Medicare And Medicaid

What is the Future of the Affordable Care Act?

The Affordable Care Act

The Affordable Care Act (ACA), Obamacare, has long been hailed a victory for healthcare policy reform advocates, yet the refusal of 14 states to expand coverage has left more than 2 million of the poorest American’s uninsured. Currently, the United States has between 27 – 31 Million uninsured, non-elderly, Americans. This is down from almost 50 million uninsured Americans, prior to the enactment of the ACA. But, the system has several mechanisms that create coverage gaps. First, because of the federal-state style of the Medicaid program access to health care is dependent on which state an individual lives. Due to the Supreme Court’s decision to allow states to refuse to expand the program. Second, the rates that Medicaid reimburses physicians are lower than private insurance or Medicare. These problems create access related issues for poorer Americans, especially for already underserved or disparaged minority groups that are disproportionately affected by poverty.

A Solution

A potential solution is to fold Medicaid into the Medicare program. This option would make funding for the program entirely federal – preventing states from limiting coverage. “Medicare-for-All,” while not the same, has already established the mechanisms for absorbing the program. This could be an important solution to providing healthcare to the poorest Americans, and it would free up state funding for other programs, such as schooling or training the police. Additionally, this constitutes a middle ground to the controversial Medicare-for-all program. In fact, Mitt Romney (R) help invent the tenets of the Affordable Care Act in Massachusetts. The ACA has been very effective at decreasing the amount of uninsured Americans.

Obamacare is a good thing: Studies have shown that uninsured individuals experience delays in accessing health care and therefore access the system once they are sicker. This correlates with presentation at later disease stages requiring longer and more costly care. The ACA addressed a major coverage issue that was driving up health care costs. However, without the tax implication of the insurance mandate.


Democratic Presidential Nominee Joe Biden is seeking to define his presidency as more than a continuation of the Obama Administration. Biden’s platform is heavily focused on economics. It’s clear Biden wants to ensure the Affordable Care Act’s survival. However, he isn’t looking to overhaul policy reforms in the healthcare industry. He would likely reinstate the tax implication for the insurance mandate. Folding the Medicaid into Medicare would be a lofty task and it does not seem this is one of Biden’s main focus points.

George Williams | Law Student

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