The Patient Protection and Affordable Care Act (Public Law 111-148) – derisively referred to as “Obamacare” – was a fundamental and substantial “reform” of the nation’s health care system conceived and implemented by President Barack Obama.
For many years, public concerns about the rising costs of health care, combined with concerns regarding the welfare of the estimated 46 to 48 million Americans without health insurance, prompted the newly-established administration of President Barack Obama to propose an enormous expansion of the federal government’s role in the provision and regulation of health care. The result of that effort was congressional passage of the Patient Protection and Affordable Care Act (hereafter referred to as ACA) on March 21, 2010. Unfortunately, the bill was so long, and the regulations that had to be passed by federal agencies to implement the new law so voluminous (as much as 20,000 pages) that few if any members of Congress had even read the legislation before it was passed. Even to the extent the full content of that legislation was known and understood by those vested with authority to vote on it, it was still certain to be a decade after the implementation of the ACA before its full ramifications were known.
The provisions of the ACA are too numerous to list and discuss here. Suffice to say, its intent of providing coverage for the millions of uninsured is, to date, proving successful, while its goal of limiting the rise in costs is failing. The reason for the latter lies primarily in the continued enormous role of the insurance industry in establishing rates and in the exorbitant costs charged by health care providers for diagnostic tests and for treatment of illnesses and injuries. While the skills associated with the provision of medical care are impressive, and the education and training required to attain a medical school degree and subsequent licensure by each state for the privilege of practicing that trade substantial, it is fair to wonder whether health care facilities’ rates for procedures and consultations are reasonable, especially when measured against the levels and costs of medical care offered in many other advanced industrialized societies [See, for instance, “21 Graphs that show America’s health-care prices are ludicrous,” Washington Post, March 26, 2013, http://www.washingtonpost.com/blogs/wonkblog/wp/2013/03/26/21-graphs-that-show-americas-health-care-prices-are-ludicrous/]
One of the most important provisions in the ACA addressed the issue of “pre-existing conditions,” those illnesses or injuries from which a patient was already suffering when he or she finally obtained health insurance. The ACA included a provision prohibiting insurance providers from denying coverage to individuals with such conditions when they initially enter the health care system due to a previous inability to attain insurance, or when individuals leave one job and begin another, which frequently involves a change in insurance plans. [http://www.webmd.com/health-insurance/getting-insurance-when-you-have-health-problem; http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html]
While the passage of the ACA represented major changes to the existing health care system in the United States, it has its detractors who believe that the federal government is incompetent to adequately take over the nation’s health care. Referencing a long history of cost overruns and budget deficits in those programs established and administered by the government, mainly Medicare, Medicaid and Social Security, these critics argue that the private sector is better able to continue as the principal instrument in providing care and insurance.