My Vote for 'ObamaCare'

The Supreme Court of the United States recently upheld the Affordable Care Act (2010) referred to as 'ObamaCare' in unofficial quarters. I wish to share a policy analysis/position paper I presented in February 2012 at the University of Kentucky Graduate School. Kindly read and share your thoughts. 

Affordable Care Act good for American People

The United States has the highest expenditure on health among all countries of the world and this progressively increases every year. However, the country ranks 31^st on life expectancy and fares relatively worse on many health indices than many other developed nations. The cost  of healthcare in the U.S. has been increasing progressively, while family income and employment numbers have fallen or been stagnant.  In addition, health disparities appear to be widening along socioeconomic lines. According to a report by US Census Bureau, the number of uninsured Americans has been increasing over the last thirteen years and has worsened during  the recent economic recession. 
The report stated that the number of American people without insurance coverage in 2010 was September 2010 was made up mainly of young adults aged 19 to 25, and low income families with an annual household income of less than $25,000. Much of the declines in the rates of insured Americans can be attributed to the loss of employer-provided coverage, which fell amid sustained unemployment and as employers continued to cut back on benefits. The percentage of people who had health insurance through their employers fell to 55.3% in 2010 from 56.1% the year before, continuing a long downward trend (compared to 64.1% in 2000). Apart from other contributory environmental factors, the relative poor health indices were attributable to the situation as analyzed above. There was therefore a compelling need to address the situation and that, in my thinking, was what the Patient's Protection and Affordable Care Act 2010 intends to do. 

President Obama giving assent to ACA

 Health Reform Policy
Before the passage of the Patient Protection & Affordable Care Act (ACA) in March 2010, a couple of futile attempts were made in the past to reform the American health sector through legislative policies; the last being President Clinton's proposed reform which failed to scale through in the Congress. Here are the implications of this policy on various age groups, when fully implemented. 

• Retirees on Medicare: Expansion of primary care by increasing Medicare payments to doctors in Family Medicine; Reduction in the cost of pharmaceutical medications; Encourages development of protective services for the elderly. 
• Young Adults: Can be kept on family insurance plans till age of 26; Can qualify for Medicaid if annual income is $14,444 or less
• Middle Class: More affordable and fairer insurance markets; Improved access to essential medical services in family medicine, pediatrics care and community medicine. 
• High Socioeconomic Class: Increased taxation for families making more than $250,000 per year. 

This policy when  fully implemented will guarantee near universal health care insurance for all American people. 

 The Case against the Policy

Final judicial pronouncement is being awaited on this policy following a suit by 26 states opposed to it seeking its nullification on the following grounds:

-          That it violates the right of an individual to choose whether to have health insurance or not.

-          That it violated the 10^th Amendment to the United States Constitution

-          That the requirement for state-level health insurance exchanges and expansion of Medicaid is an encroachment on the sovereignty of the states

In addition to the above legal challenge, a section of people believe the policy would increase the country’s deficit and harm  the economy.

My Position

From the public health perspective, I support this policy based on the fact that it will promote near universal health insurance for all American people. It will reduce health disparities and improve quality of healthcare received by people of different socioeconomic status. Given that the burden of ill health falls predominantly on those with low socioeconomic status who can often not afford care, making health care more affordable could improve the health indices of the U.S. in the near future. In addition, increasing access to  family medicine, pediatrics and screening services would lead to early detection and treatment of many non-communicable diseases and improve outcomes.
Without prejudice to the pending decision of the Supreme Court on this matter, I do not agree that ACA violates the rights of individuals; rather, I feel it guarantees the rights of individuals to affordable and proper health care which could mean right to life. 

Conclusion
While supporters and opponents of ACA may have legitimate arguments, the fact that the United States of America lags behind most other industrialized nations in health status and access to affordable healthcare insurance by citizens is indisputable. ACA has had an almost immediate positive impact on healthcare in US, by mechanisms such as providing tax credits for small businesses offering insurance to their employees as well as improve coverage for seniors. My final submission is that ACA has become, and hopefully will continue to be a positive force for improving the health of American people, and should remain in existence.