By Anna Bryner
There’s a lot of talk about health care reform in this country, but what do politicians really mean when they say they will reform the health care system? Why does the issue always seem to pit Democrats and Republicans against each other, when in reality both want better health care access and affordability for Americans? Let’s start with the basics.
What exactly are we trying to reform?
Though frequently termed “health care reform” by the media, the issue could more appropriately be termed “health insurance reform.” In reality, the reforms are aimed at improving the health care “system” so that more Americans have access to affordable health care.
What is the U.S. health care system?
That’s just the thing—the U.S. health care system isn’t actually a system at all. What we call the health care system is a complex exchange of private insurance companies, public insurance (such as Medicaid and Medicare), health care providers, and patients, to name a few. Each “player” in the system has its own goals and incentives, and the goal of health care reform is to try to legislate ways that help the “system” provide more care to more individuals at a more reasonable price.
Why is Obamacare (the Affordable Care Act) so controversial?
Before the ACA, people with “preexisting conditions,” such as diabetes, were ineligible for certain plans. If these patients could get coverage, it often involved large premiums or out-of-pocket sums because, well, these patients cost a lot. Under the ACA, preexisting conditions were no longer supposed to preclude individuals from obtaining affordable health insurance. Sound like a fair idea? Most Republicans and Democrats are actually in favor of this policy.
The controversy comes in primarily because the ACA requires everyone to obtain health insurance, a provision known as the individual mandate. Why this requirement? It’s because if everyone with preexisting conditions buys in and gets health insurance at affordable prices, insurance companies will face big challenges with sustainability and providing coverage unless the “healthy” buy in too.
While President Obama promised that people could keep the plans and doctors they were comfortable with, in reality, many people had to switch to more costly options (or start paying for health care insurance in the first place) in an attempt to absorb the cost of covering those with preexisting conditions. Republicans oppose the individual mandate for a myriad of reasons (though largely because it involves government requiring individuals to buy something), and the Supreme Court narrowly upheld the constitutionality of the mandate in National Federation of Independent Business v. Sebelius (2015).
What difficulties do Republicans face in “repealing” and “replacing” Obamacare?
While there are many challenges, a core challenge for the GOP is finding an effective way to provide the increased access and affordability to health insurance developed under the ACA without the individual mandate. Making this kind of a system work and undoing thousands upon thousands of pages of ACA legislation and regulation is no easy task. In short, it might be more difficult for a real “repeal” and “replace” than anybody anticipated.
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