The Debate over Obamacare

October 27, 2013

Students learn about the Affordable Care Act and the debates surrounding it; read and consider different points of view about the legislation; consider their own point of view in small group discussion, and consider taking action on the issue.

To the Teacher:  

Beginning in early October 2013, most of the major provisions of the healthcare law called the Affordable Care Act (popularly known as "Obamacare") began to take effect. These provisions include subsidies for low-income families, "health insurance exchanges" through which individuals and businesses can purchase insurance, a financial penalty for those who choose to remain uninsured, and a guarantee that insurance providers cannot deny coverage for pre-existing conditions. The Affordable Care Act has aroused a great deal of controversy and has become a target of opposition from Republicans in Congress. In fact, its implementation was one reason Republicans gave for shutting down the government for over two weeks in October. The ACA also faces criticism from many progressives who think it does not go far enough to reform the US healthcare system.
This lesson includes a short introductory reading about this debate, followed by a small group activity in which students read three different views on Obamacare. After sharing what they've read, students then take part in a fishbowl activity aimed at exploring their own views on the issue.


Students will: 

  • learn about the Affordable Care Act and the debates surrounding it
  • read and consider different points of view about the legislation
  • consider their own point of view in small group discussion
  • consider taking action on the issue


Ask students:  What have you heard about the Affordable Care Act, or Obamacare?
Why has this plan been in the news?  (Reasons include the government shutdown Republicans engineered to oppose the plan, and problems with, the ACA website the administration launched in October.)
Ask students to read the following summary of the debate over Obamacare, or read it out loud to the class.



The Obamacare Debate

Beginning in early October 2013, most of the major provisions of the healthcare law called the Affordable Care Act (popularly known as "Obamacare") began to take effect. This law, which was passed by Congress in December 2009, still arouses a great deal of controversy, and has been the target of ongoing opposition from Republicans in Congress. In fact, the implementation of Obamacare was one of the reasons Republicans gave for shutting down the government for over two weeks in October. The law also has progressive critics.  While Republicans think the law goes too far, some progressives believe it doesn't go far enough to reform the US healthcare system.
The ACA attempts to address some widely acknowledged problems with the US healthcare system. These include:

  • The US spends far more on healthcare than any other country in the world, yet leaves a high percentage of people uninsured.
  • The US's health outcomes (including how long we live, infant mortality, and disease rates) are among the worst in the industrialized world.
  • The system itself is extremely complex, a patchwork of private insurance and public insurance (like Medicare, for the elderly and disabled, and Medicaid, for the poor) - and the complexity contributes to its high cost.
  • The US, unlike many other industrialized countries, still relies mostly on employers to provide private health insurance, rather than relying on government to insure everyone. However, increasingly employers don't provide insurance (or force workers to pay more than they can afford for it), leaving workers in the lurch. 

For these and other reasons, a majority of Americans have long supported major reform of our healthcare system. For years before Obamacare was passed, thousands of people across the country organized actions, protests, petition drives, and letter-writing campaigns, and campaigned for candidates in support of healthcare reform. 
President Obama was elected in 2008 on the promise of achieving reform. However, any kind of healthcare reform poses huge political challenges. Many Republicans and other conservatives are opposed to expanding government's role in providing health insurance. Some even argue that existing public healthcare systems, such as Medicare, should be privatized (that is, turned over to private corporations to run). Conservatives argue that the US healthcare system would be improved if there was more private competition for people's healthcare dollars. And most conservatives are also ideologically opposed to what they call "big government."
Another major challenge healthcare reformers face is that several very politically powerful industries have a huge stake in the system —in particular, private health insurance companies, as well as pharmaceutical companies. The ACA was a compromise that included these players:  In exchange for restrictions on their practices, the insurance industry accepted a deal in which the federal government would require most individuals and many employers to buy health insurance from them, often with government subsidies. Insurance companies expect that this will result in a massive influx of new customers. The gain for those who wanted reforms: Expanded access to healthcare for millions of Americans, and restrictions on such insurance industry practices as denying coverage to people with "preexisting conditions."  
Many progressive critics of the legislation say that it does not address the fundamental problem with our healthcare system. These critics note that while ACA will provide much needed coverage to more Americans, it will not lead to high-quality, affordable healthcare for all. In fact, they maintain, it props up the existing system by bolstering the role of private health insurance companies.  To solve the healthcare crisis, they believe the US should, like many other industrialized countries, adopt a form of "national health insurance." Under such a "single payer" plan, a public program such as Medicare would be expanded to cover all Americans, reducing or eliminating the role of the private insurance industry. Advocates argue that only under such a system will the US be able to ensure and afford high-quality healthcare for everyone.  They point to countries around the world that have single-payer systems, which cost about half as much as the US system and have superior health outcomes.

After students have read the reading, ask: Do you have questions about the reading?

Record questions on the board for further exploration.


Small Group Discussion

Divide the class into three groups, and ask each group to read one of the opinions in the attached pdf. (Alternatively, assign the three groups the reading as homework and continue with the rest of this lesson tomorrow.)
Readings are:
Group One - The case for Obamacare:
Five reasons Americans already love ObamaCare 
Sally Kohn, Fox News, September 30, 2013
Group Two - Conservative critique of Obamacare:
The Case Against ObamaCare
GOP.Com, March 23, 2011
Group Three - Progressive critique of Obamacare:
Republicans' biggest misunderstanding about Obamacare
Adam Gaffney, Salon, October 10, 2013

Tell students that the readings reflect three different views about the Affordable Care Act: One reading argues in support of ACA, one critiques it on conservative grounds, and a third critiques it on progressive grounds.
Tell students that after reading the opinion, they should agree on a brief summary of what they read to share with the rest of the class. Specifically, they will share:
1)  a brief summary of what they read
2)  the reading's strongest point, in the group's opinion
3)  the reading's weakest point, in the group's opinion
Give students 10 minutes to read the article and another 5-10 minutes to prepare to share.
Reconvene the class and ask each group for its summary. If you have time, allow for one or two clarifying questions from the rest of the class after each group's summary.
Tell the class that what they read are opinions, but the"facts" they cite aren't necessarily true.  Ask students to come up with three things they could do if they were trying to verify the accuracy of what they read. Record these on the board.


Fishbowl Discussion

Now tell the class that we'll have a fishbowl discussion about Obamacare. In this discussion, students will be asked to give their own thoughts and opinions, not those expressed in their reading.  Of course students are free to cite arguments or information from the readings.
Ask two students from Group One, two from Group Two and two from Group Three to sit in a circle facing each other. Ask the remaining students to form a circle around this fishbowl group. Students should stand roughly behind the two fishbowl members who were in their small group.
After students have assembled, explain that only people in the fishbowl can speak. You will ask students in the fishbowl a question and invite students to speak to it in a "go-around." Each student responds without being interrupted. After a few minutes or so, you'll invite students from the larger circle to participate in the fishbowl conversation by tapping a fishbowl student on the shoulder and moving into that student's seat. Students should only replace the seat of someone who was in their group.

Now ask the Fishbowl group students to listen to several statements. After each statement, they should say whether they agree or disagree, and why.  Each student will have up to one minute to respond.
Statement:  The government should not be involved in providing health insurance for people.
Statement:  Obamacare goes a long way to fixing our healthcare system.
Statement:  The problem with Obamacare is that it just increases the role of the private insurance industry.
Now stop and give students outside the fishbowl a chance to join the discussion by tapping the shoulder of someone from their group and taking their seat.
Statement:  Obamacare forces people to buy health insurance, and that's not right.
Statement:  Obamacare is great because it ensures that a lot more people can get healthcare coverage.
Statement: Obamacare costs too much and doesn't cover everyone. We need a universal, public health insurance system.
Stop again and give students outside the fishbowl a chance to join the discussion by tapping the shoulder of someone from their group and taking their seat.

Statement: Obamacare could completely bankrupt the country.
Statement:  Obamacare reins in the private health insurance companies.
Statement:  Obamacare doesn't address the fundamental problems with our healthcare system.
Reconvene the whole group and ask:

  • What did you think of the discussion? 
  • Did you change your opinion about healthcare as a result of these readings and discussion?

Return to the questions students had about the first reading.  Have those questions been answered? If not, how might we answer them?

Tell students that Obamacare was passed only after extensive grassroots organizing by people who wanted healthcare reform.  Thousands of people across the country continue to organize on this issue, against Obamacare, in support of it, and in support of more thorough reform (such as national health insurance).  

Ask students if they are interested in taking an action step on this issue, and if so how they might proceed.