Is the devil we know as US healthcare worse than the devil we do not know as US healthcare under the 2010 Patient Protection and Affordable Care Act (ACA)? Also, is the ACA intimately tied to whether or not to extend unemployment insurance benefits?

In her book Policy Paradox: The Art of Political Decision Making, Deborah Stone reviews different models of persuasion. Specifically, Stone observes that persuasion in the polis is divided into business and government persuasion. Stone’s description of business persuasion appears to be overtly powerful in that it: is dominated by capitalism, sponsors and manipulates public perception of scientific research, uses education materials and programs to develop support for policy positions, and owns and uses mass media to influence public opinion. Her description of government persuasion appears to be covertly powerful in that: citizens’ behaviors are influenced by lower-level bureaucrats using benefits and punishments, some policy purposefully attempts to shape citizens’ characters, newsworthy information can be slanted, information withheld, or publication forbidden. In light of the two types of persuasion Stone discusses, what we know with regard to the ACA and extending unemployment insurance benefits is identified through the lens of who is asking what question of whom, and when.

There are few areas regarding the US healthcare system and health insurance that which both business and government seem to agree. The US is identified as being the only developed nation to not have a universal health care system; however, the US government does spend more than double that of other developed countries on this issue. The most obvious differences between these other developed countries and the US regarding healthcare provision are demonstrated in the video, Sick Around the World. Those differences are discussed as being integral parts of universal healthcare: medical providers must charge standard prices to keep cost down; by law, everyone must buy health insurance, through an employer or community plan, for which a patient cannot be turned down for a pre-existing illness; insurance for the poor is subsidized; and perhaps the largest primary difference – in a universal health care system, insurance companies are restricted from making a profit on basic medical care.

Why does the debate on the US healthcare system matter now? In her Class Blog, Dr. Margaret Palmiter makes the observation that “unemployment and health care and poverty are totally and completely entwined.” This idea is demonstrated in the video, Sick Around America. The link between these concepts is shown to be the declining economy leading to high unemployment, whereby more people end up in poverty, with one result being lost health insurance. In the US, health insurance is a private system that has failed to provide coverage for 46 million people, leaves millions more underinsured due to rising insurance costs, exposes many to being medical bankruptcy risks, and in some cases, can lead to death. Extending health care coverage to those without is the idea behind many of the reforms established by the 2010 Patient Protection and Affordable Care Act. The primary goals of the ACA are to increase quality and affordability of health insurance. Lowering the rate of those uninsured is to be achieved by enlarging public and private insurance coverage and reducing the costs of healthcare for individuals and the government.

Is the ACA changing the health insurance situations for Americans? The answer is both yes and no because, as Deborah Stone observes, for everything that is included, something else is excluded. Those remaining uninsured are illegal immigrants ineligible for insurance subsidies and Medicaid. Also remaining uninsured are citizens not enrolled in Medicaid despite being eligible, citizens not otherwise covered and opting to pay the annual penalty, and citizens whose insurance coverage would cost more than 8% of household income and are exempt from paying the annual penalty. Additionally, remaining uninsured are poor minorities and single-mother citizens who live in one of 26 states, the ones with the most uninsured, opting out of the Medicaid expansion and who qualify for neither existing Medicaid coverage or subsidized coverage through the states’ insurance exchanges. Depending on the state of residence, this description includes citizens similar to those depicted in Jason DeParle’s book American Dream. The insured include children and dependents, as portrayed in Sick Around America, who can now remain on their parents’ plans until their 26th birthday. Others described in the video can now have access to health insurance as well, such as the man with the pre-existing condition, the woman needing a second surgery, and the Massachusetts family who could not afford the previously too-high premium rates. As observed in The Mental Anguish of the Long-term Unemployed article, many long-term unemployed can qualify for Medicaid or heavily subsidized health insurance that would include coverage for the comorbid conditions of declining mental health and addiction.

How are the ACA and extending unemployment insurance benefits tied together? The primary answer is well described in a comment to the article Should We Extend Unemployment Insurance – And Cut the Minimum Wage. As one reader comments: “They’re playing games with 2 million american lives over a childish tantrum rooted in obamacare [ACA]. So we’re all losing shelter, our vehicles (forget getting a job more than walking distance from your house now), and going on welfare and foodstamps because Republican children are throwing a very old tantrum.” This situation is also observable in Tampa, Florida where a Republican narrowly won a special congressional election that which prompted the Republicans to espouse that this showed that Obamacare would cost the Democrats the mid-term elections. However, these mid-term elections highlight the risks of congressmen voting against a government program extension of unemployment insurance benefits in states where the jobless rate is particularly high, such as Ohio and Illinois. Having lost on the issue of the ACA, the Republicans are using the possibility of not extending unemployment insurance benefits as a revenge tactic. This observation is further encapsulated in the article Jobless Benefits – The GOP’s Search for an Exit.

For many Americans, such as young adults and the long-term unemployed, healthcare stories are changing as access to health insurance becomes available. Is the existence of the ACA lowering the rate of the uninsured? The latest information regarding the ACA comes from a March 2014, Gallup-Healthways Well-Being survey. Their finding suggests that the uninsured rate has dropped by 2.8 % primarily among households making less than $36,000 per year.