When Congress approved the original Patient Protection and Affordable Care Act, 2010 (known as ACA or OBAMACARE) their aim was to-

  • Enable all American citizens to obtain the healthcare they need
  • Lower the costs of treatment and care for the individual
  • Ensure the quality and availability of treatment and care
  • Control the costs of the Medicare and Medicaid programs budget

IN 2010

The Medicare and Medicaid programs were forecast to exceed the total federal budget within a generation.

Emergency hospital treatment could cost $3000 or more.

Elective treatment such as a hip replacement could cost $ 12000.

Healthcare costs were the No. 1 cause of personal bankruptcy in the USA.

Unpaid medical bills were charged to an emergency Medicaid budget, thus contributing to the soaring costs shouldered by the public at large


Congress recognised the need to

  • spread the cost of healthcare over the lifetime of the individual and across the whole population
  • encourage the use of preventative treatment to avoid future chronic conditions
  • ensure that health programs deliver essential healthcare benefits
  • offer a choice of service levels and delivery options
  • provide for those not reasonably able to fully contribute to the program, e.g. dependent children, seniors and sufferers from certain chronic illnesses


Over 80% of American citizens are covered by health insurances either as individuals or as members of a group (usually as an employee).

The health insurance marketplace is regulated by the Department of Health and Human Services (DHSS) among others, but is the government ‘health insurance exchange’ (healthcare.com). There are other exchanges, state exchanges and private health insurance exchanges, none of whom can offer less favourable conditions than the government exchange but MAY offer a wider range of coverage and service level options.

This approach is intended to increase the competition in the health insurance marketplace without reducing the quality and availability of care.

The ‘exchanges’ create a marketplace for individuals and companies to choose health insurance providers offering competitive policies that meet the appropriate regulations.

It remains an option to deal directly with an insurer of choice ‘off exchange’ but they will not be able to offer premium tax relief or other state or federally funded benefits.


  • Evidence suggests that insured individuals and their dependents are taking advantage of the reduced costs of preventative care, especially for paediatric services, which include dental and vision coverage.  Critically they have more confidence in meeting unexpected medical expenses.
  • The exchanges allow all enquirers to compare insurance plans on an apples for apples basis and let you know if you are entitled to tax credits. All new plans must provide the same ten essential benefits (apples for apples!).
  • Under OBAMACARE more families benefit from Medicare and even families with four times the federal poverty level may be entitled to subsidies on monthly premiums and reduced co-payments and deductibles. (This varies from state to state. Check with your chosen exchange)


  • A significant number of people question the right of either Federal or State governments to legislate for individuals to have or for employers to subsidize health insurance coverage?
  • Similarly, people question why the government should subsidize families with incomes up to four times the national poverty level?


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 We may not have all the answers but we can point you in the right direction.