The election of Donald Trump and his promise to repeal or alter the Affordable Care Act (ACA) has brought the ACA back into the forefront of American politics. While the ACA is nicknamed Obamacare, most of the law was written before his election in 2008. Despite its many flaws, the ACA over the past six years has led to increases in healthcare coverage. It is estimated that between 20 and 22 million people have obtained coverage since 2010, mainly through the expansion of Medicaid, coverage through parents’ policies for young adults until age 26, and the exchanges. Unfortunately many of those with new coverage cannot find a primary care doctor because the number of primary care providers is rapidly declining, plus most of these providers do not accept the ACA plans. Be that as it may, the ACA has left unanswered a basic but very important question, namely — is healthcare coverage a right or a privilege?
The federal and state governments guarantee all citizens an education, access to fire and police services, a national postal service, protection by the military, a national park system, and many other services. But the country has not committed to ensuring that all citizens have healthcare coverage. The future is filled with uncertainty regarding how the US healthcare system will evolve. For example, if healthcare savings accounts and tax credits replace the individual mandate, will people buy health insurance? Will permitting the sale of health insurance across state lines really increase competition and reduce costs, or will it adversely affect states’ rights to decide what is best for their citizens and create confusion? Will the various changes being discussed destabilize the commercial insurance market and lead to higher costs and less coverage?
Most experts agree that the ACA needs to be modified and improved. But despite its need for improvement, the ACA has accomplished much, including access to healthcare for millions, guaranteed coverage for pre-existing conditions, and coverage for young adults to age 26, albeit at a cost. Much remains to be accomplished however, including how to ensure high-quality, affordable coverage for all citizens, while at the same time controlling the ever-increasing spending for healthcare, now exceeding $3 trillion per year. If the goals of further healthcare reform are clear and measured, but not reached, then it will be necessary to re-look at previously discussed options including a single-payer system, lower age eligibility for Medicare, or further privatization of the healthcare system.
I believe that all healthcare professionals, professional societies, and the general public should speak with one voice and make sure that voice is heard by our government representatives. We need to be sure that those who make our laws understand that healthcare coverage is a basic right and not a privilege to be enjoyed only by those who can afford it. The hard part will be figuring out how to pay for this basic right. Finding the answer is an exceedingly important and worthy goal, emblematic of a fair and just society for all citizens.
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