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
, 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
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
It did this by:
can find themselves in need of health care and medical insurance at any
- Requiring most adults who were not already not
covered by a health plan,
(whether provided by their employers or sponsored by the government) to
subscribe to a health insurance policy or face being fined.
- Providing tax credits for people and
households earning less than the official "poverty level" to subsidize
the payment of
- Expanding eligibility for Medicaid,
the federal health care
program for low-income people, to include people earning
up to 38% above the poverty line. However, because Medicaid is
administered by each state, some states, particularly in the south,
have still not yet done this.
- Putting an end to some of the practises of
health insurance companies, notably requiring them to provide coverage
to all applicants and to offer the same rates regardless of health
status or gender.
Thus health insurance companies in the USA can now no
loger refuse to cover a person because of an existing health problem -
a paradox which, in the past, left many of those with most
health cover unable to obtain it.
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
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
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.
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
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.
(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
pension schemes if they want to keep up their living standards after
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
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.
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.
, see above.
For more background to the USA.....
Book / ebook
Background to modern America
people, places and
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
today's USA. Twenty-two texts, with vocabulary guides and
For California, discover About-California.com
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