What Are The Pros and Cons of Obamacare?
Obamacare, or the Affordable Care Act (also referred to as ACA) was signed into law on March 23, 2010. The ACA’s stated goal was to make health insurance accessible and more affordable for all Americans. Many of Obamacare’s reforms focused on major medical health insurance policies sold to individuals and families who buy their own health insurance because they do not get it from an employer.
There is so much written and said about Obamacare that it becomes difficult to tell the difference between opinion, reality and pure fiction.
Rather than bombard you with more opinions, we thought we would go issue-by-issue and tell you our view of certain pros and cons of Obamacare:
| CLAIM: One of Obamacare’s pros is that you get better health insurance coverage – The health insurance you buy for yourself today is “better” than what you could buy before Obamacare.
REALITY: True. Under the new Obamacare law, health insurance plans are required to cover the 10 “essential benefits” which were not guaranteed to be available before the law was implemented – but is that always a good thing? You decide. | |
| Pros of Obamacare’s essential benefits: | Cons of Obamacare’s essential benefits: |
| 1. Maternity is always covered. Prior to the ACA, only about 23% of plans covered maternity. | 1. Maternity coverage is expensive: Before Obamacare maternity coverage was an optional benefit. On average, a plan cost $177 without maternity coverage and $251 with maternity coverage. |
| 2. Many other benefits are required to be covered: Obamacare’s 10 essential benefits include outpatient care, emergency room care, hospital inpatient care, maternity care, mental and substance abuse care, prescription drugs, rehabilitative care, lab tests, preventive care at no cost, and pediatric care (even if you don’t have kids) | 2. More benefits were optional before Obamacare: Before Obamacare, most plans covered outpatient care, emergency room care, hospital inpatient care; prescription drugs, and periodic exams, though it was easier to find a plan that covered only the benefits that many valued most. |
| CLAIM: One Obamacare con is that it is harder to see a doctor – Some people claim that the biggest Obamacare con is that your doctor won’t accept the insurance.
REALITY: Partly true. Some doctors have in-network relationships with fewer insurance companies than other doctors do. As such, some health insurance plans offer fewer choices when it comes to which doctors you can see. It’s estimated that 40% of Obamacare plans cover as little as 10 percent of the doctors in their area, on a national level, but those numbers can change from state-to-state and county to county. | |
| Pros of Obamacare’s doctor access: | Cons of Obamacare’s doctor access: |
| · Most people don’t have trouble finding coverage that their doctor will accept: There are a lot of Obamacare health insurance plans to choose from and some online marketplaces can help you find plans based on your preferred doctor. | · Fewer doctors are willing to provide care under Obamacare: The number of doctors accepting certain Obamacare health insurance plans shrank significantly, according to a report from the Robert Wood Johnson Foundation. An LA Times report found that 75% of Obamacare plans in California had smaller networks of providers. |
| CLAIM: One of Obamacare’s Pros is that there are no more dollar limits on health insurance coverage: Obamacare removed limits on annual and lifetime coverage amounts.
REALITY: True. Obamacare removed limits on annual and lifetime coverage amounts. Prior to Obamacare about 29% of plans had limits on lifetime coverage amounts. | |
| Pros of Obamacare’s end to coverage limits: | Cons of Obamacare’s end to coverage limits: |
| · Never worry about running out of coverage: People who buy their own health insurance don’t have to worry that their coverage will run out if they get really sick. | · None: This is a rule that went into effect in 2011. It’s hard to tell if it had an impact on what consumers pay for coverage. |
| CLAIM: One of Obamacare’s Pros is that it makes health insurance more affordable: Many people claim that one of Obamacare’s pros is that it lowers the cost of health insurance.
COUNTER CLAIM: One of Obamacare’s cons is that it makes health insurance more expensive: Many people claim that the biggest Obamacare Con is that it raises the cost of health insurance.
REALITY: True. Obamacare increases the actual cost of health insurance, but many people buying it do not pay the full price since they qualify for government subsidies.
NOTE: President Obama said one of the pros of Obamacare was that the cost of health insurance would go down about $2,500 a year for a family. The actual cost of health insurance increased by $2,384 in 2015. | |
| Pros of Obamacare’s impact on prices: | Cons of Obamacare’s impact on prices: |
| 1. Obamacare’s “premium tax credits” (subsidies) reduce the cost of health insurance for individuals and families: The average subsidies for individuals is $290 per month, or 73 percent of the gross premium, and the average premium after subsidies is $106 per month.
| 1. Millions must buy their Obamacare insurance with a subsidy: Without Obamacare subsidies, the average individual pays $396 per month ($290 tax credit per month + $106 premium per month), according to 2016 government figures. Before Obamacare, the average individual paid $197 per month. Obamacare makes subsidies available if your income is no more than 400% of the federal poverty level and you meet other requirements. |
| CLAIM: One of Obamacare’s Pros is – Obamacare makes it easier to get health insurance: One of the pros of Obamacare’s success is that Obamacare lets you get health insurance if you have a pre-existing medical condition.
REALITY: True. You can no longer be declined coverage due to your medical history under Obamacare.
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| Pros of Obamacare’s pre-existing condition rules: | Cons of Obamacare’s pre-existing condition rules: |
| 1. It’s true – if you have a pre-existing medical condition, one of the pros of Obamacare is that it makes it easier for you to get health insurance.
How? Obamacare guarantees you can buy your own health insurance once a year during the Obamacare open enrollment period.
It should be noted, however, that before Obamacare, if you had a pre-existing medical condition, you could still get employer-based health insurance.
If you qualified, you could get Medicare or Medicaid if you had a pre-existing condition, and many states offered high-risk insurance pools for those without access to private insurance.
| 1. It’s true – if you DON’T have a pre-existing medical condition, Obamacare makes it harder to get health insurance.
How? If you miss the open enrollment period, which runs from November to February each year, then you cannot get health insurance the rest of the year.
The only way to get insurance after the open enrollment ends is to have a “qualifying life event,” like a job loss or a move.
In fact, the government made it much harder to prove you have one of these events in 2016.
According to the Washington Times, government officials said, “Consumers need to be sure to provide sufficient documentation or they could be found ineligible and lose their insurance.”
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| CLAIM: Obamacare’s Biggest con is that Obamacare taxes you if you don’t have health insurance: One of the cons of Obamacare is that it taxes people who go without health insurance.
REALITY: True. If you go uninsured for too long in a single year, you could face a tax penalty known as a “shared responsibility payment” on your federal tax return.
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| Cons of Obamacare’s tax penalty: | Pros of Obamacare’s tax penalty: |
| 1. It’s true – if you go more than two months in a year without health insurance, you can be forced to pay a tax for each month that you go uninsured in that tax year.
For 2016 the payment is either 2.5 percent of your annual taxable household income or $695 for an adult and $347.50 for child under 18 – whichever is greater. The maximum penalty is the national average premium for a bronze level health insurance plan ($2,085 per family).
| 1. Before Obamacare, people without health insurance could go to the emergency room for medical care and not pay their bill.
When that happened, hospitals had no choice but to charge people with insurance more to make up the losses.
Now, if you go without health insurance, you’re essentially paying for it at the end of the year when you file your taxes and that money goes to help pay for Obamacare’s tax credits and subsidies for lower-income people.
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What’s the verdict on Obamacare’s Pros and Cons?
As with so much in life and politics, ultimately the pros and cons of Obamacare depend on a person’s perspective and personal situation.
Overall, lower-income people or those with pre-existing conditions are more likely to benefit from Obamacare’s pros, because they get discounts on their health insurance and the insurance they get covers more stuff, like drug and alcohol abuse and maternity care.
On the flip side, if you don’t qualify for subsidies and you’re relatively healthy, you’re likely paying a lot more for health insurance that has benefits you may not want or need.