Brief History of this Legislation -- How it Became Law
When the Affordable Care Act (ACA) was signed into law by President Barack Obama in March, 2010, the legislative process was saturated with tension and heated rhetoric. After a bitter, chaotic period in which legislators attempted to hold "town hall" meetings to explain the benefits of the play -- and organized disruptions at those meetings set a nasty tone -- it squeaked through the U.S. Congress with hardly a vote to spare. It received no votes from Republican members of the House of Representatives and barely made it through the House (219-212), with all 178 Republicans voting "no." Not one Republican in the U.S. Senate supported the ACA; the vote was 60 Democrats to 39 Republicans.
Why was this healthcare legislation so unpopular with conservatives? The answer to that question is many-faceted, and likely boils down to the fact that Obama was the one pushing the legislation ("Obamacare"); anything Obama proposed throughout the first three years of his administration was attacked and rejected by Republicans, the Tea Party, and independent conservatives. Moreover, this was -- according to the opposing forces -- a "government take-over" that would create "death panels" to decide if grandma should live or die. Unfortunately, the ACA became law in a toxic political environment -- an environment made even more antagonistic by the daily drumbeat of smears and vicious assaults from right wing talk radio hosts -- and today while 32,500,000 Medicare recipients have received free preventative screening services, and 54,000,000 Americans have coverage for preventative services (White House), the bill awaits the Supreme Court decision on ACA's constitutionality.
The Most Important Component / Mandate of the Affordable Care Act of 2010: Expansion of More Healthcare Services to More People
Meantime, a key policy component within the ACA that perhaps is overlooked in the unending vitriolic attacks -- and occasional ignorant misstatements -- on the legislation is the mandate to expand healthcare services to more people in more ways. According to the White House, the ACA provides "A More Secure Future" for many Americans, according to the White House website on the legislation.
The expansion of healthcare insurance and services -- identified in the White House website -- includes the following: a) young adults can remain on their parents' health insurance plan until age 26; b) previously people with pre-existing conditions were limited on how long they could receive benefits from insurance companies; by 2014, there can be no limits on coverage by insurers; c) businesses have an easier time with ACA in terms of finding better plans to provide coverage for more of their employees; d) insurance exchanges will become part of the ACA in 2012 and will help those lacking choices to get coverage, adding more people to the list of those Americans that are covered; e) by 2014, people with disabilities -- many of whom were previously locked out of healthcare insurance because of "pre-existing conditions" -- cannot be turned down as they have been in the past; this too, expands coverage to more people; f) all new insurance health plans must cover preventative services (mammograms and vaccinations, for example) which gives more people access to preventative care; and g) by 2014, all Americans will be required to have health insurance, a controversial aspect to ACA, but this mandate is seen as pivotal to the success of insurance exchanges and will add millions to the rolls of the insured (White House).
Analysis of Affordable Care Act's Expanded Services & Impact on Consumers
Writing in the peer-reviewed National Tax Journal, Jonathan Gruber explains the reason that the Obama Administration pushed the Affordable Care Act through Congress: a) the U.S. spends 17% of its gross domestic on health care, "by far the most of any nation in the world"; b) healthcare spending is "rapidly outstripping the rate of growth of our economy"; c) the infant mortality rate for Caucasians in the U.S. is 0.57%, but for African-Americans it is "more than twice as high at 1.35%"; this is due to the fact that the U.S. is "…the only major industrialized nation without universal access to health care"; d) 1 in 5 non-elderly citizens (50 million people) do not presently have health insurance (Gruber, 2011, p. 893).
Stephen H. Gorin, a professor of Social Work at Plymouth State University in New Hampshire, has published an editorial in the peer-reviewed journal Health & Social Work. In his editorial, Gorin claims the ACA "…provides a crucial framework for addressing the critical health care issues facing our country, particularly in the areas of coverage and cost" (Gorin, 2011, p. 83). Gorin goes on to quote from the organization he is a member of, the National Association of Social Workers (NASW): the Affordable Care Act is "…a monumental piece of legislative achievement of our time" (Gorin, 83). The NASW adds that the ACA is "…a significant step forward toward a comprehensive and universal health care system for our nation" (Gorin, 83).
As regards the expansion of coverage -- the policy mandate that is interwoven throughout the legislation -- Gorin (84) notes several ways in which coverage will be expanded. One, funds are already being provided by the federal government for "high-risk pools" (preexisting conditional insurance plans) for people who don't have coverage because of preexisting conditions. Two, as already mentioned, adult children can stay on their parents' plan until they are 26. Three, Medicaid will be available to any person under the age of 65 whose income is below 133% of the federal poverty line. Four, the upcoming insurance exchange program will allow people without insurance through employers -- and small businesses -- to get good coverage at fair prices.
And five, as previously mentioned, there is a mandate that everyone have insurance in 2014. Gorin notes that while the Supreme Court may shoot down the individual mandate to have insurance or be fined, without the mandate "…many individuals would wait to purchase health insurance until they needed care" (84).
Lawrence R. Jacobs, a professor at the University of Minnesota, writes in the peer-reviewed Journal of Health Politics, Policy and Law, that the ACA will "give rise" to new patterns; one of those patterns will likely be: a "…shift in policy from distributing health insurance according to the ability to pay and obtain generous employer coverage to extending health insurance as a social right by redistributing resources from the affluent and healthy" (Jacobs, 2011, p. 625). The key phrase in Jacobs' assertion is "social right," and basically Jacobs is predicting that once health insurance is a social right, it will be greatly expanded to include most of the adults in America.
For those who can't afford to buy health insurance -- notwithstanding the fact that it is a mandatory requirement for them to do so -- the government is making a commitment "…to provide subsidies to low-and-middle-income individuals and small business to purchase insurance' (Jacobs, 626).
Who Originated the Mandate that All Americans Must be Insured?
It should be noted and can be reasonably assumed that the one policy component in the ACA that assures the numbers of Americans health insurance will expand is the mandate that every American must have health insurance coverage. Some 32 million Americans are expected to gain coverage thanks to the ACA's mandate that all adults have insurance (Gorin, 85).
According to Gorin, the "father" of the individual mandate is Mark Pauly, an economist at the University of Pennsylvania. Pauly explained that he and his colleagues put forward the idea of the individual mandate because they were "…concerned about the specter of single payer insurance, which isn't market-oriented, and we didn't think was a good idea" (Gorin, 84). In a Q&An interview by the University of Pennsylvania's Knowledge @ Wharton (an online scholarly business journal), Pauly was asked to detail his reasons for supporting individual mandate. He replied:
"…Unlike me [most people] don't get up every morning and think about health insurance. They think they're healthy, and why buy insurance if you're healthy? There's also the view that, well, if I get really sick, no one's going to leave me bleeding in the street. In fact federal law requires you to be treated at an emergency room and stabilized, regardless of your ability to pay. So in a way, people will rely on the charity of others to compensate for the fact that they don't have insurance…it's still a terribly bad idea to run around without health insurance no matter what you are and no matter how much you count on charity…we thought it was important to have a mandate to kind of round up the stragglers" (Pauly).
Gorin also references the fact that in 1993, Republican Senator John Chafee, along with twenty other Republicans that were serving in the U.S. Senate at that time (including four who were still in the Senate in 2010 when ACA was passed) "…introduced a bill that included an individual mandate" (84). Another source that…