Carolyn Engelhard, who is the director of the Health Policy Program in the Department of Public Health Sciences at the University of Virginia School of Medicine, spoke at our March 8, 2017 meeting.   She identified the promises and pitfalls of ObamaCare including the winners and losers over the last six years. The post 2016 election polls were discussed, and the “you break it you own it” politics of the current debate over repeal, replace, repair and delay.  The program was moderated by SSV Vice President Rich DeMong.  A podcast of the meeting is below along with a PDF of her excellent PowerPoint.

Professor Engelhard’s academic activities include analyzing and monitoring changes in health policy at the federal and state governmental levels and teaching in both the Graduate School of Arts and Sciences and the School of Medicine. Ms. Engelhard received her B.A. in Sociology from the University of St. Thomas, Houston, TX, and her M.P.A., Public Administration, from the University of Virginia.

Ms. Engelhard co-authored a book looking at the myths surrounding the U.S. health care system, completed a national project in conjunction with the nonpartisan Urban Institute examining the use of public policies to reduce obesity, and contributed a textbook chapter examining the effect of the new law on health care organizations.

Professor Engelhard co-directs a national webinar featuring health policy experts and students across four universities each spring, and she is a contributing health policy expert for the web-based news journal, TheHill.com.

Program Summary

“ObamaCare,” the Affordable Care Act, originally came to be to address gaps in traditional health coverage. Historically, the majority of the those not elderly in the U.S. received health insurance as a job benefit. The private non-group market charged higher premiums based on medical history and often excluded specific conditions like maternity care or cancer. In 2008, 29% of individuals 60 to 64 who applied for non-group insurance were denied coverage based on health status.

The number of non-elderly uninsured Americans reached 49.1 million in 2010, amidst rising unemployment rates and a struggling economy. The steady decline in employer-sponsored health coverage since 2000 largely explained the growing numbers of uninsured.

Conclusion: BACK TO THE FUTURE: competing philosophies as to the fundamental nature and purpose of health insurance.

The traditional Democratic philosophy favors a comprehensive medical payment structure with government subsidies to encourage preventive care and to protect against financial exposure to high medical costs due to illness.

The traditional Republican philosophy favors a market-based traditional insurance structure, with high deductibles, catastrophic protection, and routine costs paid out of pocket. Relying on taxpayer-subsidized health care for others is anathema to Republicans.

In many ways, ObamaCare has become the “new normal.” The political battle now is WHO will pay to help keep Americans insured and HOW it will be paid.