Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

What the ACA replacement must have

Manoj Jain, MD, MPH
Policy
February 7, 2017
Share
Tweet
Share

Eight years ago when the tumultuous health care reform journey began, we couldn’t have imagined the roller-coaster ride it would take. The Affordable Care Act passing without a single Republican vote, surviving the Supreme Court ruling by the vote of a Republican-appointed judge, a disastrous roll-out of HealthCare.gov, thriving for four years with Obama’s re-election, and now its inevitable repeal with Donald Trump’s win.

So it may help to look back on what Obamacare is, where it has been successful and where it has failed for Americans.

We need health care reform because our system is broken. Much like a stool with three broken legs, too many of us have high costs, low quality, and difficult access.

Cost is our ability to pay for health services as an individual or a nation. Quality is providing good care to make our lives better. Access is our ability to have health insurance and find a doctor.

The primary goals of the ACA were to improve access and quality by getting more people insured. To do this, the ACA put in place the following strategies:

Mandates. The most disliked part of the ACA was that it forced all Americans to buy health insurance, just as we have to buy car insurance, so as to have a healthy pool of people in the insurance mix. If we didn’t buy insurance, we had to pay a penalty.

Exchanges. This was a new marketplace to buy health insurance. Originally a conservative Heritage Foundation idea, it was adopted by the Democrats, then shunned by the Republicans.

Pre-existing conditions/lifetime coverage. Before the ACA, insurance companies could deny insurance to a patient with HIV or diabetes or stop their coverage during a cancer treatment.

The 80:20 plan. Insurance companies had to spend 80 percent of the premiums for patient care or return the money.

Subsidies. Families who earn on average up to $80,000 per year and wanted to buy insurance would receive financial help from the government.

Coverage up to age 26. Young adults could stay on their parents’ plan until age 26.

Medicaid expansion. States, if they chose, could expand their Medicaid program for low-income people, with the help of significant additional federal funding.

Taxes on the rich. Those earning over $200,000 had to pay an extra 0.9 percent in Medicare taxes and 3.8 percent tax on investment income. This helped keep the Medicare Trust Fund solvent.

ADVERTISEMENT

Fees on insurance companies and pharmaceuticals. They had to pay $10 billion to $20 billion in additional fees each year. This helped pay for the subsidies for working families to buy insurance.

While the 2,700-page law had many other provisions, these had the greatest impact. According to a new poll, voters are deeply divided over the law, but only 20 percent support the Republican strategy of trying to repeal it quickly without a replacement.

Why was Obamacare so disliked by half of America?

In part, the Republicans branded the health care law as all that was wrong with our health care system. And in part, the ACA failed to do what most Americans want — reduce the cost of health care.

I believe Americans and American businesses will sacrifice quality and even access (fewer people insured or less coverage for all) if only out-of-pocket expenses would be lowered or at least kept from rising to astronomical levels.

It is unclear what the replacement of the ACA will be, but the pendulum needs to swing to cost containment with the hope of retaining much of the improved access and quality that Obamacare brought in its brief time as a law. I believe that Trumpcare or Ryancare plans will have the same fate as Obamacare if they do not address health care costs.

As Republicans in Congress and the White House work to redesign our health care system, it is important to know what an ideal health care system would look like: One that strives for low costs, high quality and easy access.

But with where we are today, most will be willing to sacrifice quality and access to reduce the cost of care to make health care affordable. Ironically, this is what the Affordable Care Act was not able to do.

Manoj Jain is an infectious disease physician and contributor to the Washington Post and the Commercial Appeal.  He can be reached at his self-titled site, Dr. Manoj Jain. 

Image credit: Shutterstock.com

Prev

Should we treat anti-vaxxers with more respect?

February 7, 2017 Kevin 8
…
Next

Should we stop burping babies?

February 7, 2017 Kevin 2
…

Tagged as: Public Health & Policy

Post navigation

< Previous Post
Should we treat anti-vaxxers with more respect?
Next Post >
Should we stop burping babies?

ADVERTISEMENT

More by Manoj Jain, MD, MPH

  • 3 steps to a better health care system

    Manoj Jain, MD, MPH
  • How this physician transitions to becoming an empty nester

    Manoj Jain, MD, MPH
  • Health care in American is on life support, and the future is uncharted

    Manoj Jain, MD, MPH

Related Posts

  • 3 steps to a better health care system

    Manoj Jain, MD, MPH
  • Why the health care industry must prioritize health equity

    George T. Mathew, MD, MBA
  • Why this physician teaches health policy in medical school

    Kenneth Lin, MD
  • Health care workers need policy changes, not just applause

    Yuemei (Amy) Zhang, MD
  • Health care is not a service commodity

    Peter Spence, MD, MBA
  • Democracy and the health of a nation 

    Audrey Shafer, MD

More in Policy

  • U.S. health care leadership must prepare for policy-driven change

    Lee Scheinbart, MD
  • How locum tenens work helps physicians and APPs reclaim control

    Brian Sutter
  • Why Medicaid cuts should alarm every doctor

    Ilan Shapiro, MD
  • Why physician voices matter in the fight against anti-LGBTQ+ laws

    BJ Ferguson
  • The silent toll of ICE raids on U.S. patient care

    Carlin Lockwood
  • What Adam Smith would say about America’s for-profit health care

    M. Bennet Broner, PhD
  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • Why Canada is losing its skilled immigrant doctors

      Olumuyiwa Bamgbade, MD | Physician
    • How to speak the language of leadership to improve doctor wellness [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • Why Canada is losing its skilled immigrant doctors

      Olumuyiwa Bamgbade, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Would The Pitts’ Dr. Robby Robinavitch welcome a new colleague? Yes. Especially if their initials were AI.

      Gabe Jones, MBA | Tech
    • Why medicine must stop worshipping burnout and start valuing humanity

      Sarah White, APRN | Conditions
    • Why screening for diseases you might have can backfire

      Andy Lazris, MD and Alan Roth, DO | Physician
    • How organizational culture drives top talent away [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 5 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • Why Canada is losing its skilled immigrant doctors

      Olumuyiwa Bamgbade, MD | Physician
    • How to speak the language of leadership to improve doctor wellness [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • Why Canada is losing its skilled immigrant doctors

      Olumuyiwa Bamgbade, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Would The Pitts’ Dr. Robby Robinavitch welcome a new colleague? Yes. Especially if their initials were AI.

      Gabe Jones, MBA | Tech
    • Why medicine must stop worshipping burnout and start valuing humanity

      Sarah White, APRN | Conditions
    • Why screening for diseases you might have can backfire

      Andy Lazris, MD and Alan Roth, DO | Physician
    • How organizational culture drives top talent away [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

What the ACA replacement must have
5 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...