Leaving aside secret drone strikes, persecution of whistleblowers, and the weaponization of the Internal Revenue Service (IRS) against conservative non-profit groups, the centerpiece of Barack Hussein Obama’s presidency is the Affordable Care Act (ACA) commonly known as Obamacare (Borosage, 2017; Courtemanche, Marton, Ukert, Yelowitz, & Zapata, 2018). The ACA was signed into law 23 March 2010. It is difficult to measure its effects in a way that enables us to draw conclusions about the impact it has had on quality of care and cost of care, but we can find reasonable estimates for the number of people who have health insurance due to the expansions authorized in the ACA (Blumenthal, Abrams, & Nuzum, 2015).
Do the provisions in the ACA have any measurable impact on the behavior of consumers of healthcare? Early Effects of the Affordable Care Act on Health Care Access, Risky Health Behaviors, and Self‐Assessed Health examines whether the gains in coverage translate to changes in risky behaviors and short-term health outcomes. Unless the determinists are correct, we have agency in making choices that impact our health. Indeed, what we choose to eat, drink, and do are primary determinants of our overall health but we can make appropriate decisions to optimize our health. The ACA has decreased the number of uninsured by 7.0 million to 16.4 million according to some estimates (Blumenthal, Abrams, & Nuzum, 2015).
Provisions in the ACA prohibited insurers from considering pre-existing conditions in scheduling premium rates and qualifying applicants for policies. This is likely to lead to increases in adverse selection and cost increases, where healthy people bail out of policies as sick people pile in. The solution offered in 2014 was the individual mandate, which imposed a direct tax on individuals without qualifying health insurance. However, President Obama’s successor would repeal the individual mandate effective in January 2018. Would the newly insured and those freed of the individual mandate spend their savings on gym memberships, or junk food?
The authors found no statistically significant change in behavioral risk factors during the period of Medicare and Medicaid expansion following the ACA despite gains in the number of insured individuals. particularly among those with low incomes. The authors also noted a continuously increasing body mass index (BMI) across all categories of beneficiaries. (Courtemanche, Marton, Ukert, Yelowitz, & Zapata, 2018).
References
Blumenthal, D., Abrams, M., & Nuzum, R. (2015). The Affordable Care Act at 5 years. The New England Journal Of Medicine, (25), 2451.
Borosage, R. L. (2017). Was Barack Obama a Transformational President?. Nation, 304(1), 40-43.
Courtemanche, C., Marton, J., Ukert, B., Yelowitz, A., & Zapata, D. (2018). Early Effects of the Affordable Care Act on Health Care Access, Risky Health Behaviors, and Self‐Assessed Health. Southern Economic Journal, 84(3), 660-691. doi:10.1002/soej.12245
Perry, J., & Thompson, D. (2017). Law and Ethics In the Business of Health Care. St. Paul: West Academic.