Consider a topic (mental health, HIV, opioid epidemic, pandemics, obesity, prescription drug prices, or many others) that rises to the presidential level. How did two recent presidents handle the problem? What would you do differently?
Presidential Agenda Health Topics: Affordable Healthcare
It is a known fact that healthcare in the United States is very expensive (Sultz & Kroth, 2018). Unlike other developed countries, the US did not really have a semblance of universal healthcare for all citizens until the 44th President (Barak Obama) signed into law in 2010 the Patient Protection and Affordable Care Act or ACA 2010 (Kominski et al., 2017). The question of affordable healthcare especially for the disadvantaged and the poor in the US is a very important public health issue. The much-touted ‘Medicare for All’ would have been the solution for the much-needed single-payer system that would have facilitated universal healthcare (Cai et al., 2020). The purpose of this paper is to look at the population health concern of affordable healthcare and to determine what the current and immediate former Presidents have done concerning the same.
Identification and Description of the Population Health Concern
The population health concern identified in this case is affordable healthcare. This is a very thorny public health and political issue that presidents have had to address it as a policy issue. Most healthcare in the United States is run as a private enterprise. Healthcare is run as business and prices are dictated by market forces just like in any other capitalistic society. Health insurance coverage is available but that too is quite expensive for the poor and marginalized. This is because healthcare coverage is also mainly in the hands of private entities (Sultz & Kroth, 2018). The result is that access to healthcare is not guaranteed for the poor and marginalized citizens who are then left to die from preventable causes.
For the first time, however, the administration of the 44th President of the United States Barak Obama came up with a revolutionary healthcare policy that would change things. The piece of legislation was called ACA 2010 and it was signed into law in the year 2010 (Kominski et al., 2017). It brought the provision of individual mandate whereby every citizen would be required to pay a minimal premium to access healthcare coverage. This would be mandatory and failure to do so would lead to penalties. The idea was to use economies of scale and have each and every American subscribe to the plan.
After its enactment, a total of 22 million poor and marginalized Americans were brought into healthcare coverage. Furthermore, there would be monetary incentives provided by the federal government to private healthcare insurers to cover pre-existing conditions. This was to be revolutionary and historic as most marginalized minority communities such as Hispanics and African Americans are the ones that have many persons with pre-existing conditions like diabetes.
How the Former and Current Presidents Approached the Issue of Affordable Healthcare
The 45th President of the United States was Donald Trump. He is the immediate former President who unfortunately did not have a passion for equity and affirmative action. After he came into office following the expiry of the second term of President Obama, Donald Trump made it clear that his administration was determined to “repeal and replace” the ACA 2010 (Simmons-Duffin, 2019). At the center of this push to cancel out the gains made in providing affordable healthcare was the obsession with returning healthcare into the hands of private enterprise. In particular, the Trump administration wanted to do away with the individual mandate clause making a subscription to ACA 2010 optional. Of course, this would kill it as the intended economies of scale would have not worked.
The other target for repealing by the Trump administration was the coverage of pre-existing conditions. It wanted to stop the government from giving incentives to private insurers so that people with pre-existing conditions can be treated (Simmons-Duffin, 2019). The Trump administration never allocated any resources to facilitating the implementation and functioning of the ACA 2010.
It cannot be forgotten that the current President (Joe Biden) was the Vice President when President Obama was signing the ACA 2010 into law. This means he was deeply involved in the formulation of the policy. Unlike Donald Trump, the first thing that President Biden did after assuming office was to reinstate all the provisions in the ACA 2010 that had been removed or watered down by the Trump administration. The Biden administration is also actively providing resources at all levels to see that affordable healthcare is made a reality.
The administrative agency that would most likely be responsible for helping address the affordable healthcare issue is the Center for Medicare and Medicaid Services or CMS. The reason for this is that the CMS is a major payer in the healthcare landscape of the US. The agency will therefore be helpful in that it will be responsible for the majority of the reimbursement for services rendered to the poor and marginalized.
The healthcare issue of affordable healthcare already got on the presidential agenda because it is such an important issue. Because the ACA 2010 legislative healthcare policy was to be implemented in phases over about 10 years, it is expected that the issue will remain on the presidential agenda for quite some time. The person I would choose to be a champion for affordable healthcare is Senator Susan Collins. She has been a champion of affordable and equitable healthcare for quite some time.
Affordable healthcare solutions in the US are badly needed. The ACA 2010 legislative healthcare policy was a major step towards the realization of these solutions. The former President who was Donald Trump attempted and succeeded to thwart the policy during his first and only term. However, the current President Joe Biden has already started by reinstating all provision in the ACA 2010 that may have been removed or altered. He is also allocating more resources to that end.
Cai, C., Runte, J., Ostrer, I., Berry, K., Ponce, N., Rodriguez, M., Bertozzi, S., White, J.S., & Kahn, J.G. (2020). Projected costs of single-payer healthcare financing in the United States: A systematic review of economic analyses. PLOS Medicine, 17(1), 1-18. https://doi.og/10.1371/journal.pmed.1003013
Kominski, G.F., Nonzee, N.J. & Sorensen, A. (2017). The Affordable Care Act’s impacts on access to insurance and health care for low-income populations. Annual Review of Public Health, 38. https://doi.org/10.1146/annurev-publhealth-031816-044555
Simmons-Duffin, S. (October 14, 2019). Trump is trying hard to thwart Obamacare. How’s that going? https://www.npr.org/sections/health-shots/2019/10/14/768731628/trump-is-trying-hard-to-thwart-obamacare-hows-that-going
Sultz, H.A., & Kroth, P.J. (2018). Sultz and Young’s health care USA: Understanding its organization and delivery, 9th ed. Jones & Bartlett Learning.