Health care and coverage are ever-changing, and it is hard to keep track of all the moving parts. The ACA completely changed modern health care, and today it’s hard to tell what may happen next. It’s easier to see the changes since 2007 and how they’ve affected us all when we break it down chronologically. This is the evolution of health care from 2007 to today:
Former President George W. Bush was very opposed to universal health care as he didn’t want the federal government making choices for consumers. In 2007, his last year in office, Bush discussed a plan to provide health care tax deductions, which would trickle down and eventually lower consumer costs without sacrificing coverage. Essentially, Bush wanted to increase competition and consumer choices (much like what the AHCA aims to accomplish). It’s been ten years since Bush was in office and we may never know what the impact of his health care vision may have been.
Obama discussed his ideas for universal health care all throughout his campaign. He planned to require all big businesses to provide health care to employees, offer tax credits to small businesses who did, and expand Medicare and Medicaid coverage. His goal was to make sure everyone was covered, which was clearly not one of his opposing candidate Senator John McCain’s plans. In many ways, McCain’s plans were the exact opposite of Obama’s. McCain wanted to reduce employee involvement in health care, reduce Medicaid coverage, and not require anyone to have coverage. Health Care reform was a big part of the 2008 election, thus beginning the great evolution of health care.
Much unlike what President Trump wants to do today, Obama took baby steps in enacting the ACA. The first section in 2010 gave tax credits to small businesses who provided health care coverage and gave rebates to seniors who fell into the donut hole – all things that Obama discussed leading up to the 2008 election. In the same year, he prevented carriers from letting preexisting conditions stop kids from getting coverage, allowed kids to stay on their parent’s plans until age 26, and prevented carriers from dropping clients who developed a chronic illness.
As of 2011, insurance companies are required to spend at least 80% of premiums on medical care. Only 20% can be used for administrative purposes. The rule forces carriers to use their client’s money for the service that they are paying for, but it also provides incentive for carriers to raise prices so that the 20% administrative portion is higher. 2011 also brought free preventative care for Medicare clients and grants for employee health programs.
Accountable Care Organizations began in early 2012 as a way to reduce unnecessary medical costs and group doctors together. A few months later, an added provision required all health programs to report patient demographics such as spoken language, race, and ethnicity to promote transparency. Additionally, towards the end of 2012, safety measures were introduced to allow electronic recordkeeping.
Ironically, President Obama’s opposition in the 2012 election was Massachusetts Governor Mitt Romney. Obama’s ACA was very similar to the state health care plan that Massachusetts already had in place. During the election, Romney repeatedly stated that his Presidency would mark an end to Obamacare. Romney argued that his Massachusetts plan worked on the state level, but it may not work if federalized. He knew that his plan raised premiums and would not work everywhere. Instead, his goal was to take the Massachusetts model and allow the other 49 individual states to create their own similar plan. Essentially, Romney’s plan would make health care a state issue.
In 2013, Obama shifted his focus to Medicaid, something he had planned for since his initial election in 2008. The 2013 law included extra Medicaid funding for preventative care purposes. January also introduced a flat-fee program in the hopes of improving care quality. The end of 2013 brought two more years of coverage for children who would not be eligible for Medicare but still needed funding (CHIP).
2014’s update essentially introduced a choice of coverage for those whose needs didn’t align with their employer’s plan. It also allowed those whose employers didn’t provide insurance to purchase it on their own. Medicaid access was expanded again, and tax credits were introduced to help the middle class afford coverage. In an effort to end discrimination, 2014’s update also prevents carriers from not selling plans based on gender, health, or pre-existing conditions. The small business tax credit was raised and a credit was added for small nonprofits.
As of 2015, physicians cannot change costs based on care quality. This means that patients cannot pay more to get better care, all care quality should be equal.
Trump announced his plans to keep two of the more popular provisions from Obamacare – kids can stay on their parent’s plans until age 26, and those with pre-existing conditions cannot be denied insurance. However, there is a lot that Trump wants to change (and has not been able to yet). Trump wants to remove penalty fees for individuals who don’t purchase insurance and for companies that do not offer it. He also wants to stop requiring that the wealthy pay Medicare taxes, reduce tax credits (and stop women from using them for abortions, in line with his funding extermination from Planned Parenthood), allow everyone to have health savings accounts, stop requiring that carriers provide essential health benefits, raise premium limits, and begin to phase out the Medicare expansion.
On May 4th, congress passed the American Health Care Act. The goal of the act is to bring lower costs, more coverage choices, universal access, and bring control back to the patients. Naturally, there is serious controversy surrounding the act as it brings back the insurer’s ability to raise costs for those with preexisting conditions. The bill still has to pass through the senate before it can move to President Trump’s desk and become law. House Speaker Paul Ryan suggested that there are more additions to come.
Check back here for news and updates on today’s health care and the American Health Care Act.