On October 1, 2013, the US government enacted the Affordable Care Act, aka Obamacare. The controversial piece of legislation requires all uninsured Americans to purchase health coverage—with low-cost options available. Credited as a step towards universal healthcare and criticized for tightening the grasp of private companies on the American system, it is a large enough change to the continent’s health insurance landscape to warrant a comparison between the American and Canadian systems.
Obamacare is not limited by American geographical boundaries—Americans studying at U of T will be affected. Young adults can now retain the coverage provided by their parents’ health insurance plans until age 26, an obvious advantage for university graduates in today’s uneasy job market.
“This healthcare law will positively affect me and the many millions of Americans left to fend for themselves because of artificially expensive healthcare costs and the profit-above-people attitude of the current system of corporate health providers,” said Sean McAveley, fourth-year UofT political science student and Californian.
Comparing the US system to Ontario’s Health Insurance Plan (OHIP), McAveley commended Canada for its approach. “Perhaps that’s more of a testament to the barbaric healthcare system of my home country, the US, than to OHIP’s success.”
Obamacare’s out-of-pocket costs and premiums depend on income and family size, and no one can be turned away, pre-existing conditions or not. The kinds of insurance that companies can offer to their employees is also determined by Obamacare, with set penalties if they fail to meet the regulations.
The legislation was the source of Congressional friction responsible for the recent government shutdown. Republicans’ main argument is that Obamacare is a “job-killer,” a sentiment shared by Senator Ted Cruz (R-Texas) and House Leader John Boehner (R-Ohio).
The prospect of universal healthcare has a shaky history in American politics, with various ideological camps conflicted over the government’s role in ensuring every citizen has health coverage.
“President [Bill] Clinton came closest in bringing healthcare to the table [in the 1990s], but conservatives were very persuasive in their campaign to portray the proposed bill as anti-family and anti-business,” said Dr. Leandra Zarnow, Research Associate with the Centre for the Study of the United States at UofT.
Zarnow also described a criticism of Obamacare that came from a minority faction of the Democratic Party, namely that the Act doesn’t address universality, but rather that it “is a buy-in program complementary to privatized healthcare.”
Obamacare is unlike the Canadian system because it “relies almost entirely on an insurance scheme, rather than the single-payer set-up,” said Peter Loewen, Director for the Study of the United States and American Studies Program at UofT. “It doesn’t really approach universality and it maintains an exceedingly expensive healthcare system.”
Zarnow further highlighted the systematic differences between Obamacare and OHIP. “The law stops short of demonstrating that healthcare is a basic right—a position Americans historically have been reluctant to take.”
After being a beneficiary of both the Canadian and US healthcare systems, Zarnow is skeptical about the possibility of universal American healthcare. “I do not believe the United States will get to a system like OHIP anytime soon as there remains a stigma against government-run programs,” she said.
But Zarnow and Loewen both agree that Obamacare is a step in the right direction. It will cover a greater number of Americans with basic health insurance, and answer to a large population of citizens who have criticized the privatized system as being unjust and inequitable.