Policy Analysis

The Affordable Care Act 

 The Affordable Care Act was ratified in 2010 for the purpose of improving health care services, expanding insurance accessibility, expansion of health workforce, minimizing the health care costs, and protecting consumers. In ensuring the achievement of the initiatives, the State played the role of developing and implementing health insurance and expansion of Medicaid program. Since its enactment in 2010, ACA’s provision was effective in 2014 and by 2016; 20-24 million people were covered by insurance. This was influenced by expansion of Medicaid program and remarkable changes in insurance markets. The provision led to deliver system reforms which decreased the healthcare spending and budget deficit, and improved quality care. Since 2010, the number of insurers has been decreased by 17.6million and majority of people aged 65 years and below can now access quality care through the help of health insurance.

 

 The ACA law was aimed at reforming the health care and artcle by Fitgerald, Bias & Gurley-Calvez (2017) states that the law has played a fundamental role in consumer well-being.  The effort to improve health care started back in 1993 when President Clinton implemented a healthcare reform which aimed at bringing universal healthcare. Indeed, various policies for controlling Medicaid and Medicare cost have been implemented. ACA aimed at progressing with these reforms and came up with the goals of improving quality care, minimizing health care cost, increasing health care access and consumer protection (Fitzgerald, Bias & Gurley-Calvez, 2017).  Note that in 2011, the health care cost per capital was &8,508 in U.S and it was ranked last due to its failure to manage infant mortality and life expectancy. In addition, the country was characterized by teen pregnancies, disability, sexually transmitted diseases, obesity among other illnesses. U.S also faced financial challenges which hindered access to quality care. However, the enactment of ACA law led to remarkable changes as it aimed at eliminating out-of-pocket and increasing preventive services, improving Medicare, developing price transparent for medical services, provision of tax credits to small business and middle-class families.  ACA also improved accessibility through increasing health insurance marketplace for affordability and quality (Fitzgerald, Bias & Gurley-Calvez, 2017).  There was Medicaid expansion which covered the working poor and disabled individuals. Rural providers of health care benefited from reimbursement and this motivated them in offering quality services in rural communities thereby improving accessibility.

 Prior to the enactment of ACA, majority of people in America could not afford quality health care due to higher cost. However, Americans were interested in bringing change on issues regarding the high cost of health care and lack of insurance coverage which increased medical debt. These issues have been dealt with since the passage of ACA and it has increased the affordability to all Americans and the number of uninsured is reduced (Custer, 2017). Since 2010, only few percent of American report lack quality care for financial matter.  Medicaid expansion has played an important role in minimizing financial burdens especially in low-income Americans. ACA led to insurance options and insurers can now take health coverage in either private or public sphere. In analyzing the policy, Custer (2017) asserts that ACA was enacted with a purpose of increasing competition on cost and quality among health insurers.  Health insurers were provided with individual subsidy, a reinsurance program, a risk corridor and a risk adjustment (Custer, 2017). All these protections were aimed at minimizing risk in individual market. ACA benefits on marketplace were influenced by Medicare program which   focused on risk adjustment.  Medicare program allows insurers to plan a favorable risk selection and implement several choices of providers.

 Prior to the passage of ACA, health care disparity was an issue of concern and policymakers increased attention in addressing the issue. There was disparity in insurance coverage and effort to address this problem was aimed offering quality health care insurance and minimizing medical cost. Majority of middle- and low-income workers where the large population was Blacks experienced disparities in health care (Mitchell, 2015). However, ACA decreased the uninsured rate especially in Black and Hispanic population. ACA has managed to bring this change because it focused on expanding Medicaid and ensure that the uninsured 50million individuals will receive insurance coverage. Prior to the passage of ACA, Medicaid was used to cover low-income families but nonelderly parents were not eligible for the coverage (Mitchell, 2015). ACA brought development by providing states with federal funding which supported families which were below the federal poverty level. ACA also provided private coverage where young people aged 19-25 years gained the coverage. There was  insurance market reforms  which diminished higher premiums  and developed  benefits package  and  health insurance for marketplaces which allows individual to have options on  coverage  choices.  Individuals who failed to pay insurance were penalized and employers who failed to pay for their employees were also penalized (Mitchell, 2015).  .

The ACA policy has become a debatable issue since the Republican administration   is not satisfied with ACA provision. The administration opts to repeal and replace but supporters argue that repealing will eliminate all the coverage gains which are provided by ACA (Willison & Singer, 2017). Republicans perceive the issue through the consumer-driven approach and a decentralized approach to allow the consumers and states to have authority over insurance choices and healthcare markets. They also believe that the repeal will decrease the federal spending by $90.9 billion and $927 billion by year 2021 and 2026 respectively (Willison & Singer, 2017). On the other hand, democratic argue that the number of uninsured will increase by 81% and the population which will be affected will be the working families, young adults and non-Hispanic whites. Given that the goal of ACA was to improve healthcare through various process including provision of tax credit, repealing will eliminate this provision.  Low-income families will suffer due to lack of quality care (Willison & Singer, 2017).In addition; the number of individuals who enroll in Medicaid will decrease. Medicaid and marketplace enrollment will decrease and the 56.6 million enrollees with reduce to 14.5 million enrollees.

 

 Recommendations

  Noticeably, there are remarkable accomplishments from ACA. It has improved the health care by ensuring that 10millions American has insurance coverage.  However, there is a political opposition which has brought controversy on ACA (Willison & Singer, 2017). The recommendation in addressing the issues facing ACA is that instead or repealing and replacing, there should be a process of fixing the flaws. First, a big fix should be on the area of insurance markets. The federal government should increase the cost-sharing reduction for consumer to compensate co-pays and deductibles.  Second, the federal government should   increase the subsidies   in the markets. To eliminate the out-of-pocket costs, there should refundable tax credit, expand the Medicaid and allow individuals to have an option between government and private insurance plans (Willison & Singer, 2017). Other Americans are experiencing challenges brought by cost sharing especially the employer-based plans. ACA should address this challenge by providing protection to the middle-income Americans. Finally, the system should be designed to empower citizens and allow them to decide on high-value services in order to live productive life (Willison & Singer, 2017).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reference

 

Fitzgerald, M. P., Bias, T. K., & Gurley-Calvez, T. (2017). The Affordable Care Act and Consumer Well-

Being: Knowns and Unknowns. Journal Of Consumer Affairs, 51(1), 27-53.

doi:10.1111/joca.12059

 

Custer, W. S. (2017). Medicare Advantage as a Model for Affordable Care Act Marketplaces. Journal Of

Financial Service Professionals, 71(1), 40-42.

 

Willison, C. E., & Singer, P. M. (2017). Repealing the Affordable Care Act Essential Health Benefits:

Threats and Obstacles. American Journal Of Public Health, 107(8), 1225-1226.

 

Mitchell, F. M. (2015). Racial and Ethnic Health Disparities in an Era of Health Care Reform. Health &

Social Work, 40(3), e66-e74. doi:10.1093/hsw/hlv038