Large and Small Businesses Under Obamacare

The Affordable Care Act has contradicting rules regarding business regulation, and it’s negatively affecting business owners. On January 1st, 2016, Obamacare had changed its rules and enforced insurance challenges on business owners and employees. Stressful situations resulted due to a mandate to change business insurance plans, which confused many owners, and eventually affected the employees. A lack of communication between employers and employees have occurred due to a misinterpretation of assurance statue. This miscommunication put a damper on a practical and constructive work environment, which lead to further issues and harmed the flow of productivity. Insurance coverage, for example, is an important coverage that employees could have. If coverage is restricted due to expensive fees and unregulated changes then employees would not be able to afford the alteration.

According to the USC Annenberg School of Communication and Journalism the Affordable Care Act has many different definitions of small businesses, and they are inconsistent with one another. This is a big issue for those in the work force. Currently, the Obamacare-related changes will define small businesses as those with up to 100 full-time employees, 50 more than the previous number. By being classified as a small business, rather than a large business, employers must offer health insurance that complies with a different set of Obamacare rules. As a result, most of these employers will need to buy new insurance plans. Under the new rules, insurance plans contain standard designs such as bronze, silver, gold, and platinum coverage tiers. Employers are also required to limit how much more insurers charge older workers than younger ones. If businesses have an older, sicker workforce, premiums will decrease. Conversely, if businesses have a younger, healthier workforce, premiums will increase.

Furthermore, Obamacare requires big businesses to provide affordable health coverage to their employees or they will face financial penalties. Yikes!

According to the New York Times, Paul Krugman commented on the the Obama administration and its health reform with an interesting twist:

“The details have been something of a surprise: fewer people than expected signing up on the exchanges, but fewer employers than expected dropping coverage, and more people signing up for Medicaid — which means, incidentally, that Obamacare is looking much more like a single-payer system than anyone seems to realize. But the point is that reform has indeed delivered the big improvements in coverage it promised, and has done so at lower cost than expected.”
– Paul Krugman

Essentially, Obamacare is providing coverage to businesses who are complaining about its changes. Perhaps it is a blessing in disguise, especially due to the low drop rates.

Thanks for reading. ~Angelina

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Understanding the ACA Rollout

It seems like the Affordable Care Act, or Obamacare, was signed not too long ago. Yet, it has been six years since the implementation of this program.

Obama took office in 2008 and proposed his new idea not too long after. Why, then, has it taken so long for his idea to be implemented into office? Some of the reasons are political and others are technical, but all point to a mix of presidential over-promising, political opposition, and the secret contracting process used by the govenrment to choose which company got the job of making a website for enrollment. The website would be so big and complex in size that many would have issues with it. And that is exactly what happened.

Firstly, the health care reform was signed in 2010, yet starting up the program intended to expand health coverage to tens of millions had been failing. Waiting for the system to come into full operation had made it vulnerable to negative reaction. Check this video out to understand the woes of the website that was supposed to get the job done correctly.


In an instance, Obama refuted all the negativity by commenting: “It’s time for folks to stop rooting for its failure, because hard working middle-class families are rooting for it success.” We agree with you Obama!

Secondly, major problems with logging in as a result of multiple contractors developing different aspects of the system, created a sloppy website. The lack of compatibility between the contractors gave way to a flaunted website, which could have been prevented had they selected compatible workers. Thus, the federal procurement process failed. Obama then brought in outside workers, which he named the “tech surge.” The techs would try to fix the website issues. However, not before the Republican National Committee challenged the government “tech surge” by stating that it was a code for spending millions of un-budgeted taxpayer dollars. Of course they were wrong.

Thirdly, big start-ups always have problems when starting out.

Who wouldn’t have expected that Obamacare would occur without some glitches? Apparently, the larger-than-expected number of website visitors did not seem to expect so. In addition, insurance companies that provided coverage said that they were getting incomplete customer information and duplicate applications from the system. Of the 48 million uninsured at that time, only a small fraction managed to sign up for Obamacare.

Lastly, the good ole’ GOP attacking Obamacare is not a surprise. What we’re trying to say is: what else would the Republican party do? The Conservatives believed Obamacare to be a big example of big government overreach, knowing that the policy would boost Democratic support from those who would be able to purchase health insurance for the first time. The Republicans tried their hardest to derail Obamacare before the individual mandate to purchase health insurance closed. However, their efforts backfired.

When the Republican party began to claim that health care reform meant higher premiums, noting that some employers had changed or dropped providers as a result, the attacks on Obamacare began to worsen. Soon threats of a government shutdown began to escalate as the Republicans added demands to defund Obamacare to a spending plan. The plan fell through when Obama rejected the defunding. Obviously, the GOP were to blame.

We hope you got an idea on what went wrong with the Obamacare rollout.

Here’s a final quote from Former Secretary of Health and Human Services Kathleen Sebelius on what we agreed would be a good closing statement for this week’s post:


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“Could we have used more time and testing? You bet. I’ve said that from the start. But the site actually works. And the great thing is, there’s a market behind the site that works even better. People have competitive choices and real information for the first time ever in this insurance market.”


                           Thank you for reading.  Signing off for the week, Angelina.

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Criticizing the Affordable Care Act

For many years millions of Americans endured a very poor quality of health. This is due to the fact that most citizens of this country were either uninsured or under-insured. The prospects for poor Americans changed on March 23, 2010 when the Affordable Care Act (ACA) was signed into law by President Obama.

The implementation of the ACA meant that tens of millions of Americans who were once uninsured, are now be able to gain access to quality health care, and can now enjoy better health outcomes.

The fact that the ACA guarantees access to quality health care, does not mean that there are no controversies surrounding its implementation. Even though the ACA will afford over 47 million women access to health care, there is still an issue regarding the coverage of contraception, as well as coverage for abortions.  These are much debated topics when it comes to women’s health issues. However the ACA does include clauses that will allow breastfeeding mothers to breastfeed in public without being arrested or ticketed. It also urges employers to allow breastfeeding mothers time to pump and store breastmilk. However, not every state has enacted the breastfeeding law.


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While over 8 million senior citizens have enjoyed steep cuts in their Medicare premiums, seniors earning eighty-five thousand dollars ($85,000) annually have seen increases in the cost of their Medicare premiums. Assisted care facilities that provide care for seniors, along with their hospital partners will be penalized if residents receive substandard care, or if a resident was hospitalized and had to be readmitted to the hospital. The Affordable Care Act has also created the “family affordability glitch.” This means that families with employee funded insurance plans may find it easier or cheaper to insure their employees but very expensive to insure the dependents of those employees.

Hospitals and doctors have been forced to find new and innovative ways to treat patients since the implementation of the Affordable Care Act. If too many patients who have suffered from a serious illness such as a heart attack, stroke, or bout of pneumonia, return to the hospital within 30 days, this can cause the federal government to withhold Medicare payments to that institution. In order to avoid a financial hit, hospitals are now placing emphasis on reducing complications due to infections. They are also providing follow-up care with the patients to ensure that their prescriptions have been filled and that patients are taking their medications in a timely manner, as well as making sure that patients keep their follow-up appointments.

The new payment regulations have forced hospitals (such as Mount Sinai, Beth Israel, St. Luke’s-Roosevelt, and New York Eye and Ear Infirmary) to merge, because they found it difficult to operate on their own. Thus creating the Mount Sinai Group Inc. Institutions such as The University Hospital of Brooklyn, Maimonides Hospital, and New York Methodist have all created out-patient clinics and urgent care centers in order to boost their revenue.


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Doctors will see an increase in new patients (who are covered under the ACA) as those patients begin to have their annual physicals. This is good for the patients, as well as the overall health of the nation, because physicians will be able to detect any health problems before they become too advanced. Dentists will also see an increase in younger patients because the plan covers pediatric care, although adults will not be covered initially.

Physicians will also be required to ditch their handwritten files and upgrade to electronic medical records which offer financial incentives to physicians. The downside is that it is expensive to adapt the electronic filing system. This has forced some older physicians into retirement. Pediatricians will see an increase in well-baby visits, since immunizations and developmental screenings are free under the ACA.

It is better that Americans are insured because it guarantees more positive health outcomes for our citizens, rather than having an uninsured nation of unhealthy people.

Signing off for the week, Rozanne. 

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India: What the U.S. Should Learn About Healthcare

So, what should the U.S. learn about healthcare from India? The short answer is: A LOT!

While it’s often worthwhile to compare national statistics of health outcomes, in the case of India, it is such an enormous and diverse country, that I think we’ll benefit more by looking directly at the most ground-breaking innovations. Some of these innovations come in the form of technologies, while others are procedural and logistical.

First and foremost, I’d like to highlight the Swasthya Slate.

Although it might not look like much, what makes it so amazing is a combination of: the wide array of medical tests the devices are capable of performing; the ultra-low cost of the device; and the interface, which is designed for minimally-trained medical professionals to rapidly and intuitively master. It’s actually user-friendly, all in an easy to carry pack. It’s essentially a $10,000 medical laboratory in a briefcase; except for the fact that it only costs $600. The creator, Kanav Kahol, left Arizona State University to pursue a solution to common medical care problems that the medical industry wasn’t addressing due to the lack of profitability of such a device.

Let’s take a quick break and watch this video of the Swasthya Slate in action.


Of course now you may be asking, ‘Why can’t this be rolled out across the U.S.?’ It’d be especially great for the millions of uninsured Americans. Well, there’s really no good reason why not. But there is a reason why not; and that has to do with the FDA. According to the Director of Research at the Center for Entrepreneurship and Research Commercialization at the Pratt School of Engineering, Vivek Wadhwa: “The Swasthya Slate is not FDA-approved and may never be. The bureaucracy and time delays for testing sensor-based medical devices often discourage medical innovation in the U.S. Instead, the device will have been tested by tens of millions of people abroad before finding its way to the U.S. The results and data will speak for themselves.”

So now that we’ve spent a little time focusing on a key example of India’s technological innovations let’s dive into a few interesting numbers about India’s healthcare system in general. Much like how cell phone technology in Africa was able to leapfrog land line technology, because of the lack of existing infrastructure, India’s healthcare system is able to innovate and advanced rapidly with little interference from entrenched institutions like Big Pharma or overly stringent governmental oversight.

Harvard Business Review studied prices in India and found some jaw dropping numbers. They found that India’s “charges for most procedures are as much as 95% lower than those at U.S. hospitals. That is not because the Indian providers offer low-quality services”. In their attempt to understand the vast price differential, they of course mention that doctors and hospital staff get paid considerably less than their U.S. counterparts, but even with the labor cost difference factored in “the cost was still  only 4% to 18% of a comparable procedure in a U.S. hospital”. Part of the explanation for the low cost is the hub-and-spoke geography of where clinics and hospitals are located, enables high quality medical care to be delivered at an extremely low cost by having the most expensive medical equipment located strategically and being fully utilized, sometimes even “charging lower prices at night when the machines would normally be idle, as an incentive to patients to get scans done at inconvenient times”.

If you’re wondering whether the quality of care is affected by all this streamlining, it is, but not adversely. In fact often times India has much higher operation success rates by “developing and continually updating treatment protocols that reduce errors. Unlike many U.S. hospitals, the Indian health care providers have developed protocols for even relatively complex procedures” as well as assigning risk classes to patients in order to know when to take extra precautions with a particularly vulnerable patient. The results are staggering: “data suggest that one in 200 angioplasty patients in the U.S. will require emergency surgery and half of those patients will die, only two out of 40,000 angioplasty patients at [the Indian hospital group] required emergency surgery and just one has died on the operating table since the hospital’s inception in 1997.”

So, if that doesn’t pique your interest in India as a source for innovation that could be beneficial to the U.S. I don’t know what will. If it did pique your interest, here’s some further reading:

TEDMED Live Talk by Dr. Kanav Kahol.

Washington Post article – What New Delhi’s free clinics can teach America about fixing its broken healthcare system.

Venture Beat Article – This Indian startup could disrupt health care with an affordable diagnostic machine.

Signing off for the week, Adam. 

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Singapore: More Efficient than the U.S.?

Want to hear something surprising?  According to the Bloomberg Best and Worst, in 2014 Singapore pulled out on top, ranked as the country with the most efficient health care. This quickly caught our attention! So that’s why we have decided to further explore it.

As you can see in this graphic (created by the BBC using statistics from the OECD and WHO) Singapore surpasses the U.K., U.S., and the France in efforts to spend less in health expenditure, outside of contributions by the private sector. It also has the lowest rates of infant mortality, when compared to the U.K., France, and the U.S.


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Let’s talk about how & why Singapore remains at the top of these rankings when compared to the U.S. What can we learn from Singapore so we can begin to advocate for adaptation or implementation of it, here in the U.S.?

When we look at Singapore, in comparison to the U.S., stark differences are apparent in the percentage of the GDP spent on healthcare. Singapore has one of the lowest percentages (at 4.5 percent) meanwhile the U.S. has an alarming 17.2 percent, which is by far the highest when compared to the other 50 countries listed in Bloomberg’s Best & Worst. The efficiency values were determined by tracking factors which include the cost of health care as a percent of GDP, total medical expenditure, and life expectancy, as described further in Bloomberg article.

Looking through this analysis, we were intrigued by the fact that this Bloomberg evaluation of health efficiency only took into consideration nations who met the criteria of having a population of least 5 million, a GDP that exceeds $5000, and an overall life expectancy over 70 years within this evaluation. This Bloomberg evaluation ranked countries after having had weighed life expectancy at 60%, followed by relative per capita healthcare costs of 30%, and with absolute per capita cost of health care at 10%.

So what is this high performing healthcare system called? The health system that is instituted in Singapore is known as the Ministry of Health.  In a publication by the Harvard School of Public Health (HSPH), the president of ACCESS Health international, Haseltine, mentioned “that Singapore’s emphasis on ‘social harmony’—on ensuring that everything in society works well and smoothly—is a key factor in that nation’s health care achievements”.

In addition, Ashish Jha, a faculty speak for HSPH stated that “Singapore is tiny in comparison, with roughly the same size population as Massachusetts, and its government intervenes in the economy and society much more so than the U.S. government”. We also found it interesting to learn that Singaporeans are required to have a health savings plan, known as Medisave, which resembles the 401 K retirement savings plan in the U.S.

As described in publication by the Harvard School of Public Health, the Singaporean government sets both policies and prices for private insurance companies, as the health care costs for services and procedures must be completely transparent. Moreover, unlike the U.S. system, in Singapore the government invests heavily in medical education. Haseltine also goes on to describe further differences by claiming that the Central Provident Fund is a massive social and health stabilizer.

It is important to recognize that the efficiency of the health system in Singapore is dependent upon the emphasis of the individual’s responsibility for their own health expenditure. As this story by Liberate Healthcare points out, Singapore is known for having low individual tax rates because the nation does not depend on higher taxation revenue to fund their public health expenditure. Singapore’s health system is based on a combination of government subsidies (through taxation) and individual responsibility. The government assists individuals in meeting their personal medical expenses with the implementation of Medisave, Medishield and Medifund, which combines individual responsibility with government funding to provide a safety net which helps to support the health needs of low income earners and poorer individuals.


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So as we can see, Singapore has found a unique balance between universal and privatized health care within a free market system. The U.S. could benefit greatly by incorporating some of these efficiencies into the Affordable Care Act’s framework.

Signing off for the week, Jen.

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United States Vs. Australia

Welcome back to the CHC3 blog, as we hope you had a wonderful and productive week. Today’s post will be discussing and comparing healthcare policies within two countries: the U.S. and Australia.

Why Australia, you may ask? Well because it is a continent on the other side of the world that is usually not compared financially or legislatively with the U.S., and it is also inhabited by kangaroos and small, exotic creatures you normally would not find in other parts of the world. Otherwise, Australia has not been negatively involved in any political drama recently, making it somewhat discreet. Don’t you agree?

While senior citizens of the U.S. can obtain a governmental insurance policy known as Medicare, all citizens of Australia are entitled to obtain publicly available insurance.

While Medicare is an optional governmental insurance policy for senior citizens in the United States, in Australia that same insurance is publicly available to all. Yes, we know that sounds outrageously civil. It is completely bonkers, but in a good way.

Furthermore, Australia issues a whopping 1% tax, but only to its citizens who fall above a certain income level and still choose to use the public system. Taxation is leveled due to the very low death rates from medical care conditions. This allows the Australian government to pay for healthcare, and the people have dental, medical, and surgical coverage. Sadly, the U.S. has a 50% higher death rate than Australia, and the government is hardly paying for healthcare out of pocketAs we know, the largest portion of U.S. tax dollars goes towards healthcare spending.

Australia’s health system is not perfect, but performs better than many international countries. According to this infographAustralia spends very little on healthcare compared to the United States, who spends almost twice the amount. Household out-of-pocket spending averages to about $771 yearly in Australia, while in the U.S. it averages $1045 yearly. Finally, the average life expectancy for Aussies is 82.1 years, while the average life expectancy for U.S. citizens is 78.7 years.


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How does Australia stand in comparison to other countries when comparing GDP? The answer is, pretty well. 

Check this chart out:

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Australia is on the right side of the pink line, which means that their life expectancy is above average. Their gross domestic product is low when compared to the U.S. In addition, as mentioned in last week’s post, the U.S. spends a lot of money on healthcare, yet has poorer outcomes. Thus, we hope that one day the U.S. will pull out of its declining health outcomes and bounce back to virtuosity.

Signing off for the week, Angelina.

Header Image Credit: Australia

Header Image Credit: U.S.

U.S. Healthcare

Welcome back to the CHC3 blog! We hope you are well informed about our platform as we continue sharing more factual information about healthcare with you.
During this this week’s post we will be touring the United States healthcare system. Our post will initially include the positive and negative aspects of the system, and later dissect and evaluate our current president’s healthcare initiative named Obamacare.

A nation’s health is only as good as the health of its people. Here in the United States of America (USA) one’s health outcome is often determined by their socioeconomic status, race, gender, and environment. The more affluent members of society are more able to gain access to the best hospitals, doctors, and specialists, resulting in better health outcomes. Unfortunately, there are approximately thirty-two million people who do not have access to the best healthcare coverage. This portion of citizens decease from preventable health conditions due to the lack of their ability to gain access to appropriate care. This has created a human rights crisis in the USA as the market-based health care system makes little to no providence for people of lower socioeconomic standing.

It is amazing that the USA spends a fifth of its gross domestic product (GDP) on healthcare and pharmaceuticals, yet a positive health outcome for Americans are lower than that of people from the Netherlands, France, Germany, Canada and Switzerland.


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Americans are also more likely to die from treatable diseases such as asthma than citizens of third world countries such as Costa Rica and Brazil, even though the disease or condition has the same prevalence rate as the US. Studies show that uninsured Americans are more inclined to die from asthma than those with insurance coverage. This is due to the constant increment in the price of asthma medication. Compared to Greece, the price of an asthma inhaler is approximately 18 times more. Other life-saving drugs such as Gleevec, which is used to fight cancer, costs $1,000 in Canada but costs more than $6,000 in America. Babies born in the US are less likely to survive infancy compared to those who are born in other developed countries such as Japan, Sweden, and Germany. The US ranks 29th in infant mortality worldwide yet it costs an American family more than $10,000 to have a normal delivery and more than $17,000 for a C-section.

Here are some facts that we feel suggests that the healthcare system in the U.S. will benefit from reform:

Currently –

  1. Americans are more likely to die from treatable diseases than citizens from Costa Rica, Brazil, and other third world nations also suffer from.. These diseases and health conditions have the same prevalence rates.
  2. Uninsured Americans are more likely to die from asthma than those who have insurance coverage.
  3. The price of an asthma inhaler in the U.S. is 18 times more expensive than the price in Greece.
  4. Gleevec, a life-saving cancer drug, costs merely $1000 in Canada, yet is costs more than $6000 in the U.S.
  5. Babies born in other developed nations including Japan, Sweden, and Germany are more likely to survive infancy than babies in the U.S.
  6. The U.S. ranks 29th in infant mortality worldwide, yet it costs an American family more than $10,000 to have a normal delivery and more than $17,000 for a C-section.

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With the high cost of health care and poor health outcomes, many presidents have tried to implement a Universal Health Care (UHC) program. Due to the fact that a UHC program will infringe on the mega insurance industry’s ability to make an enormous profit, there has always been a strong opposition to the establishment of such programs. In efforts to provide healthcare to every American, Obama implemented the Affordable Care Act (ACA).

Also known as Obamacare, this system enables Americans to have access to better health care and health outcomes. Today, more Americans have health insurance which guarantees them medical, dental and optical coverage, as well as hospitalization. Since the implementation of the program, about 40 percent of uninsured individuals, including young Americans ages 19 to 25, are now insured. However, the ACA did not serve to mitigate the profit-earning mentality of the healthcare industry. Thus, the healthcare industry still operates at approximately three trillion dollars, leaving the American population in a ceaseless fight against the industry, as it ultimately denies the population the universal right to health.

Signing off for the week, Rozanne. 

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