizens, but debates regarding Medicaid’s solvency, or insolvency, over the coming years does not bode well for an already burdensome system.
In short, the pros of Obamacare involve primarily the fact of over ten million previously uninsured Americans now having access to the health care system. The cons generally involve questions about the efficiency of the newly-established market exchanges, about the true long-term costs of the law, which could be enormous, and about the inability of the federal government to efficiently run itself let alone a health care system intended to cover potentially hundreds of millions of people. Most Republicans currently running for president support repeal of or, at a minimum, modification of the Affordable Care Act, while Democratic presidential contender Bernard Sanders is advocating going even beyond the existing law to make the federal government the sole administrator of the entire nation’s health care. Between those two positions likely lies the answer to whatever problems one identifies with Obamacare. It was always going to take a solid ten years for the full effects of the 2010 law to be felt, and we’re not there yet.