On March 23, 2010, then-U.S. president Barack Obama signed the Patient Protection and Affordable Care Act into law. Some would say that this was one of the greatest moments in the history of U.S. health politics. A look at the situation before this law helps to understand why the Obama Administration – and many Americans citizens – thought this step to be inevitable.
At the time the new law was introduced, about 50 million people had no health insurance – or one out of every six Americans. That was by far the most miserable performance among healthcare systems in developed countries. In the decade before the Affordable Care Act, employer-sponsored family health coverage costs increased over 130 percent, and many American families were simply not able to pay for it.
More surprisingly, the United States spent almost 18 percent of its gross domestic product on health. For perspective, Australia’s health consumed around nine percent and Germany’s around 11 percent of their respective national GDPs. Per capita, the U.S. spent twice as much as comparable developed countries.
The previous health coverage system also allowed insurers to refuse coverage for a person if he/she had a pre-existing condition. It is obvious that these factors led to a fragile healthcare system and an insecure life for many non-affluent people. Thus, it is no wonder that according to some surveys during 2008, over 80 percent of Americans demanded an overhaul of the healthcare system.
The main aims of ‘Obamacare’ are: more access to affordable, quality healthcare and reducing the increase of U.S. health expenditures. To achieve that, focuses were consumer protection, regulations, subsides, taxes, insurance exchanges, and other necessary reforms. As of 2017, Obamacare was responsible for some 20 million newly insured people. The uninsured rates have reached all-time lows. Additionally, since the health reform implementation, health spending growth rates are the lowest they have been in the last five decades. But these are only the biggest parameters. Many things in everyday healthcare also changed. In hospitals for example, uncompensated care costs, hospital-acquired conditions, and avoidable readmissions have been significantly reduced.
Nevertheless, the new health law was and still is opposed heavily throughout the United States. Even the term ‘Obamacare’ was originally used by opponents of the law in a pejorative way. Many conservatives see it as a governmental takeover of the healthcare system, portraying it in an un-American, unconstitutional, and even ‘socialist’ light. A 2014 study has shown that some 27 million dollars were spent on TV ads supporting the new law, while opponents spent around 420 million dollars to portray the law negatively. Concerning public opinion, Americans were divided about the health reform from the very beginning. Even the most recent surveys show a virtually equal relation between proponents and opponents.
With the election of Donald Trump for president, the Affordable Care Act‘s future has become uncertain. The repeal of Obamacare was one of the cornerstones of his election campaign. Symbolically, Trump signed an Executive Order on his first day as president which introduced the law’s repeal, even if at this time there was no official Republican health program available. However, the first try to repeal Obamacare failed in March 2017 due to Republican internal quarrels and led to the biggest political defeat in the first 100 days of Trump's presidency.
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