The Affordable Care Act (ACA) covers almost a thousand pages and represents a radical attempt to review the medical insurance and health care system in the United States. From the early stages, even before its adoption and implementation, the law had generated a lot of discussion and concern on the part of both the population and the congressmen. The ACA envisaged several unpopular policies, including requiring US citizens to purchase health insurance as well as stricter requirements for employers and insurance companies.
The implementation of the law has encountered a multitude of practical challenges, economic difficulties, and, accordingly, criticism. Initiating the repeal of the law was one of Donald Trump’s key campaign promises. However, the new President, as well as his proponents, have faced the necessity to offer a practical alternative and have so far not taken decisive steps to abolish the ACA. This paper elaborates on economic concerns, the actual availability of medical care, and the consistency of public policies about the current state of health care and nursing practices.
Economic Concerns
The draft law provided that the implementation of all measures would require significant expenditures from the state budget. Nevertheless, the Congressional Budget Office predicted that the prolonged nature of the reform and its long-term benefits would ultimately lead to positive fiscal tendencies. Over time, it emerged that the ACA is potentially fraught with other economic challenges. For example, the law has reduced competition in the market of insurance services (Moffit, 2016). Moreover, “the employer mandate, which requires firms with 50 or more full-time workers to offer federally approved levels of insurance coverage or pay a tax penalty,” has resulted in job cuts (Moffit, 2016, para. 53). Employers are now more cautious when recruiting staff due to increased demands.
There is no doubt that the requirements of the ACA in respect of employers and insurance companies increase the availability of insurance and provide variability of choice for ordinary citizens. At the same time, from an economic point of view, they interfere quite strongly with the system of market competition. One of the main objectives of the Presidential Executive Order on ACA update was to promote free competition (US President, 2017). Thus, there is a certain contradiction between the social protection of poor and uninsured citizens and maintaining a free market economy. The ACA unambiguously chooses in favor of citizens, for which Republicans and other conservatives have repeatedly criticized.
Actual Availability of Health Care
It should be noted that all these measures were aimed at improving access to traditionally expensive medical care in the United States and at increasing the range of services covered by insurance. Unfortunately, “the ‘typical family’ pays about 35 percent of their income for health care” (Moffit, 2016, para. 10). The individual obligation to purchase insurance that would cover all the necessary provisions, however, proved to be a partly unpopular measure even among the population.
At the same time, the number of insured citizens has severely increased. The researchers note that if the implementation of the law is canceled, the number of uninsured people may double and become even more than in the period before Barack Obama’s reform (Blumberg et al., 2016). It may be admitted that the primary goal of the law to increase the share of the insured population is being fulfilled, and that is the greatest virtue of the ACA.
However, it should be stipulated that medical care is still expensive, and insurance does not cover all necessary treatment. In addition, insurance premiums are steadily increasing: “for 27-year-olds, premiums in 11 states more than doubled” and “for 50-year-olds, there was a premium increase of 50 percent or more in 13 states” (Moffit, 2016, para. 43). Thus, the number of insured individuals has increased, which is indeed the merit of the ACA, but health services have not become much more accessible by themselves.
Consistency of Implementation
It should be noted that the health care reform system is currently in a highly unstable political situation. Republicans initially had a negative view of the ACA, and after winning the 2016 elections, they thoughtfully planned to cut back on funding for the implementation of the law (Wilensky, 2017). However, they encountered the need to ensure “that 20 million newly insured individuals retain coverage,” which was extremely challenging (Wilensky, 2017, p. 21).
Executive measures by Donald Trump to sabotage the law began in 2017 but were not radical (Bryan, 2017). Meanwhile, the main challenges related to the implementation of the law and the initial reasons for its adoption were not overcome either by the Republicans or the new President.
It should be noted here that the extended ten-year implementation period of the ACA is its merit, given the ability of business, government, and population to adapt to new realities. However, given the change of authorities and the polar attitude to the law, this quality severely affects the consistency of its implementation. Researchers note that strong deviations from the original course can lead to extremely harmful consequences (Blumberg et al., 2016). Thus, the longevity of the provided measures has a negative side as well.
Conclusion
It can be concluded that the ACA has begun to fulfill its primary goal of increasing the share of the insured population in the US and supporting poor citizens. At the same time, the law imposes high requirements on employers and insurance companies, which has an impact on the economic situation. Its long-term implementation, on the one hand, allows the state to adapt to new circumstances and, on the other hand, makes it dependent on the political conditions.
References
Blumberg, L. J., Buettgens, M., & Holahan, J. (2016). Implications of Partial Repeal of the ACA through Reconciliation. Urban Institute. Web.
Bryan, B. (2017). Trump just took a big step to unravel Obamacare. Business Insider. Web.
Moffit, R. (2016). Year six of the Affordable Care Act: Obamacare’s mounting problems. The Heritage Foundation. Web.
US President. (2017). Presidential executive order promoting healthcare choice and competition across the United States. Washington, DC: White House.
Wilensky, G. R. (2017). The future of the ACA and health care policy in the United States. Jama, 317(1), 21-22.