New England Journal of Medicine

New England Journal of Medicine

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The current American model (ACA) is based on private healthcare. Americans lack universal access to health, so they depend on private insurance for health care. There are three ways to get coverage in the US: through a job – companies with more than 50 full-time workers must pay for part of the policy – buying it individually or, in the case of people without resources and older age 65, through two public programs.

In the present year, 2020, the Covid-19 pandemic has brought into sharp focus the need for health care reforms that promote universal access to affordable care.

About half of Americans receive health coverage through their employer, and with record numbers filing for unemployment insurance, millions find themselves without health insurance in the midst of the largest pandemic in a century. Even those who maintain insurance coverage may find care unaffordable. (King, 2020)

Before the pandemic, research showed that more than half of Americans with employer-sponsored health insurance had delayed or postponed recommended treatment for themselves or a family member in the previous year because of cost. The loss of jobs, income, and health insurance associated with the pandemic will greatly exacerbate existing health care cost challenges for all Americans. (King, 2020)

The pandemic has wreaked havoc on the country’s health system but at the same time has exposed the serious shortcomings of the American health system. However, it should not be hidden that before this event a health reform was necessary in which universal access to quality care for all Americans was guaranteed.

An adequate reform could be based on the Canadian health model, much like the British health model. In both countries, the health system is financed by the government and is based on five principles: it is accessible to all regardless of income, it offers complete services, it is publicly managed, and it is universally accessible to citizens and permanent residents. However, in the Canadian model some services such as dental and vision services are not covered. (Thomson, 2012)

Clearly, no health model will be 100% perfect and mishaps may arise along the way that must be addressed and improved, but health is a right that all people must have and a country that is a world power such as the United States, with excellent management can achieve a quality health system that is truly affordable for each and every one of its habitants.

10 essential health benefits in the ACA

  1. Ambulatorypatient services
  2. Emergencyservices
  3. Hospitalization
  4. Maternityand newborn care
  5. Mentalhealth and substance use disorder services, including behavioral healthtreatment
  6. Prescriptiondrugs
  7. Rehabilitativeand habilitative services and devices
  8. Laboratoryservices
  9. Preventiveand wellness services and chronic disease management
  10. Pediatricservices, including oral and vision care (Bagley & Levy, 2014)

Successes of the ACA

More than 20 million previously uninsured people got coverage between 2010 and 2017. In part it was because the economy improved, but many were also able to buy their own coverage thanks to federal subsidies provided by law to pay for part of the cost of insurance. Other provisions of the ACA played an important role, including a ban on restricting access to care for people with pre-existing conditions, expanding the Medicaid program to more low-income adults, and allowing children to remain in the your parents’ health plans up to age 26. (Williams, 2020)

Failures of the ACA

A growing number of insurers that signed up in 2014 – the reform’s first year of implementation – have been leaving the state regulated markets, year after year. (Williams, 2020)

Therefore, competition between policy providers has decreased, there were fewer and fewer options to choose from, reaching the point that in many counties (which act as municipal associations to offer services continuously) there was only one company that offered ACA-type policies.

At the end of October 2016, the Obama Administration announced that the ACA-type policies that insurers were going to offer for the year 2017 incorporated a national average increase in premiums of 25%. This increase was not territorially uniform at all; in states like Arizona, Illinois, Montana, Oklahoma, Pennsylvania and Tennessee it was about 50%. (Williams, 2020)

Overall, the ACA has led to an increased number of individuals with insurance; however, in many ways, it has not improved the coverage. As a result, the quality of care has not been shown to have increased. Further, the majority of the increased insurance enrollment has been with Medicaid expansion. Consequently, ACA does not work well for the working and middle class who receive much less support, particularly those who earn more than 400% of the federal poverty level, who constitute 40% of the population and do not receive any help. Further, as so many individuals don’t do well under the ACA, only about 40% of those eligible for subsidies have signed up and, with multiple insurers declaring losses, the ACA is not financially sustainable because not enough healthy people are on the rolls to compensate for the sick. (Center, 2017)

REFERENCES:

Bagley, N., & Levy, H. (2014). Essential health benefits and the Affordable Care Act: Law and process. Journal of Health Politics, Policy and Law, 39(2), 441-465.

Center, H., Woods, C. A., Manchikanti, L., & Purdue Pharma, L. P. (2017). A critical analysis of Obamacare: Affordable care or insurance for many and coverage for few. Pain Physician, 20, 111-138.

King, Jaime S. “Covid-19 and the need for health care reform.” New England Journal of Medicine (2020).

Thomson, S., Osborn, R., Squires, D., & Jun, M. (2012). International profiles of health care systems 2012: Australia, Canada, Denmark, England, France, Germany, Iceland, Italy, japan, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States.

Williams, R. A. (2020). Healthcare Reform Law (Obamacare): Update on “The Good, the Bad, and the Ugly” and the Persistence of Polarization on Repeal and Replace. In Blacks in Medicine (pp. 91-95). Springer, Cham.

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