The Affordable Care Act (ACA)
The US healthcare system has seen many health reforms since the beginning of the 20th century. The dawn of progressivism in the US in the early 1900s saw the initiation of attempts by the federal government to achieve universal coverage. The efforts of President Franklin D. Roosevelt are, to date, imprinted in the US healthcare system as his efforts to reform the healthcare system saw the establishment of a publicly funded health program. Multiple healthcare reform proposals have been made since the establishment of the publicly funded health program in 1933. The Affordable Care Act (ACA) was a landmark reform President Obama signed into law in 2010 (Warner et al., 2020). The vital federal provisions of this act include expanding insurance coverage for Americans, emphasizing preventing approaches to care and wellness, improving the quality of healthcare, curtailing the rising cost of healthcare, and expanding the workforce in the healthcare system. Despite its enormous promises to the American people, this act has downsides. This paper focuses on the pros and cons of the Affordable Care Act.
The ACA gives provisions for preventive care and emphasizes the need for disease prevention to promote healthy living and wellness for all Americans. This legislation requires that all healthcare plans offer preventative services to all their customers at no extra fees. Depending on their age, all Americans have access to preventive services such as screening tests for diabetes, hypertension, and blood cholesterol levels; cancer screening, including but not limited to colonoscopy for colon cancer and mammograms for breast cancer; and routine vaccinations against common infections outlined in the CDC’s’ immunization schedules for children and adults. Other preventive services include screening, immunization, and counseling during pregnancies, smoking cessation, weight loss, and reduction of alcohol abuse, among others (Agirdas & Holding, 2018). All these measures are integral to public health promotion. Reinforcing their executions by healthcare plans ensures that many Americans get access to them and fronts public health measures on health preservation and wellness.
Expanding Medicaid to include impoverished Americans is another benefit conferred by the ACA. One of the most lauded provisions of the ACA was the expansion of the Medicaid programs to expand Medicaid program to cover people with incomes up to 133% below the federal poverty line. This is one of the approaches to developing insurance coverage for millions of Americans. Access to healthcare is a systemic problem among poor Americans, with the surging cost of healthcare services making it barely affordable to low-income Americans. Communities that are traditionally disadvantaged by poor access to healthcare and other health disparities, such as ethnic minorities, can now access insurance coverage and, subsequently, primary healthcare. The HHS, through its Center for Medicare and Medicaid Services (CMS), reports that over 21 million Americans got insured after the ACA passage that saw the expansion of Medicaid to poor Americans below 65 years. Another 14 million enrolled in insurance coverage related to Medicaid (HHS, 2022). This achievement highlights the significance of this act to these poor individuals.
The ACA provisions have generally resulted in the improvement of healthcare outcomes. The provision of this act on improving health quality and healthcare systems performance has contributed to improved healthcare outcomes currently seen. The ACA sought to improve the quality of healthcare and systems performance by investing in health information technology systems, improving care coordination between Medicare and Medicaid, and developing a mechanism to lessen apparent health disparities (Entress & Anderson, 2020). There is a widespread use of healthcare information technologies (HITs) in various healthcare facilities, with electronic medical records systems being one of the most commonly used HITs. These HITs have increased the efficiency of healthcare services delivered in these hospitals. The Center for Medicare and Medicaid Services (CMS) also develops provisions for quality enhancement among Medicaid-approved care facilities. Such provisions as those requiring healthcare facilities not to charge patients for hospital-acquired infections place the burden on quality assurance to individual hospital entities. All these measures have considerably improved the quality of care delivered in various hospitals and subsequently improved the clinical outcomes in these healthcare facilities.
The ACA provisions have also made healthcare insurance less expensive and more fulfilling to all qualified Americans. The ACA has made healthcare insurance more affordable by providing subsidies through premium tax credits to families or households earning between 300 and 400% of the federal poverty guidelines. This legislation also established the 80/20 rule for all insurance companies. This rule requires that all insurance companies spend at least 80% of the total amount of money they take in the form of premiums for quality improvement measures and to cover healthcare costs. The 20% goes to their operationalizations, covering administrative and market costs. This provision implores these providers to provide better services to their clients to ensure they find value for their money.
The ACA also accords better insurance coverage to all Americans regardless of their health conditions. Before the enactment of this legislation, there were multiple concerns about insurance providers denying coverage to persons with preexisting medical conditions and those with comorbidities due to the high cost of treating them. As per the ACA provisions, health insurance organizations cannot deny coverage or charge their client more because of their preexisting health conditions. This also applies to the children of the insurance holder. This provision is a reprieve for millions of Americans, especially the elderly group who have chronic conditions. This plan offers an all-inclusive framework that does not isolate them because of their suffering. There is, however, an exception for those individuals with godfathered healthcare plans, as these plans do not cover preexisting health conditions.
The COVID-19 pandemic also reinforced the significance of the ACA as it ensured a better response to the pandemic through various fronts. The overall reaction to the COVID pandemic in the US was better in states with expanded Medicaid coverage than those with none. These states were better positioned to handle the downward spiral effect of the pandemic on access to healthcare and traditional health disparities that affected ethnic minority groups. In these states, many impoverished Americans had insurance coverage and were not disadvantaged by poor access to care accustomed to their low-income status. As the COVID pandemic unearthed the traditional disparities that had affected the ethnic minority groups in the US, the effect was less pronounced in the Medicaid-expanded states (Entress & Anderson, 2020). All of these are owed to the robust proposals of ACA on lessening traditional health disparities affecting ethnic minority groups, those living in rural and remote areas disadvantaged by their geographical location and proximity, disabled Americans, and those disadvantaged by language barriers.
Despite its proposals to lower the insurance cost through premium tax credits, insurance coverage was not reduced for all. Those who do not qualify for the premium tax credits (households that do not earn 300 to 400% of the federal poverty line) may find the marketplace insurance plans expensive. The provisions of this legislation also allow people to buy more decadent benefits packages but limit their options or ability to eliminate from the plan options that are unfavorable to them. For instance, an individual with no utility for maternity services and may not need them may get a package with such services.
The individual mandate provision of the ACA has also been another controversial issue under this law. This mandate required Americans to purchase minimum essential insurance coverage. Tax penalties are imposed on individuals who fail to buy a minimum basic insurance coverage unless exempted upon meeting an exemption eligibility criteria. The tax penalty was in action until it was scrapped in 2019. Many states, however, continue to impose similar mandates on health insurance. This leaves the imprint of the tax penalty provision on their insurance regulations (Fiedler, 2020). Controversies continue to rock this portion of the ACA regulation, with legal challenges and clarity calls on this provision still pending in various judicial jurisdictions.
The ACA provisions have also negatively impacted small business enterprises. As per the provisions of this law, employers are required to provide insurance coverage to their employees or pay penalties. Tax credits are also offered to smaller business enterprises that cover specific health insurance costs for their employees. The act puts a cap of 50 on the number of employees that any business can have to be incentivized by the small business option program. This can directly affect the number of workers a small business can have as full-time employees. These small businesses may employ more people temporarily part-time to continue enjoying the incentive. Some companies may also prefer having their employees purchase their insurance covers on the exchanges rather than having company-sponsored health coverage. This is a more cost-effective measure for the company but may be in contravention of the employer’s mandate that requires employers to offer affordable insurance coverage to their employees and provide a minimum value of up to 95% to their workers and their children.
Despite being centered on enhancing access to healthcare and being fronted as legislation that reduces the cost of healthcare, the cost remains expensive in the US; many Americans remain insured, and more continue to obtain insurance coverage. However, the cost of healthcare is skyrocketing in the US. The national expenditure on healthcare is expected to hit the six trillion mark by 2028. The individual household cost of healthcare currently stands at over 12,000 dollars (AMA, 2020). The ACA provisions have failed to place a cap on the price of prescription medication. The cost of insulin, for instance, has tripled from the cost in the pre-ACA era. With many Americans developing chronic disorders and even comorbidities with chronic disorders, the utility of prescription medications continues to rise (Boersma et al., 2022). Some insurance covers sometimes do not cover these prescription drugs, requiring out-of-pocket spending on their acquisition. This area remains a void in the ACA provisions and has been a tool for a political campaign in the political dispensation that succeeded Obama’s’ administration.
The act does not adequately address the high cost of prescription medications. To better manage the surging cost of healthcare in the US, this act should cap the out-of-pocket spending on prescription drugs by creating a publicly funded comprehensive plan. As such, the act will remove the burden of paying for medications for Americans. A repeal act should also address misaligned incentives contributing to the high cost of healthcare. An example of such a misaligned incentive is the reward of physicians for using the more expensive original drugs when there are cheaper alternative generics. A transparent drug prices review board should also be established that oversees drug pricing and creates caps on the prices of prescription medications that are commonly used, such as insulin.
Promoting the sale of health insurance covers is another repeal that needs to be done on the act. Allowing insurance companies to sell their insurance covers across states may create flexibility for the insured and eliminate any inconvenience that would have otherwise been created if one moves to another state. This flexible plan will allow insurance companies to sell their insurance covers without complying with the host state’s regulations, which sometimes exist. This provision is similar to the repeal act proposed by President Trump under his repeal-replace ACA policies on health. Both the insurers and the insured will feel the upside of the plan.
The enactment of the Affordable Care Act in 2010 saw the US landscape undergo several changes. Over ten years down the line, the benefits of this enactment are evident in the expansion of insurance coverages, improved quality of healthcare services, and access to preventive healthcare. This legislation has also encountered numerous controversies and opposition. Improving specific aspects of this act may further its efficiency in healthcare regulations and enable better services to Americans.
Agirdas, C., & Holding, J. (2018). Effects of the ACA on Preventive Care Disparities. Applied Health Economics And Health Policy, 16(6), 859-869. https://doi.org/10.1007/s40258-018-0423-5
Boersma, P., Black, L., & Ward, B. (2022). Prevalence of Multiple Chronic Conditions Among US Adults, 2018. CDC.gov. Retrieved 12 September 2022, from http://dx.doi.org/10.5888/pcd17.200130.
Entress, R., & Anderson, K. (2020). The Politics of Health Care: Health Disparities, the Affordable Care Act, and Solutions for Success. Social Work In Public Health, 35(4), 152-162. https://doi.org/10.1080/19371918.2020.1767750
Fiedler, M. (2020). The ACA’s’ Individual Mandate In Retrospect: What Did It Do, And Where Do We Go From Here? Health Affairs, 39(3), 429-435. https://doi.org/10.1377/hlthaff.2019.01433
New Reports Show Record 35 Million People Enrolled in Coverage Related to the Affordable Care Act, with Historic 21 Million People Enrolled in Medicaid Expansion Coverage. HHS.gov. (2022). Retrieved 12 September 2022, from https://www.hhs.gov/about/news/2022/04/29/new-reports-show-record-35-million-people-enrolled-in-coverage-related-to-the-affordable-care-act.html.
Small Business and the Affordable Care Act (ACA). HealthCare.gov. (2022). Retrieved 12 September 2022, from https://www.healthcare.gov/small-businesses/learn-more/how-aca-affects-businesses/.
Trends in health care spending. American Medical Association. (2022). Retrieved 12 September 2022, from https://www.ama-assn.org/about/research/trends-health-care-spending.
Warner, J., Benjamin, I., Churchwell, K., Firestone, G., Gardner, T., & Johnson, J. et al. (2020). Advancing Healthcare Reform: The American Heart Association’s’ 2020 Statement of Principles for Adequate, Accessible, and Affordable Health Care: A Presidential Advisory From the American Heart Association. Circulation, 141(10). https://doi.org/10.1161/cir.0000000000000759
We’ll write everything from scratch
Write a 6-page paper (not including title and reference page) discussing the pros and cons of the Affordable Care Act (ACA). Discuss what changes you would make to the ACA if you were in charge of developing a repeal.