The topic of addressing the many issues plaguing the Patient Protection and Affordable Care Act, otherwise known as Obamacare, remains highly contentious and attempting to discuss the issue often spirals into a highly emotive nonproductive discussion. It’s quite obvious as to why it is contentious, America is an enormous country, highly diverse, and some of the larger states see a significant amount of immigrants entering the country, who migrate to America seeking a better life. These individuals will also obtain access to many of the benefits America provides, as they gain citizenship. These particular components may extend to some degree in other countries, but America is quite a unique model, and addressing the skyrocketing cost of healthcare, creating access to affordable health care for low-income individuals is no easy task.

It must be stated the ACA was quite an ambitious undertaking and one long overdue. Of all the social welfare programs available to citizens, access to affordable healthcare should be at the forefront. An individual may be ambitious, hardworking, highly talented, but if they are not able to address their own basic health concerns, more precisely when tragedy strikes, their ability for success is highly limited. Healthcare.gov was an unprecedented undertaking, and generally speaking prior to the launch of the marketplace, many individuals who had access to healthcare simply obtained the plan that may have been offered by their employer. This process did not give an individual the ability to ‘shop’ for a plan as it were, and healthcare.gov launched under the assumption many individuals contained the ability to ‘shop’ for a plan and make an informed decision, able to choose the most appropriate plan well suited to address their healthcare needs. One fatal flaw of the program highly underestimated the ability or honesty of an individual to choose the correct plan, as many chose the least expensive rather than the plan well suited to address their immediate health care concerns. This component in addition to the unexpected amount of pre-existing conditions clients would require treatment for, quickly led to an increase in healthcare expenditures on the part of the insurers, which led to steadily rising premiums. Again it should be restated those developing the market place had no precedence with which to reference, through the development and implementation process.

There has been some discussion surrounding a single payer system. With the ailing ACA on life-support, the idea of a single payer system steadily seems to be gaining momentum. The single payer model may be the go to idea for affordable healthcare, but it too also faces significant challenges. One of the problems with this model stems from the providers themselves. Many of the providers rendering services under programs such as Medicaid, are incentivized to drive a profit margin to remain competitive. Some serve Medicaid clients simply on profit motive looking for avenues to exploit the system, searching for avenues with which to exploit Medicaid benefits that may return the highest profit margin. Although the program itself may have altruistic intentions, the provider themselves are driven to compete for survival and this in and of itself tends to lend a subpopulation of the providers towards nefarious means. This is one particular complication, of the many in addressing the issues that would arise under an expansion of a single payer system.

As it becomes clear, creating avenues of access to affordable healthcare is highly complicated. America is very large country, highly diverse, and is a destination for many immigrants seeking The American Dream. All these components not only make creating and implementing a successful policy difficult, it also significantly increases the cost associated with public health. With the ACA failing, an adjustment or replacement is necessary, and for any future success of creating an avenue of access to affordable healthcare to low-income individuals, we need a bipartisan collaborative effort, as simply playing politics will lead towards another doomed fragmented legislation, along with vast sums of wasted taxpayer money, albeit with altruistic intentions.

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