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Affordable Care Act for North Carolina Uninsured Population

In the recent past, health insurance coverage has become a legal mandate to all U.S citizens and legal immigrants courtesy of the Affordable Care Act (ACA). The Act has various provisions that set the new guidelines for the health insurance industry, ensure the expansion of the health insurance market, and create subsidies for the premiums. The implementation of these provisions has led to the strengthening of the overall health insurance coverage on the employer’s side. It has also created coverage for those individuals who do not have employer-sponsored coverage (Gable, 2011). Like other states in the U.S, North Carolina has managed to restructure its Medicaid policy to accommodate all U.S citizens and the documented immigrants that have incomes less than 138% of the federal poverty level. This excludes the legal immigrants with less than five years’ stay in the U.S. According to the survey did, the affected populations include; children 6-18 years of age, the working parents, the non-working parents, the childless adults, the disabled, and the elderly (Tate, 2012).

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According to this policy, employers are required to offer health insurance to their full-time employees. Failure to comply with the directive leads to the imposition of penalties. However, some employers in North Carolina have opted to pay penalties which are relatively lower compared to the cost of insurance coverage of the employees. Sadly, other employers have adopted different strategies geared towards reducing the impacts of this law on their profitability. One is limiting the employment of new workers (Jacobs & Skocpol, 2012). This has greatly hindered the job search process in North Carolina as job seekers, although covered by the ACA, are not able to secure any meaningful employment opportunities. The other strategy is converting full-time employees to part-timers. This is done by reducing the number of working hours per week required by law for an employee to be regarded as full-time. Consequently, the affected employees’ wages and salaries reduce due to the change of status from full-time to part-time. The implication here is that the Affordable Care Act has and will continue to worsen the welfare of people, especially the low-income earners, rather than improving it.

The ACA law requires employers to increase the number of individuals enrolled in employer-sponsored coverage. This is applicable to all businesses. However, large businesses may not bear the burden so much because they enjoy economies of scale. Thus, the amount collected from the deductible health plans of the employees is sufficiently large enough to pay premiums. On the contrary, small businesses usually have a small pool of human resources. As a result, the ACA impacts can be strong enough to affect their financial stability. According to a study conducted recently by the National Federation of Independent Businesses (NFIB), the cost incurred in providing health insurance coverage was identified as one greatest challenges facing small businesses (Jacobs & Skocpol, 2012). This explains why there have been steady but persistent increases in total worker compensation, reduction in the degree of competitiveness in comparison to other large and well-established companies, and a raise in organizational conflicts. Since the economy largely depends on small and medium-sized, a negative correlation between health costs and employment growth will negatively affect the economy of North Carolina. This will result in retarded economic development in the long run.

The Act has affected the cost, quality, and access of treatment. One of the provisions is Medicaid. The enrolled individuals are able acquire financial assistance for various medical complications. Since the introduction of the Act, the cost of treatment has sky-rocketed due to the forces of demand and supply in the health sector. The treatment costs have become prohibitive especially for those under no cover, for instance, the illegal immigrants (Gable, 2011). The universal coverage has also compromised the quality of treatment in North Carolina due to strain on the available facilities and human resource (nurses, doctors, clinical laboratory technicians among others). However, the accessibility to treatment has improved significantly under this policy courtesy of the efforts made by the federal government. The compulsory universal coverage has to a large extent eliminated cases of price discrimination and coverage practices that are commonplace in private health insurance industry. Thus, the consumers are protected from exploitation.

Typical of the Affordable Care Act, most discussions normally revolve around its effective implementation. It has stirred different opinions on its ethical implication. Some critics have been arguing that the individual mandate is unethical. This is because Native Americans or foreigners are required to meet certain requirements before being permitted to purchase a health insurance scheme (Sorrell, 2012). Furthermore, the question of what ethical guidelines should be used in the allocation of scarce health resources is the impending challenge to the policymakers. They have not yet proposed any possible solution. Given that the ACA policy requires everyone to be insured, some criticisms are leveled on the implementation costs which are expected to be huge. This will overburden some people at the expense of others, especially those with chronic illnesses.


Gable, L. (2011). The patient protection and affordable care act, public health, and the elusive target of human rights. Journal of Law, Medicine and Ethics, 39(3), 340-354.

Jacobs, L.,& Skocpol, T. (2012). Healthcare reform and American politics: What everyone need to know. New York, U.S.A: Oxford University Press.

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Sorrell, J. (2012). The patient protection and affordable care act: Ethical perspectives in 21st century health care. OJIN: The Online Journal of Issues in Nursing, 18. Web.

Tate, N. (2012). Obamacare survival guide: The affordable care act and what it means for you and your healthcare. West Palm Beach, U.S.A: Humanix Books.

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