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After calamitous rollout, Obamacare enrolment hailed success

© Photo: AFP

Text by Sophie PILGRIM

Latest update : 2014-04-01

The Obama administration was relieved on Monday as enrolment numbers for the US president’s signature healthcare reform looked likely to hit the hoped-for seven million just hours before the midnight sign-up deadline.

The victory for the Obama administration was all the sweeter after the calamitous roll-out of the scheme triggered a torrent of harsh criticism from Republican critics, who have doggedly opposed the reform since Obama first floated it in 2008.

Major hurdles remain. Obama’s plan to ensure health coverage for some 50 million uninsured Americans has been a hard sell, with large swathes of the public and many healthcare officials lobbying hard against the bill.

But in New York, where the reform is popular, many enrolees - 70 percent of whom had no insurance beforehand - seem satisfied, even relieved, with the change.

Tom Vogt, a documentary editor in his mid-forties, is one of them. Like many freelance artists, he has done without health insurance his whole life. The Affordable Care Act (ACA) means he is now legally required to acquire coverage. Vogt, like seven million others across the country, decided to opt for the state-linked option, dubbed Obamacare.

“Having that sort of prescribed safety net, I guess is a little bit more peace of mind,” he told FRANCE 24. “I am not sure about the bureaucracy of it all but I feel it’s probably overall a good thing.”

Vogt will have to pay several hundred dollars a month for his insurance plan but says he now realises the risk he was taking living without coverage.

“If I broke my wrist, I wouldn’t have been able to work,” he said. “I didn’t go to the doctor for five years.”

Step in the right direction

For Dr Sanjay Sinha, who works in a clinic in Manhattan, there's no doubt that Obamacare is a step forward.

“I have more than one patient who has uncontrolled diabetes who, as a result of the Affordable Care Act, can now come see me," he said. The diabetics also now had coverage for preventive screening,  such as important tests for kidney function, he said.

A survey carried out in March by the Kaiser Family Foundation polling agency showed that, while most Americans dislike the law, 59 percent of them would prefer to see Obamacare altered rather than repealed. The US currently suffers some of the worst health statistics in the Western world, and yet pays more per capita and as a percentage of GDP on health services than its industrial peers.


A minority of Americans would like to see the reform go  further. Dr Oliver Fein, former president of the Physicians for a National Health Program, is one of them. At a roundtable discussion in his office, a group of medical students debating the ACA argued that while the change is a step in the right direction, the reform will fail to “substantially” improve access to services for patients facing serious ailments, such as life-threatening diseases.

“If you really ask Americans what they want, they would say universal access to healthcare,” Fein told FRANCE 24. He was referring to a single-payer system, whereby one entity (typically the state), funded by taxes, provides comprehensive healthcare, a system that exists in most developed countries.

“Medicare [US state insurance for elderly and disabled people] has an overhead of about 3 percent, which means that about 97 percent of the dollars collected go out to pay doctors and hospitals and prescription drugs,” Fein explained. “Whereas with private insurance the average is about 20 percent, which means that only 80 percent of the premium dollars collected by a private insurance company go to pay doctors in hospitals. But 20% is kept for profit and administration.

"Well, we need to get rid of those multiple insurers and get to a situation where we have a single-payer insurance programme.”

Here to stay

Dr Fein and his students are the first to admit that that their ideal is still far from  reality.

But  almost everybody seems to agree that Obamacare is here to stay. "It's the framework that everybody in the healthcare industry is working within and developing their strategic plans around,” Dr Ezekiel Emanuel, who was a top White House adviser on healthcare during the law's development, told Reuters in an interview on Sunday.

"Even the opposition, the Republicans, recognize the ACA is the law of the land, and despite the rhetoric, actually accept it.”

But with November midterm congressional elections looming, Republicans are using uncertainty surrounding the ACA to discredit Democrats ahead of the poll, and have already called for certain parts of the law to be repealed.

Obama himself has admitted that the roll-out of the scheme was “botched”. In November, he was forced to allow health insurers to forgo the minimum requirements initially drawn up in order that millions of people would be able to renew coverage plans which would otherwise have been cancelled. Even after that alteration, many customers have been forced to change provider and/or doctor and sometimes accept a less extensive coverage plan as a result of the overhaul.

If Republicans win control of the Senate from Democrats in November, Obama might have to compromise on certain aspects of the law, such as insurance being a universal requirement and companies with more than 50 employees being legally required to provide coverage.

Date created : 2014-03-31

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