Unlike the UK, there is no free at the point of use national health care provision in the USA.

Protesters campaigning for publicly-funded healthcare, New York, 2013
Protesters campaigning for publicly-funded healthcare, New York, 2013.

Most Americans are expected to provide for their own health care through private medical insurance. 58 per cent receive their private health insurance through their employer. Companies such as BlueCross BlueShield are among the leading private health care providers.

US government health programmes cover around 28 per cent of the population (83 million people) and include: -

  • Medicare – Mostly for people over 65 years of age and administered by federal government
  • Medicaid – Covers people on low incomes including children, pregnant women and people with disabilities. It is administered by states
  • State Children’s Health Insurance Program – Covers those children who do not qualify for Medicaid

Until recently, around 45 million Americans (15 per cent of the population) had no private health insurance and did not qualify for Medicaid.

In America, African American and Hispanic people are more likely to have lower incomes or to be unemployed and therefore are less likely to have private medical insurance. They are also more likely to depend on Medicare or to be uninsured.

The Affordable Care Act

Often referred to as Obamacare, the act was passed to give Americans better health security by putting in place comprehensive health insurance reforms that: -

  • expand coverage
  • hold insurance companies accountable
  • lower health care costs
  • guarantee more choice
  • enhance the quality of care for all Americans

Repealing the act

Obamacare has been divisive. Republicans are against it and believe it is unaffordable, that it has led to hundreds of thousands of jobs losses and represents excessive government interference in private lives.

Many Democrats have embraced Obamacare. It has led to higher insurance premiums for some, but it has widened access to health insurance.

An opponent of Obamacare, in October 2017 President Trump signed an executive order to allow the sale of health insurance plans that are exempt from the act’s regulations. Trump declared that this measure was the first step in repealing the act.

Trump and the Republican Party are working on their own health act to replace Obamacare. The problem for Trump and the Republicans is that polls show that more than half of Americans support Obamacare.