Health care and Social Security

The main social programs in the USA

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A learner's guide to discovering the United States

Obamacare in the USA since 2010

At the start of the 21st century, the United States stood out among developed nations, as being the one nation without a universal health care system. While there were  two federal programmes, Medicare and Medicaid, that provided care for millions of Americans who would otherwise have had no health cover, millions more Americans, for one reason or another, had either no health cover at all, or else only inadequate cover.
    To people in Europe or in Canada, and even Australia, the lack of universal health care in a country as rich and as powerful as the United States was largely incomprehensible. Still less understandable was why anyone would want to object to such as democratic principle as universal health care. In Britain, for example, politicians of all persuasions, even the most conservative of Conservatives often go out of their way to show support for  the National Health Service. In the USA, even in the twenty-twenties, there are still those who object to the idea of state intervention in health care.
    Yet at the start of the century, the absence of universal health cover in the USA was also incomprehensible to a considerable number of Americans, particularly to Democrats, who for years had been trying to move public opinion in this direction.
    In the end, it was Barack Obama who took the bold decision to bring the United States more into line with other developed nations, with the introduction of new measures popularly known as "Obamacare".


       The Patient Protection and Affordable Care Act (ACA) of 2010, which revolutionized health care in the USA, was one of the great achievements of the Barack Obama Presidency.
    Signed into law by President Obama on March 23, 2010, it expanded the role of the state in the field of health care. It brought affordable health care to some 30 million  previously uninsured Americans, improved the health care conditions of others, and established in the United States a state sponsored health system more in line with the public health care systems that already existed in virtually all other Western countries. Its aim was to considerably reduce the number of people in the USA, notably the poor and the aged, who until then had insufficient or no health care.  It did this by:
Anyone can find themselves in need of health care and medical insurance at any moment.
    Nevertheless, during his campaign for the Presidency in 2016, and in order to appeal to his voters on the far right, Donald Trump pledged to scrap the ACA, the whole idea of state sponsored social care being  rejected by neoconservatives. In the end, he did not scrap it, and was only able to make some small changes – opinion polls persistently showing that around 60% of Americans now approve of the ACA and want to keep it.
    Most interestingly, back in 2010 when the ACA came into law, only 39% of white voters were in favor of it, with 48% hostile.. By 2023, after Americans had had more than ten years to judge the benefits of an extended health care programme, attitudes among white American voters had changed significantly and in March 2023 54% of white Americans were favorable to ACA with only 45% unfavorable (source: KFF Independent Health Policy Research polling)..

Medicare and Medicaid


   There are two parts to Medicare: hospital insurance (also known as Part A) and medical insurance  (a.k.a. Part B). Generally, people over 65 benefiting from Social Security automatically qualify for Medicare too. So do people who have been getting disability benefits for two years. Others must file an application.
    Part A is paid for by a portion of the Social Security tax on people who are in work, and helps pay for hospital stays, nursing and other services. Part B is paid for  by monthly premiums of those who are enrolled in the program, and from general taxation. It helps pay for visits to the doctor, outpatient hospital visits and other genberal medical services and supplies.


This primary health care program pays for the basic medical costs of people on low incomes. It is financed jointly by the federal government and by the states, and  administered by states within federal guidelines. The number of people enrolled expanded considerably during and shortly after the Covid pandemic, and the program now covers around 90 million low-income people in the United States.  In 2023, Medicaid programs are facing new challenges and millions of Americans are at risk of losing all or part of their cover as some states  limit eligibility to the program or reduce the services covered.

Social Security:

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    Almost all people in the United States are enrolled in the Social Security system, which covers five categories: retirement pensions, disability payements, family benefits, payments to "survivors" (in the event of death), and Medicare.

    Generally speaking, people in work acquire one Social Security credit per quarter - 4  credits per year - and can qualify to recieve benefits once they have acquired 40 credits. Younger people need fewer credits to qualify for disability or survivors benefits.

    Social Security contributions are deducted for the pay of virtually all people in work, whether they work for an employer or they are self employed.
    Among the few exemptions are self-employed people people who earn less than $400 in the year, and non-immigrant aliens (people from other countries), in particular foreign students and researchers. Some religious groups are also exempt, as long as they provide alternative care for their members.

    Retirement benefits (a state pension) are paid to people over 65. Since social Security retirement benefits are based on lifetime earnings, the more people contribute, the more they eventually receive in old age. Some people may be eligible to receive reduced payments as from age 62, and people who stay in work beyond the age of 70 receive extra payments when they eventually retire. However with average Retirement benefits in the USA representing just 40% of earnings, retirees in the USA remain poorly off compared to those in many other developed countries, and Americans are encouraged to subscribe to other private pension schemes if they want to keep up their living standards after they retire.

Disability benefits can be paid to people at any age who have enough Social Security credits and who can no longer work on account of a physical or mental disability.

Family Benefits  These are limited to members of direct family of a person receiving retirement or disability benefits, notably to a spouse of at least 62 years old or caring for a child under age 16.

Survivors benefits may be paid to a widow(er) aged 60 or older, aged 50 or older if disabled, or to a survivor caring for a child under age 16.

For Medicare, see above.

For more background to the USA.....

Book / ebook     A Background to modern America -  people, places and events  that have played a significant role in the shaping of modern America. A C1-level Advanced English reader for speakers of other languages, and anyone wanting to  learn some of the background to today's USA.  Twenty-two texts, with vocabulary guides and exercises.

For California, discover About-California.com, a short guide for visitors.

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Health care for visitors and tourists to the USA

People visiting the USA as a tourist, even those with US citizenship, are very strongly advised to take out a travel health insurance policy to cover their stay/s in the USA. Medical costs in the USA can be very high, and even a simple visit to a doctor can cost typically between $100 and $200, and a day in hospital may well cost over $3,000.

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