The Patient Protection and Affordable Care Act commonly referred to as Obamacare was passed as a legislative effort to address America’s crumbling health care system. Two crucial problems of cost and access to care, due to a dramatically large number of uninsured, fueled the debate. Out of this nearly two year process came a highly complex piece of legislation with numerous tasks and detail left to the Federal bureaucracy. This responsibility is something that did not have similar precedent, and one that makes predicting the true cost and benefits of this program to be a near impossible task at this moment.
The bill, exceeding 2000 pages was highly conceptual, granting power to the Federal bureaucracy to craft essential details over a ten year implementation period. At least 10,000 pages of regulations have been written thus far. The law is expected to cover some 32 million individuals, but cost concerns remain. The Congressional Budget Office based on assumptions, estimated at the time of passage that the law will be budget neutral by 2020, arguing that it may reduce the deficit. This has been contested.
Long term budget forecasts show uncertainty due to rising costs and the expansion of an existing entitlement program (Medicaid) as well as the creation of middle class subsidies to purchase health insurance. Several indirect consequences could potentially exacerbate unemployment or lead to employees paying larger shares of their premiums.
32 million individuals are expected to insured by 2019, IF the law is fully implemented, but those without insurance will still be able to receive care in emergency rooms. The law does not adequately address the cost issue despite modest efforts, and future action is going to be necessary on this issue. Rising costs will continue to strain individuals, and businesses will make less profit, thus less take home pay for employees due to rising insurance premiums. Workforce issues also remain problematic, as an aging health workforce will need to be replaced and expanded to deal with the newly insured, particularly those in rural and urban underserved areas.
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