Healthcare reform is a hot-button issue in politics, the media and households across America. With a new Republican president in office, you might be wondering about the future of the current healthcare reforms implemented under former President Obama. The word “access” has been used extensively by rightwing members of Congress, but what does that mean in relation to health insurance? As President Trump prepares to announce his ideas for reform – and what those mean for the country – let’s take a look at how Republicans approach healthcare.
Access vs. Universal Coverage
The prevailing stances in healthcare can be defined as “universal access” by Republican representatives and “universal coverage” by Democrats. It boils down to this:
- Republicans want to ensure that people have access to health insurance.
- Democrats want to ensure that people get health insurance.
It’s a slight difference in terms that makes a big practical difference in the administration of health insurance and healthcare in the United States. Access is simply that. You have access to a wide range of items at your local shopping mall, but you may not be able to afford anything. By contrast, universal coverage grants you not only the right but the guarantee to fill your bags – in this case, with health insurance.
There are arguments for and against both approaches. An access-based approach saves the government money by not making health insurance guaranteed-issue, meaning people with medical problems pay more for coverage. A universal approach ensures that people can get treated for those medical problems, but the cost to taxpayers is substantially higher.
Parameters for Universal Access
The National Center for Biotechnology Information (NCBI) describes access as having healthcare services that are available and adequate in number to help people promote and care for their health. Certain criteria must be met to be able to claim that everyone has access to those medical services. According to the NCBI, there are several different components that must be addressed before claims can be made that healthcare is universally accessible, including:
- Financial barriers
- Organization and infrastructure of the medical system
- Cultural or social constraints
In our shopping mall analogy, it’s not enough to simply open up the stores in the mall for consumers to browse. The stores have to offer products designed to fit in with a wide range of budgets, and shopping has to be easy to navigate so that consumers don’t have trouble finding what they want – and comparing those products to other products. Furthermore, there can’t be any cultural or social barriers to the stores, meaning anyone of any background should, in an ideal scenario, be able to walk into a store and buy what she can afford.
How Access Affects Healthcare Reform
Republicans are advocating for universal access to medical services over universal coverage. In an article for The Atlantic, Representative Tom Price describes how he wants citizens to be able to obtain affordable coverage. With universal healthcare access, people would not be obligated to obtain health insurance, but everyone would have the opportunity to do so. This mindset aims to repeal the heavy burden of mandatory healthcare premiums and allows healthcare to be dictated by the consumer instead of the government.
There is concern that this method of health insurance delivery will create a barrier for people who cannot afford the services that they could theoretically obtain. According to Republicans, if consumers have more options in the private healthcare marketplace, then they have the opportunity to shop around for coverage and potentially lessen the financial burden.
Universal Coverage: The Democratic Approach
Democrats typically support the idea of universal coverage. The goal is for every – or almost every – citizen to have health insurance regardless of the ability to pay. This approach regards healthcare as a basic individual right, akin to the right to representation in court during a trial. The Affordable Care Act sought to get the American healthcare system closer to universal coverage via the individual mandate, a penalty system that imposed fines on people who didn’t get health insurance.
Changes under Obamacare
Obamacare reformed many aspects of the American healthcare industry, but there are three in particular of note:
- Pre-existing conditions are covered, period. The ACA made health insurance guaranteed-issue, which means anyone can sign up without the fear of being charged higher premiums or denied coverage altogether.
- There are 10 covered essential health benefits in every major medical plan. Even if you won’t ever use one of these benefits, like pregnancy services, you will pay for them via your monthly premium. The idea is that cost gets spread throughout the population, lowering the cost of care nationwide.
- There’s an out-of-pocket cap for private health insurance, meaning that once you hit your plan’s OOP maximum for the coverage year, your insurance provider will pay for your remaining covered expenses at no additional cost to you.
Universal coverage affects healthcare reform in several ways. According to CNN, the continuation of the ACA offers many Americans inexpensive or free access to many healthcare services, including contraception and preventive care. These expenses are shared by all insured, as mentioned above, which can translate into increased cost for individuals not using those services, per The Fiscal Times.
There’s also concern that given the option, younger and healthier individuals will choose not to buy insurance, which would increase costs for people who need more medical care. Universal coverage seeks to provide all Americans with the guarantee of a variety of healthcare options regardless of the cost.
Access vs. Coverage: The Bottom Line
Healthcare reform hinges on the answer to one basic question: Is healthcare a right or a market product? Republicans are using the word “access” to describe a consumer-driven model for healthcare. Access means that there are sufficient facilities and providers for everyone, but this approach enables individuals to decide how much they want to pay for health insurance and how much coverage they want. On the other side of the spectrum, Democrats use the phrase “universal coverage” to define healthcare as a right, which by definition demands a viable option for every individual. This approach uses government-dictated directives to ensure that healthcare is available to everyone. Which side Trump will land on remains to be seen.