Cause And Effect Essay On Obamacare

By Dan Gorenstein

January 06, 2016 | 6:50 AM

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Nearly a year ago, the CEO of the parent company that owns Carl's Jr. and Hardee's made a significant claim.

“Obamacare," said Andy Puzder, “has caused millions of full-time jobs to become part-time.”

It’s just one of many bold predictions that the health care reform law would lead to employers reducing workers’ hours to avoid the costs of providing insurance to their workers.  

Yet, a new report in the journal Health Affairs finds little evidence that the health care law is pushing people out of full-time work.

In 2015, companies with 100 or more employees had to start offering coverage to anyone working at least 30 hours — or face fines.

Given that, if there ever was a year to see a spike in part-time work it was last year.

“Whatever changes that have happened has been really small,” said Kosali Simon, a co-author of the report and a professor at Indiana University’s School of Public and Environmental Affairs.  

When Simon says “small,” she says the data suggest about 250,000 older workers, as well as less-educated ones, moved from full-time to part-time over the last two years.

That’s out of some 50 million workers in those two categories.

The Urban Institute’s Bowen Garrett has also studied Obamacare’s impact on employment.

“We still need to know more about whether that’s really an effect of the ACA or if that is due to the economic recovery,” he said. “That could be causing some of these shifts.”

Garrett said this paper should put to rest a lot of the bombastic rhetoric we’ve all heard about the ACA driving us to become a nation of part-time workers.

And it makes the case for more research about what’s happening to those vulnerable workers at the margins.

Follow Dan Gorenstein at @dmgorenstein. 

Repealing and replacing Obamacare was one of the rallying points for President Trump’s presidential campaign, but has proven to be difficult even with a Republican-controlled Congress.  There are a number of reasons that repeal and replace has been difficult, even though the Affordable Care Act (the ACA) was, at best, an imperfect solution to the modern healthcare crises.  Public support for repealing Obamacare has lessened as people have become aware that Obamacare and the ACA are the same thing.  Republicans have not been able to develop a plan that would provide better care for the American people without having an individual mandate.  Finally, the for-profit medical structure currently in the United States makes it difficult, if not impossible, to provide significant reform.  These barriers make it seem unlikely that Obamacare will be repealed or replaced in the near future.

Perhaps the most significant barrier to repeal and replace is the fact that support for repeal and replace was based, in part, on people not understanding Obamacare.  A large segment of the voting population that supported repeal and replace did not understand that Obamacare and the ACA were the same program.  In addition, even those who did understand they were the same may not have realized that some of the insurance benefits they received were due to the ACA.  When people began to realize what benefits they would lose if the ACA was repealed, popular support for repeal began to wane (Pramuck, 2017).  It became clear that the voters would not settle for simply replacing Obamacare, but were demanding a better replacement.

However, crafting a better replacement was more challenging than many Republicans initially realized.  One of the most significant ways that Obamacare improved health care access in the United States was by greatly expanding the pool of Medicaid-eligible people.  Attempts to reduce those numbers would result in millions of people losing their health coverage.  In addition, the health savings accounts that the replacement plans suggested as an alternative to health insurance would not realistically be large enough to see a person through even a minor medical issue.  One of the problems is that the replacement bills wanted to eliminate the individual mandate.  However, a viable replacement would have to expand coverage and make coverage more affordable for people, which is not possible under the current healthcare system without an individual mandate pulling healthy people into the system.

Finally, the replacement efforts have not addressed the underlying issue of having a for-profit medical structure.  The actual costs for medical treatments in the United States are significantly higher than for similar treatments in other countries.  This is not due to inflated doctor or nurse salaries, but to profits to for-profit medical groups.  In addition, Obamacare does not address this issue, but forces more people into the for-profit health insurance market.  The only way to make healthcare more affordable in the United States is to address the underlying price inflation in the healthcare market.  This could be done in a number of ways, including regulation or a single-payer system.  However, lobbyists from the healthcare industry have effectively blocked Congress from seriously developing those options.

Although healthcare in the United States remains prohibitively expensive for many people, repealing and replacing Obamacare will only be successful if the replacement can provide more affordable healthcare for a greater number of people than the existing options.  To do this, Congress needs to understand that most of the public does not support repealing the ACA without having a better replacement.  They also need to understand that a better replacement that does not include an individual mandate must look at some radical solutions.  These radical solutions may include looking at the for-profit medical structure and considering regulations or a single-payer system.  Without considering these changes, it seems unlikely that there will ever be sufficient support for any repeal-and-replace plan.


Pramuck, J.  (2017, Jul 18).  GOP’s Obamacare repeal-only push quickly collapses.  CNBC. Retrieved from


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