Is Obamacare Safe

US Health Care Reform: Roller Coaster Ride For Obamacare

More than seven million Americans have had health insurance in the past six months. The number shows: Obamacare is taking effect. Nevertheless, the country continues to struggle with the reform.

Need for advice: At the end of March, residents of Allentown, Pennsylvania, will find out about the new Obamacare insurance conditions. Photos: picture alliance

Reaching the seven million applications was a feat of strength for the administration of US President Barack Obama. Because the initial phase for acquiring the new, private insurance was one thing: a disaster. From early October through late March, America's citizens should be able to obtain health insurance through a central government online portal (HealthCare.gov) and some regional health exchanges. But just a few days after the start, the technology on the main page failed. The portal went down on its knees and was inaccessible for weeks. The government blamed the “great rush of patients”, and the less uncritical voices were simply serious technical errors. It was thanks to an intensive final offensive by the government camp that it was successful. President Barack Obama used his campaign experience from winning two election campaigns to show uninsured Americans the route to health insurance.

Resignation after a series of breakdowns: Health Minister Kathleen Sebelius (right) has to resign in mid-April because there have been technical problems on the websites of the new insurance offers for months. President Barack Obama and successor Sylvia Mathews Burwell applaud her demonstratively.

The policies that selected insurers offer on the stock exchanges must meet minimum standards and are comparatively affordable. Anyone who does not have health insurance in the USA from now on faces a tax penalty of up to one percent of their taxable income when filing their 2014 tax return. It will only be possible to obtain insurance from the state-regulated stock exchanges again from autumn onwards.

Turbulent implementation

The good result of the first registration deadline for health insurances cannot hide the fact that the health reform in the country continues to have a difficult time. The entire implementation process was turbulent and had consequences at the beginning of April. Health Minister Kathleen Sebelius resigned from her position. Not only the establishment of the central online exchange was fraught with problems, the entry into force of individual elements of Obamacare was also delayed.

The result: The reform of the century gives the Republicans new material to ignite again and again. The law brings "chaos in America's families, small businesses and the US economy," says John A. Boehner, spokesman for the Republican-dominated House of Representatives. He announced that his party would not slack off in its attempts to overthrow the law. It is an announcement with consequences. There will be elections in the USA this fall. The House of Representatives and parts of the Senate will be filled. Obamacare will - once again - become an election issue.

The Democrats are worried about the autumn, not only because of the expected attacks by the Republicans. Your problem: Large parts of the population are still critical of Obamacare. Now, even more Americans are opposed to the law than they are in favor. Obama's predictions that citizens will learn to appreciate the law the longer it is in place have not yet come true.

From the perspective of many Americans, getting the government involved in the healthcare system is a turning point that they reject. The state should stay out of the life of the individual as far as possible, especially from such a personal area as one's own body. When it became known a few months ago that Americans who were already insured would lose their current policies as a result of the reform because they no longer meet the standards set by Obamacare in the overall market, there was criticism. In the multi-year struggle for reform, Obama had always affirmed that the reform would not change anything for Americans who were already insured.

Obama defends reform

Still, the reform has already made a difference in the American health system. In addition to the more than seven million citizens who have acquired private insurance in the past six months, there are another three million who have been able to slip under the umbrella of Medicaid, the health insurance for the socially disadvantaged, as a result of the reform. The - voluntary - expansion of the regionally organized social program is another component of Obamacare. According to the government, more than three million young Americans could be insured because the reform allows them to be insured through their parents up to the age of 26.

The renowned polling institute Gallup announced in early April that the number of uninsured had dropped to its lowest level since the end of 2008. In the first quarter of 2014 in particular, at the core of the enrollment phase, the number of those without health insurance fell significantly. Official forecasts assume that up to 13 million citizens will be supplied via the state-regulated health exchanges in 2015; in 2016 the number is expected to be 22 million.

The fact that all Americans must be insured with immediate effect is the most fundamental change that Obama's health care reform will bring, but by no means the only one. The more than 1,000-page law tries on a broad scale to remedy the worst excesses of the American health system. The minimum standards prescribed by law include, for example, care for mental illnesses and a whole range of preventive benefits. People with previous illnesses now have to be accepted by the insurers - until now, chronically ill people could be refused.

Also under Obamacare it is no longer possible for insurers to send a letter of termination to a patient because his care costs have skyrocketed. In the US before Obamacare, only senior citizens and the socially disadvantaged who were covered by the two state programs Medicare and Medicaid had a kind of full protection as in Europe. For everyone else, illness and personal bankruptcy often went hand in hand. Obamacare should put an end to the times when there is a risk of ruin in the event of illness. The democratic president calls the changes “fundamental rights for patients”. And he is certain: "This law is already helping millions of Americans, and it will help millions more in the years to come."

Independent voices are more cautious in assessing what has been achieved so far. The government has not yet been able to say how many of the citizens now covered by Obamacare were actually uninsured and how many of them had to purchase new policies because they had lost their old health insurance as part of the new standards. The New York Times reported that up to 20 percent of citizens had not yet paid the insurance premiums for their new policies. It is also unclear what the quality of care will be under the new Obamacare plans. With some policies, the choice of practitioners and clinics is severely restricted, or the stipulated co-payments are very high.

Even after the reform, at least two major problems are left out. Furthermore, millions in the country are not insured. Eleven million illegal immigrants live in the United States. They do not have access to health care. At least five million Americans live in states that have opposed the expansion of Medicaid and are denied access to the central health exchange due to a lack of requirements.

Medicine is extremely expensive

The second elementary problem: the individual health costs. Medicine is expensive in the US. Doctor and hospital bills are still abstruse high. For outpatient treatments, they can easily run into the thousands of dollars. Anyone who has to spend some time in the hospital is confronted with bills in excess of $ 10,000 even for minor interventions. This high-priced medicine cannot even be covered by the new Obamacare insurance.

Nora Schmitt-Sausen