In December 2017, Congress passed the Tax Cuts and Jobs Act, which eliminated the individual mandate penalty, effective January 1, 2019. The tax bill included a provision that revoked the individual mandate that was part of the 2010 Affordable Care Act (ACA). The individual mandate requires most Americans (other than those who qualify for a hardship exemption) to carry a minimum level of health coverage. Under the ACA, individuals can purchase healthcare insurance that meets the minimum healthcare coverage standards required by law from licensed agents or on or offline directly from insurance companies regardless of pre-existing conditions. Section 6055 of the Internal Revenue Code, adopted through the ACA, requires employers with 50 or more full-time employees and government programs to offer 'minimum essential coverage' and report proof of health insurance coverage for anyone employed with that company or who is in a government program. Organizations that do not report the coverage information will face high penalties. This is still in effect for 2018, which means if an individual does not carry the minimum level of health coverage, then they could face a penalty of 2.5% of total household income or $695.00 per person, whichever one is higher. The IRS has announced that it will reject electronic filings of taxes for 2017 that do not claim coverage or an exemption or include payment of the penalty.
The Independent Payment Advisory Board (IPAB) would have consisted of a panel of 15 members, appointed by the president with recommendations from congressional leaders and confirmed by the Senate. IPAB would impose cuts (get spending under control) in Medicare payments to doctors if cost increases exceeded a certain amount. This panel would have had the power to do this even over a presidential veto. “The IPAB would have taken away Congress’s power to make the cost-saving choices it wanted or its choice to avoid them” (Sanger-Katz, 2018, para. 8). Congress could accept the plan or create an alternative that saved the same amount. Medicare spending growth was low after the implementation of the ACA, and no one was ever appointed to the IPAB. The IPAB was sometimes referred to as the 'death panel' because its decisions could lead to the rationing of healthcare. The idea of IPAB was abolished in 2018 as part of the Budget Act.
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One of the aspects that made the Affordable Care Act so controversial is that citizens are required to purchase a health insurance plan or pay a fine. Twenty-eight states challenged the mandate. Federal district court judges in Florida and Virginia ruled it unconstitutional because it was forcing individuals to purchase a product that they may not want. This did not sit well with many people, including economist Michael Tanner, who felt like purchasing healthcare should be a choice. “We should all eat better and exercise more, but that doesn't mean we should be doing morning exercises out in the square like they do in North Korea. Freedom sometimes means the freedom to be stupid” (Montopoli, 2009).
Another aspect that makes the ACA controversial is that before the Affordable Care Act, insurance companies were allowed to refuse coverage to patients with pre-existing conditions. With the ACA, they were not allowed to refuse coverage or charge a higher premium for pre-existing conditions. This was done to provide everyone with affordable healthcare coverage. This caused a problem for insurance companies because they had to take losses on paying for their care. Many young adults were opting to pay the tax penalty, leaving insurance companies to pay the medical costs of the older, more sick generation. “As a result of high financial losses on the exchanges, some national insurers, like UnitedHealthcare and Aetna, have decided to either drop out of the exchanges completely or cut back on the number of regions they’re serving” (Gruessner, 2016). Payers will need to recover their loss through increasing premiums. The end result will be higher-priced premiums for those of us who carry health insurance through our employers.
Some people suggest that universal healthcare is the solution. Universal health care is a system that provides quality medical services to all citizens, regardless of their ability to pay. Universal healthcare in the UK is funded by income taxes deducted through payroll; the same deduction that we call FICA here in the US which funds our Medicare. The advantage of this is that the government controls the cost of medical care and medications through negotiation and regulation. Individuals would receive the same standard of care at a low cost. One of the disadvantages is that people who lead healthier lifestyles will not have any financial incentives and will pay for the costs of those who may not be as careful with their health. I have a cousin who is British and who does not seek medical services using his universal healthcare benefit, even though he contributes to it. Instead, he opts to purchase coverage through his employer (doubling his cost for healthcare benefits) because he says that those who use universal healthcare have longer wait times to see a physician and are not provided with the same quality of care as those who have private healthcare insurance. You may wait longer to see an orthopedic doctor if you have a broken arm with universal healthcare than you would if you had private healthcare insurance.
In conclusion, it is important to understand the purpose of the ACA, which is to make health insurance more affordable for those who would not or could not buy health insurance due to either pre-existing conditions or due to high premium costs. The individual mandate requires everyone to carry a minimum level of health insurance. Those who elect not to purchase health insurance coverage face a tax penalty through tax year 2018. While there are aspects that have made the ACA controversial, the fact remains that everyone has a right to access healthcare. It is a right, not a privilege, and everyone should contribute to it. We need a system that works for everyone, and we need to work together as a whole to resolve this issue.
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