The Affordable Care Act was passed in 2010 and is also known as “Obamacare” since it was implemented under President Barack Obama in an effort to increase the affordability of healthcare for all Americans. It is considered to be the second most significant milestones in healthcare, second to the establishment of Medicare and Medicaid in 1965. The ACA’s key provisions are to increase access to healthcare, reduce the cost of receiving healthcare, remove barriers in attaining health insurance, and to improve the quality of healthcare. Prior to the ACA, an alarming percentage of American’s were without medical insurance due to high costs and preexisting conditions limiting them from affordable plans. Furthermore, the ACA has driven significant changes in healthcare such as placing a higher emphasis on the value of care over the volume by implementing preventative care at no cost. Ongoing debates arise in regard to the ideological divides between healthcare and government, and many argue it is the government’s attempt to implement socialized care. Reflecting on the ACA I am impressed by the transformative impact it has made for millions of Americans who now have medical coverage who once did not qualify. By expanding access to care and enhancing consumer protections, the ACA’s focus is on alignment with the core values in healthcare leading to health equity. Furthermore, the ACA’s adaptability and resilience has proven advocacy for healthcare is much needed.
For me personally when Obamacare was passed, I was not on a health insurance plan since I was self-employed as a licensed massage therapist at the time. Leading up to the ACA, I would schedule appointments for my annual physical exams and my health was good overall. I felt the implementation of Obamacare made healthcare more expensive for me, since I was now mandated to have coverage to avoid a fine. I paid on average $400/month for an “affordable plan” which was far from comprehensive coverage. I would on average pay an estimated $500/year to have an annual physical and bloodwork. The ACA did not make it affordable for me to attain lower costs. I was happy when they did away with the fine for not having coverage. The cost of copays and deductibles for the self-employed were outrageous. I feel the ACA has impacted Americans at a disproportionate rate, with the working middle class being negatively impacted the most.
The most important thing the ACA has accomplished is reducing the number of uninsured Americans, while increasing the access and education on preventative health measures. With a great deal of emphasis provided on preventative care, early detection is key to limiting the manifestation into chronic life-long conditions. Preventative health measures are multi-factorial and give us insight on the ‘big picture’ when it comes to overall systemic health. The greatest benefit I have witnessed from a general viewpoint are patients have become more aware of their health practices and how systemic and oral health are interrelated. I have been amazed how many patients have come to have their teeth cleaned who had been educated on the importance of oral health and how poor oral health (periodontal disease) is strongly associated with cardiovascular disease and diabetes.
Being employed in the dental profession, often the dental practices employ anywhere from 5-20 people I would say on average. The ACA’s Employer Shared Responsibility Provisions (ESRP) also known as the ’employer mandate’, require employers to provide healthcare coverage to all full-time employees if they employ more than 50 full-time employees. For practices with less than 50 FT employees a “Small Business Health Options Program” (SHOP) was established to provide a marketplace where employers can shop plans and rates while receiving a tax credit for practices with less than 25 employees. Many dental offices tried to evade offering their employees benefits by only offering part-time work, stating benefits are available for full-time only. In fact, it was rather difficult finding a job with more than 30 hours a week when I started out. Luckily in the profession of Dental Hygiene, 32 hours is considered full-time due to the nature of our work. Thankfully I have had health insurance throughout my career as a dental hygienist and I pay a fair price. Small business insurance plans typically have higher deductibles and copays, but fact the ACA has regulations on maximum out-of-pocket costs helps us as consumers know the ‘worst case scenario’ in the event we experience an unexpected health dilemma.