Obamacare or the Affordable Care Act (ACA), was signed into law in 2010 in the United
States. The Act’s main goal was to provide better health insurance coverage to Americans at an
affordable cost (Dawes and Satcher 14). The debate about the law has been intense, and does not
seem to end today given the political reactions it continues to generate. President Donald Trump
has continued to lead the Republicans in opposing the Obamacare, even going as far as
promising his supporters that they are going to get rid of the troubled Act. The Congress has
debated the law widely, and the Republicans continue to oppose it despite its continued use. So
far, the law has ensured an increase in healthcare coverage, despite it facing continual challenges
in terms of state-level adoption, funding, and the general public support.
Before the law was enacted, US healthcare had been seen as lagging behind its global
peers in the international levels. This historical inequality was measured in terms of efficacy and
coverage, with many of the services offered by private insurance companies through employers
(Thompson 29). According to reports, Americans spend more in health care than any other
developed country yet it still failed to provide healthcare coverage to all its residents. The
rallying call was to make healthcare insurance accessible and affordable to all, hence the birth of
the Affordable Care Act.
The debate about its legitimacy
Today marks the ninth year since Affordable Care Act was signed into law. Affordable
Care Act has generated a lot of controversy since its enactment. The controversies are around its
legitimacy has been in existence since the law was enacted. Despite its complexity, the law has
withstood pressure, particularly from the republicans. In June 2015, Supreme Court ruled in
favor of the Affordable Care Act, which was landmark decision given the controversy the Act
had generated. But the question remains whether the law is working as it was intended or not or
rather whether the law is legitimate.
Before its signing into law, the proposal was widely debated between various
stakeholders, including politicians, private health insurers, government agencies, state level
stakeholders, congressional committee members, leaders from all sectors, commercial groups
who had direct interest in the law and the general public. The stakeholder engagement was well
implemented, with the wider focus being on the need to get opinions of every interested party
(Ko 677). Within the debate spectrum, the Democrats favored the more socialized approach to
healthcare reforms with an expanded Medicare to work in conjunction with Medicaid, but
covering everyone in a single system of payment, similar to the Canadian healthcare program.
The Republicans, on the other hand, supported a less detailed law that focused on the
government giving subsidies to help the uninsurable persons get medical care, with the goal of
letting the healthcare market operate in the normal system.
The Obama administration had argued that it had learnt from previous failures of such
schemes, and were willing to offer a lasting solution through enactment of the law. For example,
Clinton administration, through a taskforce led by the then First Lady, developed the Health
Security Act of 1993 (Ko 678). The plan, which was commonly referred to as “Clinton’s Health
Plan”, was aimed at making healthcare affordable to all citizens. The plan’s objective was to
manage the competition, allowing the government to control insurance cost, particularly the
premiums and doctors’ bills. While the plan was initially hailed as revolutionary, it could not
stand the test of time because it was considered too ambitious, yet lacked legitimacy because of
insufficient public participation. Unlike the Obamacare that gave the public and stakeholders
more power in deciding the components of the law, including giving the Congress more
opportunity to input their proposals, Clinton’s healthcare program failed in this aspect.
The concept of political commitment
One of the ways of legitimizing a public policy is through ensuring the involvement of
the political class, and pushing for their approval. One of the most important features of most of
the previous years’ healthcare programs was their wide political approval across the political
divide. For example, the Clinton health care plan had wide approval across political divide, with
less controversy. Levy (2) notes that previous programs touching on healthcare had received
more consensual support from political leaders across the political divide, yet the Affordable
Care Act courted more controversy.
The approval journey of Obamacare was riddled with conflicts, as Republicans waged an
all-out war on the plan, as they voted en mass to delay, defund or repeal the law in more than 50
occasions. The extreme partisan divide on the issue signified a weak political goodwill or lack of
political consensus as far the health care reforms were concerned.
In the Clinton health care reform plans, the political disagreement was based on rationale
that it was not offering the people options to choose between private health insurance or
Affordable Care options subsidized by the government (Levy 2). Even after the defeat of Clinton
health care plan, the underlying challenges of health care system continued to escalate, including
rise in costs, which shut out more people out of health coverage. It was these renewed demand to
reign on the cost of health care that prompted the Obamacare debate. Probably the proponents of
Obamacare program were not prepared to repeat what happened with Clinton plan, hence their
desire to get it passed in congress.
The Affordable Care Act, which is broken into ten titles, contains chapters touching
almost all dimension of heath care system. The provisions were designed to increase insurance
coverage, and at the same time increase protection of health care consumer with more emphasis
on “prevention, wellness, quality improvement, system performance improvement, strengthening
of health care workforce, and curb rising health care costs” (Bias 633). Reports indicate that
about 31 million Americans had taken up insurance based on the Affordable Care Act. However,
it must be noted that not all states have undertaken to implement the act, especially on the
Public confidence rating
Obamacare has been widely debated both among political actors and the general public.
Given that its measures have affected people differently (for better and worse), support and
approval have been mixed and changing since implementation, and the public seem to be split
down the middle in terms of overall support. A survey by Kaiser Family Foundation had about
54% approval rating, which was the highest ever public rating of a health care program (Levy 3).
The high public confidence rating is not an accident, as far as the outcome of the
implementation so far is concerned. For instance, a recent study reveal that Obamacare has not
just achieved its mandate of providing access to quality health care but has already surpassed the
people’s expectations (Levy 3). According to the authors, Obamacare has had a significa...