The ACA: Not a Solution, But a Big Step Forward
When we think about healthcare disparities, it actually consists of three parts — disparities in health, in care, and in health insurance. Disparities in health itself are the most obvious and most easily identifiable from nationally representative data. People of different ethnicity group and socioeconomic class could have drastically different rates of heart disease, cancer, diabetes and even psychological and behavioral problems, such as depression and substance dependence. But with just a little more digging into the subject, you will find out that the disparities are not necessarily artifacts of demographics per se. In other words, being in a socially disadvantaged group itself does not make someone an unhealthy person. The real problem lies behind the other two parts of the disparities. And it is this correlation between socially disadvantaged groups and lower quality of care and insurance coverage that really troubles our healthcare system and policymakers.
Luckily, we as a society are well aware of the disparities, and actively seeking for solutions. One of the most influential attempts to narrow the gap — also one of the most significant reformations in the medical community — is President Obama’s healthcare law, the Patient Protection and Affordable Care Act, aka Obamacare or the ACA. The idea is not hard to grasp: People above a certain level of annual income are now mandated to have health insurance. For those who are below this level, Medicaid will cover them. Even more simply put, Obama wants to have a healthcare structure that covers as many people as possible.
The Congress passed the ACA in 2010. Now, six years have flew by. How is the Act doing? Well, there’s one thing for sure, the ACA is not the magic pill to our problem (because, let’s face it, nothing is or will ever be). This is by no mean saying the ACA is a complete failure either. It has actually done us a lot of good. First and foremost, it did raise insurance rates by a significant amount. And more importantly, by mandating insurance companies to cover people regardless of their pre existing conditions, the ACA has helped hundreds of thousands of virtually “uninsurable” people get insured. Okay, but what does the greater insurance coverage suggest, you may ask? With only six years of implementation, it is hard to say whether better insurance coverage will lead to decreased rates of chronic diseases. But some study did find that the expansion of Medicaid coverage could improve chronic disease management, and ultimately prevent premature deaths. And perhaps the most prominent effect at an individual level is the financial stability. With the insurance, people no longer need to pay astronomical numbers when they get ill. Their life really does get better. As one of the researchers from the Medicaid study put it,
“Insurance is not just supposed to get you access to care; it’s supposed to keep you from getting evicted from your apartment because you paid your hospital bill instead of your rent.”
Now, let’s get to the disappointing part. Two years after the Congress passed the ACA, the Supreme Court created a rule, which made being part of the Medicaid expansion an option of the states. Some states did make their decision on not expanding the Medicaid coverage, with a lot of them being in the South. Ironically Southern states also tend to have poorer quality of care to begin with. On the other hand, those states that did improve their Medicaid coverage are not necessarily narrowing the gap in healthcare disparities either. Ethnic minorities are in fact still more difficult to provide quality care for due to their cultural barrier to the physicians, as well as some other reasons.
All this being said, I still want to give a big shout out to ObamaCare. Obviously it is not the perfect solution to the healthcare disparities the country is facing — a comprehensive solution would require much more complex analyses and delicate decision making process. Nonetheless, I would think of it as a necessary step to the ultimate success.
