The US healthcare plan, dubbed ‘Obamacare’, marks Barack Obama’s career as one of the most decisive and controversial moves he has made in his eight years as president. But now, as Obama prepares to step down as the president of the US, this legacy of his is under threat of being repealed by the Republican members of the US Senate. Members of the Republican party have opposed the Affordable Care Act ever since it came into being in 2010. However, now under new president-elect, Donald Trump, they believe they will finally succeed. The Daily Vox team unpacks what Obamacare is and what it will mean for Americans and the rest of the world if it is repealed.
Obamacare is the informal name for the Affordable Care Act, which was adopted by the US President Barack Obama on 23 March 2010. It is a healthcare reform law that sought to improve and expand access to healthcare.
The Act mostly provides health insurance coverage for the percentage of the population who don’t have it: those people who mostly are not covered by their employers and are not covered by other programmes. In order to provide healthcare coverage to all citizens, the law requires that all Americans need to have health insurance. However, the law offers subsidies in order to ensure the insurance is affordable. The Act also wanted to bring younger and healthier people into the medical coverage system. Health insurance companies are also not allowed to deny health cover to people who have pre-existing health conditions.
The act offered Americans many healthcare benefits, protections and rights. It improved on Medicaid for senior citizens as well as those with long-term disabilities. Medicaid is a joint federal and state program that helps with medical costs for those people who have limited income and resources.
A Health Insurance Marketplace was also set up where American citizens could purchase federally regulated and subsidised health insurance.
“The Affordable Care Act’s main focus is on providing more Americans with access to affordable health insurance, improving the quality of health care and health insurance, regulating the health insurance industry, and reducing health care spending in the US. The law contains hundreds of different provisions that address different aspects of ‘the healthcare crisis’ in the US,” the Act’s website explains.
The Republican members of the US Senate are trying to repeal Obamacare because, well, it’s something that was put in place by Obama (and they don’t really like him). On a serious note though, they say that they believe that the act costs too much for business, even though since the implementation of the health care act, jobs in the sector have risen by 9%.
The Republicans also say that it is an intrusion into the private affairs of individuals and business.
On 12 January, the Republicans took a very important step towards getting the act repealed. In a 51-48 vote, the Senate voted to be able to instruct key committees responsible for legislation to draft legislation that will repeal the act. The decision is now going to the House of Representatives who are expected to vote in favour of it within the week.
Both the Senate and the House have a Republican majority and both have scrapping Obamacare as a top priority. They have until 27 January 2017 to come up with repeal legislation – after that, both the Senate and the House will have to approve the legislation before the repeal can come into effect.
Despite the haste at which the Republicans are working to get the act repealed, many do not have any idea what will take the place of the act, or when this new healthcare plan will come into play.
Senator Susan Collins, Republican of Maine has said that she agreed with Trump that Congress should repeal the health law and adopt a replacement plan at about the same time. “But I don’t see any possibility of our being able to come up with a comprehensive reform bill that would replace Obamacare by the end of this month,” she said. “I just don’t see that as being feasible.”
The Democrats have condemned these moves by the Republicans, saying that they were taking away the health insurance of many Americans without knowing what will take its place.
“Ripping apart our health care system with no plan to replace it will create chaos,” said Senator Patty Murray of Washington, the senior Democrat on the Health, Education, Labor and Pensions Committee. “If Republicans repeal the Affordable Care Act, it’s women, kids, seniors, patients with serious illnesses, and people with disabilities who will bear the burden. Premiums will skyrocket,” she continued. “Out-of-pocket prescription drug costs will rise. And overall health care costs will increase. It’s a perfect storm to make America sick again and absolutely the wrong direction for families and for our economy.”
If the Republicans under the Trump administration succeed in repealing Obamacare, there could be a possibility that health insurance companies might no longer want to insure pregnant women, cancer survivors and others because they are not profitable to insure. Women might be made to pay more for insurance because of their gender. This is because some of the measures under the Affordable Care Act were: ensuring women weren’t charged more for health insurance, insurance companies not being allowed to deny women coverage because they were pregnant, women receiving free birth control and mammograms and insurance companies being expected to cover maternity care.
Moving the conversation away from the US to South Africa, we should look at what effect the US repealing Obamacare might have on us.
In December 2015, the South African government released a White Paper on a health insurance fund, which has been – at times – compared to Obamacare. The National Health Insurance (NHI) is supposed to be a medical scheme which will be compulsory for all, while private medical schemes will only offer complementary services. The NHI aims to provide this service for all citizens and permanent residents. A special fund will be set up for refugees. The White Paper also proposes that documented asylum seekers will be able to access emergency care. Anyone who does not fall under these categories will need medical insurance.
Despite the release of the White Paper and the plans by the Health Minister, Dr Aaron Motsoaledi, to extend NHI pilot districts in the 2015/16 financial year by using grants so as to encourage doctors from the private sector to work in public clinics, there has not been much said about the projects.
However, the Democratic Alliance (DA) is already deeply critical of the NHI because they believe the government policy of phasing out primary health care insurance, which is mentioned in a publication of the “Demarcation Regulations” is them clearing the way to make way for the NHI. In a press release, the DA have also said that the government should rather support the expansion of the private sector if they really cared about the citizens of the country.
The trend for the third world to follow the US on critical issues is not a new one. Just after same-sex marriage was legalised in the US, Mozambique followed suit, and so did many other countries. In addition to this, strong white nationalism has sprung up all over the world since Trump’s election in November 2016.
Therefore, if Obamacare is to be repealed in the US and there is already opposition to the NHI in South Africa, it does not look good for the move away from the privatisation of healthcare, which often excludes those who are most in need of healthcare – the poor.
