Term Paper on "Universal Healthcare Obamacare"

Term Paper 6 pages (1528 words) Sources: 6

[EXCERPT] . . . .

Universal Healthcare (Obamacare)

Since its enactment in 2010, the Patient Protection and Affordable Care Act, otherwise known as Obamacare, has elicited much debate in the United States' health and political realms. This paper seeks to interrogate whether the Universal health care for all means a better healthcare for patients than the private insurance.

Universal healthcare for all has its glaring strengths and weaknesses. The law vests authority on states to choose health insurance for its residents. These states have got powers to fail to collaborate if they intend to repeal. The states input in this healthcare have at times been criticized because others feel their health insurance choices are limited. The issue of choice negatively impact care that is given to patients under the new universal healthcare.

The waivers that were granted to allow employers of one million low income workers a year delay to comply with the new regulations was plausible bearing in mind this category of patients were left out by the former health insurance scheme.

The letter of universal healthcare law prescribes flexibility of states in structuring exchanges something that is lacking in many states including Massachusetts whose health exchange is deemed consumer unfriendly. Massachusetts' is a sharp contrast to Utah's health care exchange where spouses are allowed to aggregate defined contributions from different employers. Households in Utah are allowed to decide to spend their contributions on a family policy of their choice. Their federal regulations accommodate group coverage. Their healthcare exchange offers modified guaranteed-issue policies where all applicants are accepted regardless of their health status. Premiums charged range within a band narrower than actuarially accurate premiums would be. Premiums to be charged to each applicant are determined by risk rating rules. The element of flexibility makes private insurance more consumer friendly as opposed to the Obamacare that is deemed restrictive from other quarters hence a notion that private insurance provides better care than the universal healthcare plan.

Half a trillion federal dollars will be used to subsidize the health exchange between 2014 and 2019. This stands to make operationalization of the exchange very expensive and an administrative nightmare (Graham, 2010). When a healthcare system is faced with administrative bottlenecks, service delivery will be compromised hence poor patient outcomes under the Obamacare.

Federal law calls for respect for the conscience of healthcare providers with regard to contraception, sterilization, and abortifacients. However, the Department of Health and Human Services (HHS) new preventive services guidelines continues to pay very little attention to healthcare provider's freedom of conscience. The Obamacare legislation blanketly called for private insurance coverage of women's preventive services on mandatory and preferential basis. It is not so clear on preventive services to be covered. One can therefore be taken into believing that the services also cover drugs, devices, and procedures that prevent conception and terminate pregnancy that would infringe on institutions' and individuals' moral and religious beliefs. Some of the social questions that the Obamacare preventive services elicit include provision of drugs and devices to minor children, conscience of providers, insurers, and the insured.

The HHS conscience protection is offensively narrow as it offers protection to select religious employers. Conscience protection is only offered to entities that inculcate religious values. In essence it only applies to traditional houses of worship and seminaries but excludes religious institutions that provide socially beneficial services that do not include the inculcation of religious values. Besides, these religious institutions are also major stakeholders in delivery of healthcare services. One would be tempted to conclude that the law targets personal and institutional conscience on morally controversial issues that entail sterilization, contraception, and abortifacients. That HHS protection only applies to entities that serve persons who share religious tenets is a manifestation that it denies protection to certain religious non-profits. It has a potential danger of forcing charities and other organizations to make impossible choice of stopping to serve people without regard to creed.

The HHS guidelines appeared to premise on mistaken notion that freedom of conscience either does not exist or is not worthy of protection unless it is religiously motivated (Donovan, 2011). The issue of choice is not prioritized by Obamacare. Institutions and individuals have moral standings and can take sides with regard to issues pertaining to sterilization, contraception, and abortifacients. A healthcare system with disgruntled players cannot live up to its patients' expectations. Therefore the universal healthcare plan is more likely to be marred with poor service delivery to patients.

Proponents of Obamacare opined that when enacted into law it would limit government health spending. However, spiraling health spending can only be capped by reforming the tax rules. President Obama's administration projected that enactment of the bill into law would reduce the government health spending by 30% in the next two decades. The president prioritized "healthcare that works" through elimination of high cost, low-value treatment, and putting in place performance measures.

Critics of Obamacare have quite often associated it with rationing citing a situation where a government agency only approves expensive treatments that add at least one Quality Adjusted Life Year (QALY) per $49, 685 of a healthcare spending. They associate this with denial of lifesaving care. This they say would translate into adamancy by Medical researchers to carry out certain researches because of fear that the government might reject their discoveries as too expensive. Medical research is the lifeline of a healthcare system and lack of it spells doom to patient outcomes (Feldstein, 2009). In as much as the Universal healthcare tries to bring as many Americans on board as possible, the element of rationing negatively impacts medical research which is a key ingredient in healthcare provision. This gives private insurance an edge over the Obamacare in terms of provision of better healthcare to patients.

In as much as Obamacare results in less insurer competition chances are that it can lead to high coverage costs. A massive Medicaid expansion will result into a significant expense to the states. Considering that federal taxpayers are only entitled to pay for the entire benefit costs of the Medicaid expansion from 2014 to 2016, in the subsequent years the tax payers will be on the hook for a tidy percentage of benefit costs that would keep increasing. Besides, there would be additional administrative costs to the federal and state governments at a match rate of 50%. Every $100 increase in benefit spending generates $5.50 in administrative costs. With the match rate of 50%, the states would be expected to pay $2.48.

Obamacare stands to increase tax obligations by utmost $33.5 billion for federal fiscal years 2014 through 2020. This implies that the states share of administrative costs will exceed $100 million in states like California, Florida, New York, and Texas. Other than the administrative costs, states will have to contend with higher costs that will come about as a result of enrolling individuals who had qualified for Medicaid under prior eligibility standards but had not previously enrolled in the program. The total cost of Medicaid expansion will translate into $400 billion over the first seven years. This will be shouldered by the tax payers. Tax payers must therefore brace themselves for higher tax bills. Federal taxes or borrowing that will be used to fund the expansion will also negatively impact economic activities in respective states. States must also be prepared to incur costs that come about as a result of payments to Disproportionate Share Hospitals (DSH) and payments to specialist physicians. The former refers to payments made to hospitals that treat disproportionate share of Medicaid patients (Haislmaier & Blase, 2010). These costs are likely to scare away low income earners from participating in the healthcare plan. The universal healthcare plan that was intended to provide better healthcare to patients will not have attained its objective.

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