On our monthly catch-up with legal counsel Elias Fillas of Sacco and Fillas LLP, we addressed crucial concerns regarding our healthcare system and some of the challenges that stand between Americans and their right to affordable, quality, universal health coverage.

GMA: The Affordable Care Act under Obama was supposed to solve the issue of affordable health insurance for all Americans. Premiums under the ACA are still astronomical for medical class earners. Do you think the ACA has fulfilled its promise?

EF: The success of the Affordable Care Act is not black and white. In some ways, it has helped close certain gaps. However, it still has not solved some of the significant problems of insurance. Health care remains unaffordable for many in the middle class who are left in limbo, not qualifying for Medicaid or Federal subsidies to afford individual policies. Further, most plans have deductibles, meaning an amount the patient needs to pay before coverage kicks in. The ACA has allowed insurance companies to set higher deductibles versus those Americans can get through health insurance at work. Many have found it frustrating that they now have health insurance but can still not afford to see a doctor due to the deductible. One thing the ACA was supposed to implement was the lowering of health care costs, however overall, as stated by Bob Kocher, a former health policy adviser to President Obama, “The biggest problem is that health care costs have grown relentlessly.”

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GMA: I often hear people saying they need a higher degree of education just to understand what their insurance coverage is about. How do we make it easier for people to navigate their way through a complicated infrastructure of health coverage?

EF: The American healthcare system is complex and emphasizes intervention rather than prevention. As of 2020, 52% of US consumers have low health care literacy. The best way to tackle this is to make the information more accessible and written for the average user.  Specifically, insurance companies should provide what is covered in writing and provide courses for people to take like you would for understanding mortgage options. Currently, there is also a movement for the cost of treatments to be presented up front and not billed at a later date. For example, answering the questions of where I can receive care and what my plan covers are instrumental to understanding what plan is best and when it can be used.

GMA: What options do self-employed individuals, freelancers, or start-up companies, who don’t have much income, have for affordable health coverage?

EF: If you want to apply for health insurance, it has been made easier by looking online and comparing rates depending on your family and individual needs. The best place to start is with healthcare.gov, which will provide you with the tax estimators, and other calculators to see if you will qualify to shop in the marketplace.  You can also shop on the site and compare quotes. The contact number for healthcare.gov is 1-800-706-7893.

GMA: Why has the US been so resistant, or so it seems, to a “free” healthcare system, like other western nations such as Canada and Europe?

EF: One of the main reasons the US has been so resistant to universal health care is the amount of work required to dismantle our current system, including the financial and loss of job costs. In addition, the current system allows a diverse market in both medical providers and drug firms that have created an incentive to maintain the current set prices instead of a single government payer.

GMA: Does quality of health care drop for those who can’t afford private, more expensive health insurance plans?

EF: In regards to the ACA versus private health care, the quality is generally the same. The more important question is the equality of cost towards the quality of care. Healthcare quality is dependent on access.  Lower-income families spend a more significant share of their income on health costs than those with higher incomes. While the ACA helped improve healthcare affordability for many low-income families without access to employer coverage, it did little to provide relief to the much larger group of people offered health benefits at work. That may be part of what is fueling interest in proposals like Medicare-for-all and options for employers and/or workers to buy into Medicare. Though the gap of disparity to healthcare access is shrinking, it still persists for low-income households.