Week 4 – The ACA & Public Health

Week 4 – The ACA & Public Health

What I found to be most surprising for me in President Obama’s JAMA article was the drastic change in the % of individuals without health insurance after the ACA took effect. The percentage dropped from around 14% down to 9%, which is a considerable change. This was surprising for me because I never knew the actual percentage of Americans who still lived without health insurance.

Looking at this upcoming election we have two very different candidates and two very different sets of health care policies. Although I am not entirely politically educated, I have a general understanding of what each candidate has proposed for their health care system. What worries me the most out of both plans comes from Trumps plan to repeal the Affordable Care Act. I think that his decision to repeal this is simply a decision made along party lines, and doesn’t necessarily weigh in the consequences of doing so. I do believe that there are many inherent flaws of the ACA, but I think that by repealing the ACA it would defeat many years of work. Considering our history with health care reform and all of the massive struggles we have had with it for decades, I find it unlikely that if the ACA were repealed, that a new reform would quickly follow.

Two improvements that I think would beneficial to the healthcare system would be lowering the cost of healthcare so that even the lowest earning families can afford it, and increasing the penalty in the individual mandate so that more Americans will have to have health insurance. In an ideal world, prices would need to be at a point where the difference in the penalties of not having insurance and the cost of having insurance are not so glaringly different that it makes paying the penalty seem ideal.

30 thoughts on “Week 4 – The ACA & Public Health

  1. Week 4-September 29th: The Affordable Care Act and Public Health
    What surprised me the most about the JAMA article was how effective the Affordable Care Act was in such a short amount of time. In five years, the percentage of uninsured citizens in the United States declined 43 percent! To me, this signified how vital the changes in out health care policies were to the country.

    Health care is a very touchy topic in this country because it is so controversial between the two leading parties. Democrats and Republicans can hardly ever reach any kind of common ground with any particular issue. For this reason, I am worried about how health care policies will be modified following the election of a new president this coming November. Republicans have taken the legitimacy of the ACA to the Supreme Court twice, and have made many more efforts to have the act altered of completely removed. If a Republican candidate is to win this years presidency, health care will become unstable once again. I fear the amount of people who are uninsured will rise again because health care could be left up to the private hospitals.

    I believe two improvements can be made in regards to health care in the United States. First, health care must be more accessible to more families, not just those who financially deemed unable to pay for health care. If having health care is required by law, it should be more accessible to all families. The cost of health care should be reduced. Also, i believe it would benefit this country if the government reached a common ground on whether health care is a privilege or a right. Due to differing beliefs in this aspect, America has been unable to create a successful health care system for centuries. The standards of health care in this country will continue to fluctuate unless a common understanding is reached.

    1. Yeah, the fact that the percent of uninsured citizens in the United States declined that much in a short amount of time really surprised me too. This leads me to think that there is a lot of potential with the ACA and its healthcare policies. This is why I’m worried for healthcare if Trump is elected. After decades of work to reform healthcare in the United States, the ACA has finally started to prove effective in the last five years. But with the Republican Party looking to repeal the ACA, all that work could be for nothing and healthcare could become a mess, after it has been improving in these last years.

    2. I agree with you on your comment about the parties. What i put in my post last week was that it has been very tough for health care to be instituted in large part because the parties can not cooperate with one another. It amazes me how the United States is the most developed country and claims to be the greatest country in the world, yet took forever to institute a universal health care program. A program, that, for the most part, is widely controversial and has plenty of skeptics.

  2. I was surprised that the AFA was so effective in its goal which was to decrease the amount of uninsured Americans. I have not looked much into the healthcare policies of either candidate. Though, Trump seems to be admanant about repealing the AFA. While the cost of healthcare insurance has gone up for the average person, possibly due to government intervention such an action is likely to be purely a political move. Playing with a three trillion dollar part of the American economy in this manner is risky.

    An improvement for the health care system is that the government should play a more minimal role in it. The government should lend a hand in trying to promote preventive care rather than the current system. I believe Obamacare tried going in this direction.

  3. I, too, was surprised at the large decrease of Americans without health insurance. I think that data really shows how effective the Affordable Care Act has been. Although it is not perfect, it has really helped many people get the treatment and care that they need.
    I am not that up-to-date on the specific health care policies of the two presidential candidates, but I do think that getting rid of the ACA, what Trump wants to do, would do some harm to many families. Removing the ACA would provide some political advances most likely, but in the long run, I am not sure it would be the best for the American population as a whole. I also agree that it would take a lot of time and resources to bring this act back if it was exonerated.
    I think that the ACA has made some great improvement in health care, but there is always room for improvement and the ACA is no exception. I agree that the ACA should be affordable for all Americans because everyone deserves to have coverage. This affordability, I think, will help some people be ok with having to have health insurance because I know that is a problem amongst many citizens.

  4. I agree that healthcare should not be something that is decided upon as a bi-partisan issue. I found it surprising and respectable that Governor Kasich of Ohio decided to expand medicaid. He decided that universal healthcare is a right and took some middle ground in expanding medicaid. If more people followed Kasich’s lead in more issues, where they are willing to find common ground in the bi-partisanship, we would have much more progression as a country in not only healthcare, but other branches of legislature as well. I agree the ACA is not perfect, but a full repeal on it would hurt too many Americans.
    To improve on the ACA, I believe there needs to be more federal workers whose sole job it is to help people apply for medicaid. The online website was not stable enough and was too complicated for many elderly people who needed it, and more humans should have the job to help others enroll for care.

  5. In my opinion, the healthcare system should be completely socialized. The ACA is not enough, and the problem lies in our economic system. Capitalism turns our healthcare system into a business for profit rather than a for-the-people organization. However, this could not be unless we provided a way for all aspects of healthcare to be socialized. Everything from the training of the doctors, to the care itself would have to be subsidized by the government. This would ensure that medical school graduates could come out of school debt free (as paid for by the tax payers), and may be willing to work to make less many.

    The medical profession, like public safety should be government run. This creates the mentality that caring for the public is the #1 goal. No one becomes a police officer because they believe they can become very rich. I believe it is a fair assumption to make that some people go into the medical field to make obscene amounts of money. If we adopt a system similar to European nations, our healthcare system would be better off in the long-run. Though taxes would be higher, I believe this is the best system so that every person, regardless of socioeconomic status, could have the best care possible.

    1. I have to disagree with you on socialized medicine. While I do agree that the government should help with things like insurance until a better system is found, helping medical students pay for school, it should not be completely subsidized by the government. I’ll link a couple articles that show a couple issues with European-style healthcare.

      Capitalism is not an entirely evil system, but rather a double-edged sword. Yes, people are focused on making a profit, but they will go to great lengths in order to do so. In other words, people will work harder and perform higher quality work if there’s some kind of incentive involved. This is great for creating new medical technologies as well. Healthcare will improve because capitalism forces people to be altruistic so they can make money. There are also the people who are involved in it because they genuinely want to help others. For me, I want to help others and also have a lucrative, stable career. The more ways we can entice people into entering healthcare, the better off the system will be in the long run.

      In terms of paying for healthcare, I still have yet to solidify my beliefs on the issue. Of course, I believe people of all socio-economic statuses should have access to good quality healthcare. Socialized medicine, in my opinion, is not the way to go about it.

      http://www.bloomberg.com/news/articles/2013-01-03/frances-health-care-system-is-going-broke

      http://www.bbc.com/news/health-32057948

  6. I was also very surprised by the percentage of people without health care presented in President Obama’s JAMA article. Fourteen percent is very high, but given the prices of many reliable health insurance plans it makes sense. I was more surprised by the amount of people who still do not have health insurance plans. Although 9% is considerably lower than 14%, in terms of the entire population that is still a lot of people. I thought that because Obamacare made health insurance much more affordable, even if you were on the lowest plan, that many more people would take advantage of it,
    I agree that it would be irresponsible of Trump to repeal the Affordable Care Act just because he is a republican. He should think about all the good that it does for America. There are republicans who have endorsed the ACA, and I think that Trump should really take the time to analyze its benefits before appealing it for no reason other than party lines.
    In terms of lowering the cost of healthcare, I agree that there are some aspects of health care that are absurdly over priced, and that going in and lowering those costs would be beneficial: prescription medicines for example. However, lowering the cost of health care in general would make it difficult to pay doctors, nurses, PA’s, etc. and find people still willing to go through the extensive education process required for those jobs. I am sure there are healthcare professionals who love their jobs because they get to help people, but lowering the cost of health care, and in turn their salaries, would make it nearly impossible for them to pay off the debts of graduate school. The costs would start to outweigh the benefits. Also, I believe that the majority of the people who still do not have health insurance are people who genuinely cannot afford it. Raising the fine on them for not having health insurance would put them in even worse situations than they are already it. I think we should figure out a way to get these people to get health insurance, but I do not know if making them pay more money is necessarily the right way.

  7. Although the ACA was able to decrease the number of uninsured Americans, I do not think that the benefits outweighed the cons. A lot of people were forced to pay more taxes in order to fund health care for others and those who were above the poverty line, but not quite self-sufficient are still suffering from health care costs.

    Both candidates for election have very different policies towards health care, but I am not overly concerned about them. However, I do slightly favor Trump’s policies because he is determined to repeal the ACA, which would advance the political and economic standings of the country.

    One improvement I would like to make to health care would be a reduction in effectiveness or total appeal of the ACA in order to lessen the burden on the country’s budget. Another improvement would be more coverage from health care on other subjects of health such as hearing aid. It would be nice for those who can afford medical to have such benefits in order to improve their quality of living.

  8. I agree that the drop in individuals without health insurance is interesting but I think its even more fascinating how many Americans got a health insurance plan as a result of the ACA. The amount of people insured increase by approximately 34%, a huge increase in such a short amount of time. This demonstrates the effectiveness of the ADA.

    I, too, think Donald Trump’s plan to appeal Obamacare is a decision solely made to appease those against it. His plan does not take any consideration into how difficult it really is to reform healthcare. The Affordable care act is far from perfect and probably isn’t the best way for healthcare to run in America but at this point it is the only way to make progress in the healthcare arena in my opinion. I would feel much more comfortable if we continued to build off of the ACA like Hillary proposes.

    The ACA can be improved by hiring more enrollment assisters to help americans enroll in medicaid. This will ease the process of signing up and make the process smother. I agree that the penalty for not having health insurance should increase because for this system to work everyone has to have health insurance. If it is a better option to not pay for insurance then people won’t pay. The penalty should be high enough so it is smarter to pay for the benefit of insurance than to pay the penalty.

  9. I agree that the huge decrease in the number of uninsured individuals is the most surprising part of the article.
    I don’t have that strong an opinion about the health care policy of either candidate. While I don’t think Trump repealing the ACA will make things better I also am unconvinced that the ACA will be a large net positive, as the improvements it makes will likely be accompanied by new problems. I also think its worth considering that Trump being elected would not guarantee his ability to overturn the ACA. I think the biggest problems with health care in the US are underhanded tactics such as price gauging and commercials for prescription medicines by some pharmaceutical companies and the current system of insurance where many important things are left uncovered.

  10. I, too, did not realize that there was such a high percentage of Americans uninsured under previous healthcare policies. The fact that so many more people are now insured is itself a incredible positive move in the right direction. I think that there are so many things that the Affordable Care Acts has done right for America, one of the foremost being the great influx of newly insured people.

    The one issue I have, though, is that I believe in this class we haven’t covered very much of what the Affordable Healthcare Act doesn’t do well. We all learned almost ad nauseam about its benefits, and that it has drawbacks and limitations, but we haven’t covered nearly as extensively exactly what those drawbacks are. Certainly we’ve covered some, like the issue of people paying the penalty rather than paying for insurance, but we’ve spent a disproportionately large chunk of our time learning the positives and not taking ample time to learn what needs improvement. I do approve greatly of the ACA and what it’s done, and I believe it’s a strong move where we need to be headed, but I would like to know a little more about what needs fixing in this sea of overwhelmingly positive talk.

    1. Mitchell, this is a great point. Thank you for raising it. I was hoping we would have more time during Dr. Lantz’s talk to discuss specific ways to improve the ACA / American health care in general.

      I think the reason why people talk about this less (other than saying to simply repeal the ACA), is because A) there aren’t easy solutions (which is no excuse) and B) because this is such a polarized topic.

      I’ll give you my very broad opinions. I think Obamacare is still not reaching everyone that it could be. That’s the nature of policy. You’ll rarely find something that reaches everyone who could use it. Also, some states didn’t expand Medicare, leaving many people without health care coverage who otherwise cannot afford it. I think that health care costs are still too high. There are so many moving parts to that issue that I can’t even say where to begin to fix it. Another issue that Dr. Lantz talked about is that despite the ACA, health care premium costs have risen in recent years. Something needs to be done about that as well. Another issue that isn’t at the forefront of the ACA is: who is going to care for all the sick people? We face a nationwide shortage of health care providers now, which is projected to increase in the future. We need people to start thinking about the health care workforce of the future. What does it look like? Who’s involved? What changes from the contemporary system do we need to make?

      I’d be happy to talk more in office hours, and would love to hear if you have any specific ideas.

      Again, thanks for bringing this up.

  11. I too was surprised by the change in the % of individuals without health insurance after ACA. I remember that my history teacher showed us the % of uninsured individuals back in 2013-2014, and the percentage then was still relatively high. Therefore, I thought that ACA wasn’t effective after all. But now looking at the new statistics, I do change my view on ACA and believe in its impact on expanding health insurance coverage in the U.S. The decrease in the % of uninsured people also illustrates the significant role that ACA plays in the nation’s health care reform history.
    I also agree that Trump’s plan to repeal ACA will undo years of work on health care reform. Even though ACA is not perfect (such as the continually increasing premiums), it does represent a huge step in reforming the healthcare system. The act still needs corrections and improvements in order to reach its full potential. Repealing it simply based on political factors would harm not only the system but also the people who can’t afford health insurance otherwise.

  12. I completely agree with you. I have always been blessed to have health insurance and I always took it for granted that those around me benefited from the same privileges. I was astounded to see the percentage of people without health insurance and even more so by the amount of people that had it after ACA took effect.
    Similar to you, I am also worried about the effects Trump’s potential candidacy may have on the health sector and healthcare for the underprivileged in particular.
    While i think lowering healthcare would be beneficial to the healthcare sector I don’t think that’s a viable option. To be totally, honest I’m not sure what solution would be both viable and effective.

  13. I am not that surprised that the percent of individuals without health insurance has decreased since the enactment of ACA. Since health insurance is now “mandatory,” it seems logical that the overall percentage would decrease. With that being said, I think that the ACA gets a bad reputation because the prices of health insurance are still relatively high. If the goal is to get health care more accessible to people who can’t afford it, the focus should be on lowering the price, not just the percentage of those without it. I think that, while it should not be repealed, the ACA should be amended gradually by whoever is the next president. For instance the individual mandate seems to me like too much government interference on people’s choices. I think it would be better to find a more satisfactory way to lower the percentage of people without insurance. I do agree that Trump’s plan to get rid of the ACA would undo years of hard work to get something significant passed through.

  14. I agree, Trump’s policy to repeal the ACA would diminish all the handwork it took to put the legislation in place in the first place. There is a lot of negative feedback over the act but as you pointed out the statistics do show a decrease in the number of uninsured people which is certainly a win for US. Repealing the act would make that statistic pointless.
    The ACA could be improved just by building off the success it already has. I think the healthcare system should work on making enrollment into insurance plans easier. Also, instead of having a costly penalty, I think the penalty should rather be a deduction in the amount of coverage the insurance will grant so that they have a better incentive to stay enrolled in a plan.

  15. While it is not the full universal health care coverage, I am proud of the progress that the Affordable Care Act (ACA) has put it in place for health care. While it is small, incremental steps, they are certainly steps in the right direction. With a drop from 16 % uninsured Americans to 11 %, I applaud ACA. Listening to all these points/learning more about Health Care in general, has gotten me interested in searching up the presidential candidate’s policies. Trump wants to “repeal Obamacare” and align health care with the “free market.”While I understand that ACA is not perfect, repealing it will be taking a step backwards. Instead of progressing, we are regressing. I am in agreement with, however, expanding health care. I hope that progress is made before it is my time to get Medicare.

    1. In addition, it is hard to imagine that a country as large as the United States to get universal coverage, but through legislation implemented at the federal level, it can ultimately trickle down to the state level. I certainly applaud Kasich’s actions in Ohio. Healthcare does not have to be partisan. There needs to be change without having to draw party lines.

  16. I also found it to be very interesting that the percentage of individuals without health insurance decreased after the ACA took effect. 5% is indeed a considerable change. This also surprised me as I also never knew how many Americans didn’t actually have health insurance.

    I am also not very educated in politics, but I am worried about repealing the Affordable Care Act. It took many years to achieve what the ACA has done and I think repealing it would be a step backwards. However, it is likely that a new reform would appear in place of the ACA. Whether it is as helpful or not is unknown.

    I agree that making health care more affordable is important. Sometimes those who need health care the most can’t afford it. The penalty in the individual mandate should indeed be increased in order to cover the cost of making health care cheaper for those who need it. Having health care available for as many people as possible no matter the socioeconomic class would be ideal.

  17. A decrease by 5% is considerable, and I agree, the effectiveness of the AFA was surprising. The Affordable Care Act has its flaws, but it has created positive turnouts for many uninsured Americans. Having a repeal on the ACA would likely create more problems than it would supposedly solve. It would essentially be a step backwards in our progress towards improving the healthcare system. While it would temporarily solve some of the political issues and disputes that the parties have, it would be detrimental in the long run. It has taken several decades to reach the point that we are at currently, and repealing it would taken an extraneous amount of resources and funds to bring it back. I also agree with your point on making it more affordable for low income families because everyone deserves such a basic right. There are still many things to do before healthcare can reach its optimal level of effectiveness, but the ACA is a step in the right direction.

  18. While there is still a lot of room for improvement for the ACA to work more efficiently, the services provided come at a great cost.  I think any time you try to implement something new, the hope is that there will be some improvement (with fewer deaths and fewer repeat visits), but I’m sure there is a lot more initial cost that is not the focus of this article.  In addressing the concern of more health care costs, until the system is completely implemented, there will always be some area in the healthcare system still finding the loophole, if it is the health insurance costs or the prescription drugs.  As with any new program, many new regulations or corrections to the ACA will follow.   If Obamacare survives, there will always be improvements being made.

  19. The fact that Obamacare did help improved the coverage of health insurance in the United States also surprised me, especially when the change happened in a very short amount of time. The importance of health care reform is strongly proved by this fact. I could still remember when Obamacare was just launched, many people around me were strongly against this new policy. The reason included cost and worries towards the uncertainty of the health care future. However, now we get to know the benefits of this health care reform policy. It also proved that though it could be hard to promote development in a certain field, once it got to be applied the outcome would be better than what people anticipated.
    Therefore, I personally do not want to see a Republican candidate wins this year’s presidency. Because it somehow will lead the reform to be at a standstill again, just like what happened at some point in the past 70 years. Proposing to replace most of the main elements of Obamacare, Republicans did not give a clear solution of the health care coverage issue, which might destroy the achievement Obamacare has already reached.

  20. In capitalist America, you don’t extort the insurance companies, the insurance companies extort you. You have to seriously reconsider your policies when you spend the highest percentage of government income in the world in health care, but you still have to punish the beneficiaries for not voluntarily receiving your aid. I agree that the ACA was certainly helpful, but it still left the insurance company with too much control of the pricing. I think solutions are opening the market and allow foreign insurance companies to compete in this market, or create a basic federalized insurance plan that is cheap that does cover the cost as much as the private insurances do. The third paragraph is paradox by itself: you want make insurance more affordable, by making people pay more. The insurance structure now like the elevator in a 10-story-building. People living on the first second and third floor are forced to pay for the elevator they never use. You are suggesting that the lower level residents should pay more so the elevator is cheaper for the upper level residents.

  21. I found President Barack Obama’s JAMA article to be quite interesting. The thing that surprised me the most about the article was the big drop in individuals who were uninsured. With a 43% decrease in the number of uninsured, I find it confusing how so many politicians can be opposed to the Affordable Care Act. Another surprising element of the article was the effect the Affordable Care Act also had on people who already had insurance prior to the enforcement of the law. When people talk about the Act, they generally talk about how it helps those who are uninsured, but I seldom hear anyone mention how it helps with things like preventative care or maternity care.

    This election season I have paid more attention to than usual because of the fact that I actually have a voice. Looking at the proposals of both Hillary Clinton and Donald Trump, I am a little worried about what is to come. The biggest concern about the proposals is how Donald Trump is planning to repeal Obamacare and work more closely with state based insurance. This is concerning because so many million people depend on Obamacare for health care coverage. I believe repealing this act would give private insurance companies the opportunity to drive the cost of their health plans and premiums higher, once again leaving low-income citizens without health coverage. Another problem I see with Donald Trump’s proposals is that he does not have a lot of plans outside of repealing Obamacare. Hillary’s health proposals included ideas for prescription drug costs, immigration, community health centers, and reproductive health care.

    Two improvements that need to be made to the healthcare system in the United States is more regulation on big corporations like pharmaceutical companies and private insurance companies. Not that the government needs to take complete control over these two entities, but the rising costs of health care generally start in these two organizations. Another improvement that needs to be made is the overall thought process regarding healthcare. Most decisions are made based on the economic side of healthcare, which is why I believe there is so much opposition from the two parties. I think if public health was the main concern in decisions about policy, there would be a lot more compromise than there is now.

  22. I too am most worried about the healthcare system as it relates to the next presidential election. Trump plans to repeal the Affordable Care Act and I think that would leave millions of people without proper care. Although health care is expensive and it is required, not being able to have health care at all carries it’s own risks. A person may seem healthy but could end up having a disease a few years later that could have been prevented with an annual checkup. I am not entirely sure what Trump plan for health care, but I also agree that he wishes to repeal the Affordable Care Act because of his political party and not because he thinks it is better for the economy. Trump continuously criticizes everything that Obama has done; therefore, I think the repeal would just be a way for him to undo all of Obama’s work. I also agree that an improvement within the healthcare system should be the price of insurance. Not everyone can afford healthcare and though there are programs that help with this problem, it can continue to be a burden.

  23. I want to first start by saying, that I believe that the ACA policy is one of the most important policies that in the government at this moment. I also agree that the efficiency of the act depends on who we deem as president in this coming up election. Depending in the president, we may have no health care act or the health care act may not reach it’s full potential. In regards to the ways in which we can improve our health care system, I completely agree that it should be offered to all families regardless of social status because we all deserve the same care that those around us receive.

  24. I agree with you, if the affordable care act is repealed it will take a long time for a new one to take it’s place. It had previously taken the United States decades to get any kind of healthcare act passed. I think the decision to get rid of the plan because of party lines is foolish. I understand that they all have different beliefs about how healthcare and government in general should be run, but that doesn’t mean we should kill the process we have made. Instead the plan should be tweaked a little bit to more accommodate your beliefs.
    It is amazing how the affordable care took 49 million uninsured and brought it down to just 29 million. Especially considering the act has been in place for just a few years. Hopefully politicians will be able to see past party lines in the future in order to do what is best for our country.

  25. I agree with you strongly on two points; the first being that Trump repealing the ACA would be detrimental and simply an act of defiance along party lines and also that the penalty for not signing up for ACA should increase. When considering objections to the ACA by republicans many dislike the fact that it denies people the right to choose, but I believe that healthcare should be considered a right and not a privilege if we want to ensure that our citizens are all heathy. Another more arbitrary objection that republicans have is that the cost of healthcare has continued to go up despite the ACA’s implementation; what many do not realize is that health care costs would have increased even more if not for the ACA and also that as more sign up for the ACA prices are likely to drop; the system is designed to work best when everybody is covered, as with more healthy people buying into the system costs can be reduced across the board. Overall the ACA simply requires more time and more people buying into it to become maximally effective.

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