The Assurance of Insurance: America’s Hurdling to Healthcare

picture: LaDawna Howard, Flickr

picture: LaDawna Howard, Flickr

Sometimes referred to with pejorative moniker ‘Obamacare’, President Barack Obama’s signature piece of legislation, the Affordable Care Act has now been implemented to the point where it is seen to be a fact of American life henceforth. This was not a certainty, however. Obamacare has several times escaped catastrophe in many heated political battles in Washington D.C – surviving a mid-term election, parliamentary loss of life, legislative trickery, the unexpected switch of a single Supreme Court Justice, and culminating with the re-election of the President himself.

The United States has one of the costliest health insurance markets in the world. One of the most frequent reasons for declaring personal bankruptcy in United States is medical care expenses. Uninsured people in 2013 accounted for a total of 46 million Americans. The uninsured tend to go to hospital emergency rooms only when treatment becomes absolutely necessary, predicating the quintessential ‘free rider’ problem: Emergency treatment is obligated for everyone who comes to the emergency room, but someone has to pay for it, meaning those with health insurance essentially pay treatment for those without. Emergency care happens to be one of the most expensive ways to deliver care.

Even if one happens to have been uninsured in the past but desperately wanted to get coverage, private insurance companies used to have the right to deny people if they had existing health problems. This is because they did not want to welcome unhealthy people who might become an economic loss. Insurance companies used to also have the ability to put financial limits on treatments, making those who already had insurance weigh cost against benefits on whether the additional medical treatments were necessary to stay healthy. Though now eliminated in the beginning of 2014, both of these concerns were among the many reasons why Barack Obama decided in 2009 to set his sights on tackling health care.

After sweeping wins in the 2008 election, the Democratic party held a sizable majority in the House, a 60 seat veto-proof majority in the Senate and held the Presidency. A promising situation when setting out to overhaul a sector which accounts for 17% of US Gross Domestic Product.

Both chambers of the House and the Senate need to confirm an identical bill in order for legislation to pass in the United States Congress. However, during the negotiations of health care reform bill, America’s long-time universal healthcare champion Senator Ted Kennedy passed away. His seat was succeeded in a special election by Republican Scott Brown. This meant Democrats were left one single vote short of the super majority they needed in the Senate to pass the bill. To circumvent this, the House deviously passed an earlier version of the Senate’s own version of the bill in return for asking the Senate to adjust some concerns through a budgetary process that allowed for a mere simple majority.

This took place right in the middle of the 2010 mid-term election when the anti-government Tea Party’s popularity reigned high. The election introduced a strong Republican majority in the House. With their newly established majority, the Republican-controlled legislature and passed its own bill to repeal the entire health care law. But by then it was too late: Both chambers in Congress had already adopted the Affordable Care Act. Only days later President Obama signed the bill in late March 2010. House Republicans have since then attempted to repeal the law an additional 49 times.

Soon thereafter, the healthcare bill was challenged by group of Republican-controlled states. They contested a specific provision in the reform that mandated people buy health insurance as unconstitutional. Their challenge went all the way up to the highest court in the country, the United States Supreme Court. The Court was in a position to either keep the Affordable Care Act or to repeal it entirely. Chief Justice John Roberts initially sided with the group to overturn it. However, in the middle of deliberations, he changed his mind – opting instead to side with the justices who wanted to keep the law. Health care reform had survived repeal by Chief Justice Robert’s decision to switch his vote.

The last great hurdle for the law was the Presidential election. The bill was designed to roll out gradually, with some provisions not coming into effect until 2018. This meant whoever became President had the possibility to stop or hinder its implementation by virtue of being in charge of executing government policy. Governor Mitt Romney had promised throughout his entire campaign that, after being sworn in as President on his first day in the White House, he would set in motion to undoing the law. Thus the outcome of the Presidential election in 2012 was more than just whether President Obama or Governor Romney were to ascend to the Presidency of the United States: It was the election to cement into the fabric of America one of the biggest reforms in its health care history.

Despite attempts at political posturing through fruitless filibustering and technical errors, the reelection of President Barack Obama meant that the path towards fully implementing the Affordable Care Act survived its last big political obstacle. Not surprisingly then that Obama eventually chose to embrace the name ‘Obamacare’, “…because [he] does care”.

NIKLAS HJELM SMITH