Public opinion

12 December 2013

Almost four years ago Congress passed the Affordable Care Act (ACA) dubbed "Obamacare" by detractors. As this new year begins most aspects of the ACA that haven't already started are now effective-such as the health care exchanges for people buying their own plans, and making it illegal for insurers to deny coverage based on preexisting conditions.

Not only has this fall's government shutdown/Tea Party hostage situation challenged the ACA, since President Obama signed the bill into law it's also been taken to the Supreme Court and a handful of Republican governors have declined federal funding for their states.

Through this, the ACA has stayed and the US even reelected President Obama just two years after the bill became law, but two years before the law made it even easier for some 50 million uninsured people to obtain coverage.

In the last few years people have not made a fuss about young adults up to 26 years of age staying on their parents' health insurance, an immediate benefit of the ACA. And no one seems upset that insurance companies can deny coverage for pre-existing conditions - a move that some health insurance companies, though not required, chose to do prior to the law changing January 1, 2014.

The individual mandate - a person without employer-based insurance must sign up for a policy or face fines - and the requirement that companies with more than 50 employees to offer health insurance or face fines seem to be the two that really bother the Republicans opposed to the ACA.

Statistics released by the White House show that most US businesses are exempt from the mandate. Specifically, 96 per cent of US companies have fewer than 50 people, and will not have any employer responsibility requirements. Most firms, 96 per cent, with 50 or more employees already offer health insurance. This means, less than 0.2 per cent of all US companies (about 10,000 out of 6M) may face employer responsibility requirements.

For healthy, young adults without a family, especially male, there is definitely an incentive to skip out on the purchase of insurance, especially if one breaks down the numbers and the fine is cheaper than a year's policy. It's a gamble. Without the threat of insurers refusing to pay for your pre-existing condition, why would you bother? Begin experiencing pain in your foot, sign up for insurance and go see the doctor.

These are the healthy, young people needed to keep the costs in insurance pools low and competitive. Whether or not they do only time will tell. Many people aren't gamblers. On October 1, even with all the reported glitches the new health care website received 4.7M unique visitors in its first 24 hours, according to the Health and Human Services Department.

Around the world the approach to paying for health care varies country by country. No one system is perfect. Whether single-payer or private, they all have flaws and benefits alike.

The ACA may not be a step in the right direction, but it's not a step in the wrong direction. Whatever comes from this year's change in policy can only be an improvement and improved upon.