What exactly is/was Obama care?

10 comments

1. https://en.m.wikipedia.org/wiki/Affordable_Care_Act

2. President Obama passed some health care regulations that meant that health insurance companies could no longer reject people due to pre-existing medical conditions, and that states were required to set up their own health insurance plans for the very poor.

   These changes to health insurance in the US meant that many more people got health coverage who previously would have been denied due to pre-existing conditions. Health insurance companies don’t like it if someone who is very likely to require expensive medical procedures gets insured, because they won’t make as much money off that person. Obamacare made it harder for health insurance companies to refuse service in those cases.

   While many people were able to get insurance for the first time, a lot of people disagreed with how it was being done. Many insurance companies started raising their rates, and new standards of what was legally required for insurance meant that many people’s previous plans were no longer considered sufficient.

   Tl;Dr – It was a series of regulations that helped poor people get health insurance, but didn’t establish any sort of national universal health care.

3. People use the term in a couple ways. Some people use “Obamacare” to refer to the health insurance marketplace that was set up at healthcare.gov to enable people to explore and obtain insurance. Sixteen million people enrolled in plans through this marketplace in 2023, a record number.

   Others use “Obamacare” to refer to the totality of the Patient Protection and Affordable Care Act (ACA) of 2010, which established this marketplace but also did a lot of other things.

4. The Patient Protection and Affordable Care Act was an enormous piece of legislation passed in 2010 that revamped large sections of Americas healthcare and insurance systems. Some highlights include:

   * making it mandatory and punishable by a fine *not* to have health insurance (fine has since been lowered to $0)

   * establishing state and federal marketplaces where people who don’t get insurance through their employer can purchase insurance relatively easily (often with significant federal subsidies)

   * eliminating pricing and other forms of discrimination based on preexisting conditions and a variety of other factors (except age and smoking)

   * capping insurance company profits at 15 – 20% of revenue

   * expanding Medicaid to many poor, working-age, non-disabled adults (though many states have chosen not to participate)

   * making various changes to the mandatory benefits of insurance plans

5. A titanically complicated piece of legislation. The most important aspects were/are the subsidies for health insurance for those who can’t afford it and requirements for employers to provide health insurance and for people to have health insurance. Critically, it also prevented health insurance companies from denying coverage for people with pre-existing conditions.

   Very controversial in some circles. In practice it helps a lot of people get healthcare who otherwise wouldn’t be able to. Make no mistake, it has saved many lives.

6. “Obamacare” is a slang term for the Patient Protection and Affordable Care Act, a landmark law passed in 2010 which changed a lot about the healthcare system. Among other things it *required* Americans to have some kind of health insurance, banned companies from discriminating against people with preexisting conditions and generally made it easier for poor to get insured.

7. People have already answered more specifically, but in a very general sense it was a moderate plan to reform the existing insurance coverage system in the US based on plans originally created by Republicans. It was a moderate or even conservative attempt to reform things without making any radical changes to the system so that more people could have access to health care. Obama seemed to genuinely think (at least at first) that this could be bi-partisan legislation that some Republicans would support. One thing it was not was an attempt to create a system of universal health coverage like almost all of the wealthier nations have.

   This might not be obvious because the Republicans reacted to it like it was some kind of communist plot and started attacking it from every direction even though it was based on a plan originally proposed by Republicans.

   No one has really attempted to get any major bipartisan reforms of any sort through Congress since this happened, so it basically marked the end of the post-World War II Federal political consensus.

   Before Obamacare and after WWII, almost every major piece of legislation was bi-partisan and since Obamacare almost none of them are.

8. The Patient Protection and Affordable Care Act (commonly called “Obamacare”) is a major piece of healthcare legislation in the US, passed in 2010.

   It made health insurance more common and affordable in the US.

   The major points of it are:

   1. Employers are required to provide health insurance for their employees. Small employers with only a few employees are exempt from this.
   2. States are provided with funds to expand the Medicaid system (health insurance for the poor and disabled) to cover more people and raise the income threshold at which people can qualify for the program.
   3. People can buy health insurance from a government administered “marketplace” that offers private health insurance plans for sale, and there are income-based subsidies designed to make it affordable for all.

   It included a number of small technical rules that made health insurance more useful as well, such as letting minors remain on their parents health insurance after reaching the age of 18, until they reach the age of 26 and requiring all health insurance plans to provide a certain basic level of coverage.

9. A payoff to the insurance industry.

10. It was an attempt at making sure everybody in the country had healthcare coverage by requiring that everybody buy healthcare coverage or pay a big fine.

    The underlying idea is that you lower insurance premiums by making *everybody* sign up (instead of just the least healthy and most likely to make a claim people). It’s a risk management technique. It’s why health insurance through employers with thousands of employees is cheaper than a single person getting it on their own.

    It was also supposed to provide grants to people who couldn’t afford it.

    To get the thing passed, all sorts of compromises and pet projects had to be added to it to get the votes of people in Congress. It was not popular, and barely squeaked through even though the Democrats had giant majorities in both houses.

    All the compromises and add-ons meant the final bill was a Frankenstein’s monster of legislation. There was something in there to piss off everybody. It came *this* close to being declared un-Constitutional, since the Constitution doesn’t give the Federal government the power to require people to buy something from a private business, but that’s exactly what they were doing.

    Also, perhaps the stupidest part of the whole bill was the requirement that businesses cover the cost of their employee’s healthcare. Coupling healthcare to employment is one of the dumbest things about this country, and trying to enshrine it into law when we were trying to come out of the deepest recession in a generation was an awful idea and very likely a drag on employment and growth.

    Healthcare costs definitely increased after its passage. There was also the debacle of its disastrous rollout. The website that was supposed to run the whole thing was contracted out to a horrifically unqualified Democratic donor or something and it was constantly crashing and creating all kinds of confusion for a long time.

    It was also amended/defunded in bits and pieces over the years so a lot of the sting was taken out of it. The individual mandate, that people buy a healthcare plan through one of the exchanges on the website, is basically dead.

    It’s a terrible idea to fight rising healthcare costs by ignoring costs at the provider level and just trying to artificially lower healthcare insurance premiums. The whole program was like trying to slow down a car by grabbing the speedometer needle with your fingers and pushing it over to zero.

    What especially bothers me is that the fundamental idea–insurance mandates–is not a bad one in principle from an economic theory point of view. And the whole experience has soured a lot of people on the idea who might’ve been receptive to it otherwise.