In 2010, Barack Obama’s Affordable Care Act (the ACA or Obamacare, as it is often glibly called) was heralded as the most significant reform of the US health care system since the 1965 creation of Medicare and Medicaid. So it is little wonder that various interest groups, politicians and the public got twitchy. Ever since the ACA became law in 2010, opponents have been finding ways to critique, repeal and avoid implementation of the new legislation. The conveniently complex structure of federal and state laws means that they have been moderately successful in these efforts.
However, opponents of the ACA were unsuccessful in having it repealed through the Supreme Court earlier this year. So the Republicans have vowed to overturn Obamacare if they win the forthcoming election.
The problem that the Republicans and their presidential candidate, Mitt Romney, have with the ACA is that it fundamentally opposes their values around government involvement in health care and notions of individual free will and choice. In essence, the controversial parts of the ACA stipulate that more employers will be mandated to provide insurance to their employees, health plans will be mandated to cover all applicants regardless of pre-existing conditions (other than smoking), and individuals not covered by an employer-sponsored health plan or a public programme will be mandated to purchase individual health insurance, or pay a penalty. These mandates are designed to reduce the number of uninsured Americans and ultimately reduce the overall cost of health care.
The forthcoming election has brought these issues to a head again. However, in trying to assemble and compare the policies of the Democrat and Republican candidates, it has become starkly apparent that there is very little known about the substance behind the ’politics’.
The first presidential debate spent an unexpectedly long time arguing about Big Bird (yes, that Big Bird from Sesame Street). But when that wound up, and they started talking about health care, what I was able to garner from the pantomime-style politics was that the headlines (such as ‘20 million Americans will lose their health insurance under Obama’, or ‘under a Romney presidency, people with pre-existing conditions will not be able to get health insurance’) were either wrong, over dramatisations or, at the very least, can be countered by arguing ’yeah, but…’. A pollster for Romney summed up the sentiment of political debate by stating, ’we’re not going to let our campaign be dictated by fact-checkers’. However, this has built a superficial understanding of the opposing health care policies among the general public and does not give the public enough credit for being able to make an informed choice in the forthcoming election.
What we do know is that the US is at a significant crossroads. The period following the 4 November presidential election is likely to mean business as usual if Obama retains the presidency, with a mandate to drive through implementation of the ACA. However, if the US elects a Republican president, it will mean a complete reversal of the progress that has been made since the ACA was signed into law, with no indication of what would replace it.
The arguments, threats and promises being thrown around in the 2012 US presidential election create a climate of political and policy instability. Republicans in the US need to realise that the overwhelming uncertainty is going to be alleviated only by providing a comprehensive and realistic alternative.
This blog is also featured in Health Service Journal