"There are two Affordable Care Acts. There's the legislation passed by Congress in 2009, and then there's the mythical Affordable Care Act – the perfidious 'government takeover' decried and demagogued by so many conservatives (and quite a few liberals). The former is quite popular, the latter gets decidedly mixed reviews."
Obamacare (Patient Protection and Affordable Care Act)
On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (PPACA) into law. Popularly known as Obamacare, the PPACA sought to bring government reform to America's health care system. For better or for worse, it is one of the most bitterly contested pieces of national legislation in recent history.
The debate over Obamacare is largely framed by individuals' beliefs about whether or not healthcare is a right. It also deals with whether or not the government should be involved in the provision of healthcare, and if so, how much.
Those who believe that healthcare is a right base their claim on the right to "life", as expressed by the Declaration of Independence. They argue that adequate healthcare, like other basic necessities (such as food, clothing, shelter, education), should be provided by government to protect that right to life. As the American Medical Student Association puts it:
"The Declaration of Independence states there are certain “inalienable rights”, including life, liberty and the pursuit of happiness. If Americans believe in an inalienable right to life, how can we tolerate a system that denies people lifesaving medications and treatments? Similarly, if Americans believe in an inalienable right to the pursuit of happiness, how can we allow millions of dreams to be smashed by the financial and physical consequences of uninsurance?"
Those who believe that healthcare is not a right contend that if healthcare was indeed a right enforceable by government, others would have a corresponding duty to provide that care. Since healthcare isn't free, someone will have to pay for it. That means, either we force doctors, hospitals, or insurance companies to provide medical services to people for free even when they can't pay--or we forcibly take some of the earned money of those who can afford their medical care (for instance, in the form of taxes) to pay for the care of those who can't. This side agrees that everyone should have access to adequate care, and the way they want to ensure it is through private, voluntary charity. Here's a representative expression of this position:
For Congress to guarantee a right to health care, or any other good or service, whether a person can afford it or not, it must diminish someone else's rights, namely their rights to their earnings. The reason is that Congress has no resources of its very own. ...The fact that government has no resources of its very own forces one to recognize that in order for government to give one American citizen a dollar, it must first, through intimidation, threats and coercion, confiscate that dollar from some other American. If one person has a right to something he did not earn, of necessity it requires that another person not have a right to something that he did earn. ...
I, too, wish that everyone had adequate health care, decent housing and nutritious meals. ...None of my argument is to argue against charity. Reaching into one's own pockets to assist his fellow man in need is praiseworthy and laudable. Reaching into someone else's pockets to do so is despicable and deserves condemnation.
The bill for the "Patient Protection and Affordable Care Act," commonly known as Obamacare, was first introduced as a measure to deal with rising healthcare costs and numbers of uninsured. Legislators such as Senator Baucus recognized this problem, and with the election of President Obama, the 111th Congress decided to try their hand at what the 103rd Congress could not accomplish in 1994, namely, produce a bill that would ensure that all Americans had access to adequate health insurance coverage.
The heart of PPACA consists of three provisions: guaranteed issue (insurers must offer coverage regardless of the applicant's health status or pre-existing conditions), community rating (insurers must offer policies within a given territory at the same price regardless of health status, age, gender, or other factors), and an individual mandate. The individual mandate assures that everyone has a minimum amount of coverage: those above a certain annual income are required to purchase coverage or incur a tax penalty; those who cannot afford it will have their coverage paid for by the government.
Proponents of the law argue that it provides everyone with adequate care and reduces the cost of healthcare overall. This, in turn, will produce a variety of other economic benefits, such as: increased GDP; higher incomes for families; reducing future federal budget deficits; lower unemployment rates; improved job mobility; a level playing field between big and small business; and an overall rise in "net economic well-being by roughly $100 billion a year."
Opponents of the PPACA reject those claims. They argue that the PPACA will not reduce healthcare costs, will fall far short of its universal coverage goal, produce doctor shortages, cause millions of Americans to lose their current employer-based health insurance, and will restrict patient health care access and choice. Most of their fire, though, is directed against the individual mandate. Opponents consider it unconstitutional and an invasion of individual rights and privacy, often using the comparison to the government penalizing individuals by taxing them for not buying broccoli.
Critics of PPACA have also ascribed a hidden agenda of income redistribution to the Act. In support, they cite Senator Baucus, one of the law's primary architects, who in a May 2010 C-SPAN interview said:
"This is also an income shift -- it's a shift, it's a leveling to help lower income Americans. Too often, much of late, the last couple three years the mal-distribution of income in America is gone up way too much, the wealthy are getting way, way too wealthy, and the middle income class is left behind. Wages have not kept up with increased income of the highest income in America. This legislation will have the effect of addressing that mal-distribution of income in America, because healthcare is now a right for all Americans, because healthcare is now affordable for all Americans."
The years following the passage of the Patient Protection and Affordable Care Act saw a number of legal challenges on various constitutional grounds--currently more than 30 cases, with 28 states as plaintiffs. Although many courts upheld the law as constitutional, several key court decisions determined that Congress overstepped its bounds by passing the law. The law was ultimately brought before the United States Supreme Court, which upheld it in June 2012.
Despite the heated debate and legal challenges that have transpired since Obamacare's passage, a March 2012 poll by the Kaiser Family Foundation found that "public opinion on the law remains evenly split." The poll also found that while most Americans don't understand how PPACA will impact them personally, many support its specific provisions—with exception of the individual mandate. By contrast, another poll from September 2012 finds that "a majority of voters still support ... repeal of President Obama's national health care law and believe ... it will increase the federal deficit and the cost of health care." Doctors also seem split about the merits of PPACA.
During the 2012 presidential election, much debate occurred concerning Obamacare's impact on Medicare. Even though the law was supposed to ensure that Medicare will remain financially solvent by implementing $718 billion in cuts (without affecting recipients' benefits), the Social Security and Medicare Boards of Trustees 2012 report says that "sustaining these payment reductions indefinitely will require unprecedented efficiency-enhancing innovations in health care payment and delivery systems that are by no means certain. In addition, the Trustees assume an almost 31-percent reduction in Medicare payment rates for physician services will be implemented in 2013 as required by current law, which is also highly uncertain."
As Obamacare continues to be implemented and challenged throughout the country, understanding the issues and implications surrounding healthcare reform becomes all the more important.
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