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The Future of Obamacare: Personal Change Still Needed

President Obama ran his first election for president on the premise of change, and with the passage of the Affordable Care Act (ACA), he achieved change.

While the ACA is a potentially good premise, poor execution, compounding taxes, employer responsibility, and the individual mandate only led to exactly what the business community and the insurance community knew would happen… a debacle; in fact, a multi-trillion-dollar debacle.[1]

At the end of January 2017, 12.2 million people have enrolled in plans through the Health Insurance Marketplace and state marketplaces.[2]  According to a January 2017 Gallup Healthways poll, approximately 10.9% of Americans remained uninsured in the fourth quarter of 2016.[3],[4]  In 2016, enrollment started out at 12.7 million as of March 31, 2016 and ended at 11.5 million people as of December 24, 2016, a 1.2-million enrollee decline.[5],[6]  The enrollment decline in 2015 was more significant, from 11.67 million to 8.78 million over the year.  Top reasons for the annual declines include: inability to verify citizenship or immigration status, perception of plans having little value due to extremely high deductibles, and dropping coverage after using services.[7]

The ACA had great ideas, including: no preexisting conditions, no lifetime limits, preventative care for free, young adults staying on their parents’ plan until age 26…but, someone must pay for these ideas.  There’s no such thing as free healthcare.

Changes to the health insurance business model didn’t work and continue not to work because they still haven’t hit the underlying cause for runaway health costs.  Yes, you can point to fraud, waste, and abuse, and the pharmaceutical industry, as it tries to pass off huge increases in costs.  These are all factors in the puzzle of affordable health care.

However, one fact the Affordable Care Act has not addressed is:  What is in the mirror?

If everyone in this country looked in the mirror, we would see, as Dr. Steven Aldana says, “the culprit and the cure.”[8]  To quote Walt Kelly, creator of Pogo, “We have met the enemy and he is us.”

What is the cure?  Sanity.

If we have the option to order as many McDonald’s Grand Macs, Starbucks Trenta drinks, 7-Eleven Big Gulps without limit, and if we expect insurance or social assistance will help us afford our poor lifestyle choices without consequences, then why change?  From the CDC: “Obesity is common, serious and costly,” and 70.7% of adults age 20 years and over are overweight (37.9% of whom are obese)![9]

Let’s go for 100%, ye nation of strivers!  We can get there!  It’s only 29.3 more percentage points; it’s doable!

Should we all be hooked up to a machine, take another pill, have another surgery?  How many dystopian movies and novels can you name with this as the end result of humanity?[10]

No, those extreme interventions are for the things about which we cannot do anything.  In America’s case, we can control our lifestyles and 75 percent of the cost of the healthcare that results. According to the Institute for HealthCare Consumerism as cited by National Association of Health Underwriters, lifestyle factors account for 70 percent of healthcare costs.[11]  Smoking alone costs employers $5,182 a year in healthcare costs and lost productivity.[12]  Type II diabetes can be managed and sometimes reversed with lifestyle interventions: diet, exercise, stress management.[13]

The election was a surprise to everyone, given the pre-election media coverage.  So now we have a trifecta:  a Republican House, Senate, and President.

Should Obamacare be repealed and replaced?  Every senator, congressional representative, business executive, and insurance wizard has their opinion on how to play with the minutiae of high-risk pools, age-rating, what parts of it to repeal, what parts of it to replace.  But guess what, people: all of that doesn’t make a bit of difference on $3.35 trillion per year in national healthcare expenses.[14]  We are the problem!

America needs health guidelines, beyond coverage, costs, and eligibility information.  If we’re going to insure hundreds of millions of people—through employer-sponsored insurance, the individual market, Medicare, Medicaid, and Tricare—then the rest is up to us!

Instead of looking at the Department of Veterans Affairs (VA) as this black hole, where you go to die or never be treated properly, what would happen if all healthcare in this country—military, government, private sector, social assistance—were driven off the same theory we in the health insurance industry call wellness or well-being?

Wellness is not just about the biggest loser.  You never want to lose 15 lbs.; you’ll just find it again, believe me, I know.  We need to elevate our society to become more aware and accountable citizens.  If I speed at 100 mph, I’m aware I’m disobeying the posted speed limit.  If I am caught by a police officer or a speed camera, I will be held accountable with traffic fines and raised car insurance premiums.  In the long run, if I am responsible and practice better driving behavior over time, my premium will eventually decrease.

We as a society need to change, to emphasize personal responsibility for our health.  Most geneticists say that genetics are not a death sentence nor a guarantee of a certain outcome, and lifestyle interventions can be helpful in mitigating risks.[15]  Runner and author Jim Fixx changed his lifestyle at age 35, the age his father had his first heart attack (before dying of another heart attack at age 43).  He cultivated an active and health-conscious lifestyle, stopped smoking, lost 61 pounds, and thus became healthier, and avoided some of his health risks, despite dying of a heart attack at age 52.  With today’s technology, he may have even lived longer.  Had he both changed his lifestyle and his insurance offered him a monitoring method, such as a bodyscan, he might have been able to detect and treat the arteriosclerosis that eventually killed him.  With a commitment to wellness and the proper tools and support, he could have been alive today, at the ripe old age of 85, teaching us more about the connection between health and exercise.[16],[17]

As President Obama declared eight years ago, the country needs change.  Eight years later, we still need change for our future, and to change ourselves positively.

Wellness, the set of ideas and practices employers and insurance companies are pushing, when done correctly for employees, is not about the biggest loser.  It’s about a lifestyle change: enjoying life; being physically active; not using food, alcohol, drugs, cigarettes as a crutch; and developing the mental resilience to maintain a healthy lifestyle.

Health insurance should be there for everyone, to pay for the unexpected.  When you’re morbidly obese and sedentary, and you don’t take care of yourself, then your medical expenses are not unexpected.  You have made them an expectation.  You do not have a right to create a million-dollar expense because you love food or are using it as a crutch.  If you decide to avail yourself of the super-sized options in this country, be prepared to not only pay for that super-sized food, but for your healthcare, because you have done it to yourself.  After the extremism of this last election cycle, there needs to be a balance in the United States moving forward.  The cure for this country’s health is not buried in the Affordable Care Act’s minutiae—fraud, waste, and abuse, high-risk pools, young invincibles.  How about we try on accountability for size?  It fits everyone: government, insurers, employers, and more importantly, citizens.


  1. Jeffrey H. Anderson., “CBO: Obamacare’s 10-Year Costs Will Now Eclipse $2 Trillion,” the Weekly Standard, February 5, 2014, http://www.weeklystandard.com/cbo-obamacares-10-year-costs-will-now-eclipse-2-trillion/article/778723
  2. Amy Goldstein, “HealthCare.gov suffers first enrollment decline as GOP works to kill the ACA,” The Washington Post, February 3, 2017, https://www.washingtonpost.com/national/health-science/healthcaregov-suffers-first-enrollment-decline-ever-as-gop-works-to-kill-the-aca/2017/02/03/941e0e3a-ea2d-11e6-bf6f-301b6b443624_story.html?utm_term=.dd1d2bd1ca25
  3. Zac Auter, “US Uninsured Rate Holds at Low of 10.9% in Fourth Quarter,” Gallup, January 9, 2017, http://www.gallup.com/poll/201641/uninsured-rate-holds-low-fourth-quarter.aspx
  4. Ricardo Alonso-Zaldivar and Kevin S. Vineys, “With health law in jeopardy, more than 12M still sign up,” Associated Press, February 9, 2017, http://hosted2.ap.org/APDEFAULT/bbd825583c8542898e6fa7d440b9febc/Article_2017-02-09-US–Health%20Overhaul-Sign-ups/id-f4721fb5e46d4e60895708b7be3eb89c
  5. Larry Levitt, Gary Claxton, Anthony Damioco, Cynthia Cox, “Assessing ACA Marketplace Enrollment,” KFF.org, March 4, 2016, http://kff.org/health-reform/issue-brief/assessing-aca-marketplace-enrollment/
  6. “Interactive Maps: Estimates of Enrollment in ACA Marketplace and Medicaid Expansion,” KFF.org, January 10, 2017, http://kff.org/interactive/interactive-maps-estimates-of-enrollment-in-aca-marketplaces-and-medicaid-expansion/
  7. Brian Blase, “Obamacare Losing Enrollees: Exchange Enrollment Drops By Over 1.1 Million In Last Half of 2015,” Forbes, March 14, 2016, http://www.forbes.com/sites/theapothecary/2016/03/14/obamacare-losing-enrollees-exchange-enrollment-drops-by-over-1-1-million-in-last-half-of-2015/#1155bc629abf
  8. Steven Aldana, The Culprit and The Cure: Why Lifestyle is the Culprit behind America’s Poor Health (Mapleton: Maple Mountain Press, 2004).
  9. “Obesity and Overweight,” National Center for Health Statistics, Centers for Disease Control and Prevention, June 13, 2016, http://www.cdc.gov/nchs/fastats/obesity-overweight.htm
  10. “Wall-E Hoverchair,” Sci-Fi Interfaces, https://scifiinterfaces.files.wordpress.com/2014/01/walle-hoverchair05.jpg
  11. “Healthcare Cost Drivers White Paper,” National Association of Health Underwriters, June 2015, http://www.nahu.org/legislative/policydocuments/NAHUWhitePaperCost.pdf
  12. Ibid.
  13. Sonya Collins, “Can You Reverse Type 2 Diabetes?” WebMD, http://www.webmd.com/diabetes/type-2-diabetes-guide/reversing-type-2-diabetes#1
  14. Tribune news services, “New peak for U.S. health care spending: $10,345 per person,” Chicago Tribune, July 14, 2016, http://www.chicagotribune.com/business/ct-health-care-spending-20160714-story.html
  15. Gina Kolata, “Genetic Heart Disease Risk Eased by Healthy Habits, Study Finds,” The New York Times, November 13, 2016, http://www.nytimes.com/2016/11/14/health/genetic-heart-disease-risk-eased-by-healthy-habits-study-finds.html?_r=0
  16. Jane Gross, “James F. Fixx Dies Jogging; Author on Running was 52,” The New York Times, July 22, 1984, http://www.nytimes.com/1984/07/22/obituaries/james-f-fixx-dies-jogging-author-on-running-was-52.html
  17. Lawrence K. Altman, M.D., “The Doctor’s World; James Fixx: The Enigma of Heart Disease,” The New York Times, July 24, 1984, http://www.nytimes.com/1984/07/24/science/the-doctor-s-world-james-fixx-the-enigma-of-heart-disease.html?pagewanted=all

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