Accessible, affordable, unlikely

Issue: BCMJ, vol. 59 , No. 4 , May 2017 , Pages 208 Editorials

President Trump insists that “Obamacare is a complete and total disaster [that] is imploding,” and that it needs to be repealed and replaced by an equitable health care plan with lower premiums and expanded coverage.

President Trump insists that “Obamacare is a complete and total disaster [that] is imploding,” and that it needs to be repealed and replaced by an equitable health care plan with lower premiums and expanded coverage.

About 8 years ago I wrote an editorial soon after Barack Obama took office as president of the United States [BCMJ 2009;51:148]. His ascension paralleled my meteoric rise to the position of editor of the BCMJ so I felt a kinship toward this great man. I discussed his lofty promise of instituting an affordable health care plan for all Americans. His Patient Protection and Affordable Care Act, better known as Obamacare, was signed into law in March 2010, and I have to admit that I didn’t give it much attention until the current president started efforts to repeal it. Now, I don’t claim to be an expert on American health care policy, but I have Google so here goes.

President Obama had a vision to provide health care to all Americans; many working poor were risking financial ruin by going without coverage due to the high cost of health insurance. In America the very poor are covered by Medicaid and the older population is taken care of by Medicare. Obama made it mandatory for all other Americans to purchase a private health care plan or face a monthly financial penalty. To aid in this process, government subsidies (based on an individual’s financial means) were made available. Obamacare also prohibited insurance companies from dropping sick individuals and made it illegal to deny coverage or raise costs for Americans with pre-existing conditions. It also protected against gender discrimination, broadened Medicaid, and improved Medicare while expanding preventive health services and benefits. In addition, under Obamacare, large employers (more than 50 employees) must provide health insurance to their employees. After learning this, I can certainly understand why it needs to go.

Certainly, Obamacare has encountered a few challenges. Insurance companies were not making the profits they expected so have dramatically increased premiums or withdrawn from the program altogether. A number of states now have only one insurer, which has reduced competition. In addition, the funding required for Medicaid has jumped significantly because more newly eligible Americans signed up than expected.

I researched medical plans under Obamacare as if I were living a few miles across the border in Blaine, Washington. I am pretty sure my wife and I wouldn’t qualify for subsidies, so the cheapest plan I could find would cost over $700 per month, with a deductible of $7000 each!

Interestingly, President Trump’s American Health Care Act, which didn’t even see a vote, looked a lot like Obamacare but with a few changes. Subsidies were replaced by tax credits and Americans would no longer be forced to purchase health care or face financial penalty. His plan was met with fierce opposition from both Democrats and Republicans and was withdrawn. It seems that providing affordable and accessible health care is quite difficult after all.

I realize that the Canadian experience also has some challenges, but after researching Obamacare I feel quite blessed to live where I do. Regardless of our long wait lists, having significantly lower medical plan premiums without a deductible is a beautiful thing. I often complain about our bloated health care bureaucracy, but at least profit-seeking insurance companies are not part of the equation.

The current American president remains adamant that Obamacare will soon implode, at which point he will introduce his revised accessible and affordable health care plan for all Americans. To him I wish the best of luck.

David R. Richardson, MD. Accessible, affordable, unlikely. BCMJ, Vol. 59, No. 4, May, 2017, Page(s) 208 - Editorials.

Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

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