New acts in the spheres of healthcare always entail both considerable challenges and opportunities for all stakeholders. As a result, every new act, especially those which imply major changes, gets subject to criticism. The Affordable Care Act (ACA) enacted in 2010 became significant legislation which, to a large extent, reformed the healthcare industry of the United States. Today, more than a decade later, the ACA remains a controversial topic which causes many experts to continue exploring it and offering new proposals on how the provisions of the act could be adjusted. Although the ACA has many advantages, it can be changed to feature public option insurance plans and support for middle-income individuals.
The Patient Protection and Affordable Care Act (PPACA), also known as the Affordable Care Act, is a healthcare reform law adopted during Obama’s presidency. In short, the ACA can be described as a complex law which was designed to offer Americans better quality health insurance at an affordable price and tried to contain healthcare spending in the country. Specifically, the act established benefits, protections, and rights for patients, as well as clear rules for insurance providers. Additionally, it specified the size of taxes, the existing tax breaks, and the matters related to education, committees, jobs, and other aspects of the healthcare system of the United States. Essentially, the act was adopted to reduce both out-of-pocket and premium expenses for millions of citizens of the country, especially those who could not afford insurance coverage previously.
In order to explore the ACA in detail, it is important to mention the key provisions contained in the ACA. For instance, the act introduced new coverage standards which targeted the prevention of discrimination against insurance applicants (Morris et al., 2019). One of the essential elements of the policy was the banning of the practice when insurance providers charged people with pre-existing conditions higher premiums. Additionally, the act expanded the public Medicaid program, which now included all individuals under 65 years old who had incomes of up to 133% of the Federal Poverty Level (Chait & Glied, 2018). At the same time, the act also imposed an annual tax of $695 on people who did not get qualifying coverage (Chait & Glied, 2018). Moreover, the act made it obligatory to issue health coverage to all applicants without regard to their income, health status, or age.
The ACA has had a considerable impact on the healthcare system of the United States, and today, it is possible to observe the implications of its adoption. For instance, in six years, the number of individuals who did not have insurance had decreased to a mere 28 million (Rapfogel et al., 2020). The increase in the number of people with health insurance positively affected the growth in terms of access to care and resulted in more extensive use of health services. The expansion of Medicaid and the introduction of marketplace subsidies reduced the size of out-of-pocket expenses of enrolled individuals. Thus, the act achieved its goal of decreasing the number of uninsured people and helping individuals to access health services. At the same time, it is difficult to trace the effect of the ACA on the cost and quality of health care in the country.
Personally, I believe that the ACA is one of the most important health care reforms in the history of the United States, and therefore, I decided to analyze it. The role of the ACA in the shaping of the current healthcare system of the country is highly significant. Additionally, it is also crucial to explore the ACA to see how the act caused a partisan conflict and encouraged the two parties to introduce their changes to the law.
Table 1. Strengths and Weaknesses of the ACA
The strengths and weaknesses of the ACA must be studied more carefully to understand the value of the act. Over 10 million people, particularly young adults, in the United States got their health insurance coverage within the period of the first five years since the implementation of the law (Gaffney & McCormick, 2017). It became prohibited for insurers to establish limits on the financial size of the insurance coverage offered to clients. Previously, people who had pre-existing conditions could be given insurance coverage which had a limit on how much they could spend on services. The ACA introduced broader coverage for preventive care and screenings, which also allowed people to be proactive and identify possible health problems early (Chait & Glied, 2018). The ACA also contributed to the creation of a more inclusive healthcare system in the country by banning discrimination and providing coverage to people who previously could not afford it (Table 1). The ACA also extended the period when children could have insurance under the plan of their parents, which enabled younger people to avoid spending their money on separate health insurance.
At the same time, the ACA had certain weaknesses, which became the main points of criticism. For example, some people, especially those who were not eligible for subsidies, found it difficult to get insurance due to the rise in the price of premiums (Chait & Glied, 2018). Moreover, the requirements stipulated by the ACA provisions made insurance companies reduce the size of their networks of healthcare service providers and thus left clients with fewer options to choose from. The main weakness of the ACA was the introduction of insurance mandates (Table 1). In other words, the act made it obligatory to obtain insurance, and people who refused to do it eventually were given penalties. Eventually, such penalties were removed on the federal level, yet some states decided to create local laws mandating people to get insured (Buntin & Graves, 2020). Additionally, many people struggled to receive insurance due to numerous obstacles, such as poorly functioning websites, limited coverage options, and confusion over the enrollment procedure. Finally, smaller businesses found it difficult to cover all employees and, as a result, had to reduce the number of working hours.
There are three main recommendations which can be made in order to improve the ACA and enable it to achieve more goals. First of all, it is clear that ACA has not yet made health insurance more affordable for all Americans, and in some cases, the situation became worse. One of the reasons why the ACA was not successful in addressing affordability as initially expected is the refusal of certain states to extend the Medicaid program. Therefore, it is important to offer federal subsidies to the low-income individuals living in those states. Additionally, similar subsidies must be provided to people who have an income which is below the federal poverty level.
Another recommendation which can be made in relation to the ACA is the need to make healthcare more affordable for middle-income citizens. Many people who do not qualify for employer-sponsored coverage or tax credits continue having problems with obtaining affordable coverage. Therefore, it is important to offer them tax credits or provide insurers with an option of reinsurance which can protect them from potentially high medical costs. Finally, an initiative which can significantly improve affordability for all citizens is the introduction of the public option, which is also known as a buy-in. Essentially, the public option is a health insurance program paid by the state, which is available as one of the possible choices alongside private plans. Such a public option may have a lower price and fewer services, but it can be a viable choice for people who do not have insurance.
The Affordable Care Act is one of the most important legislation in the history of the United States, which still requires adjustments. Although the act allowed millions of people to obtain health insurance, it gave rise to a variety of other problems. For instance, the act caused prices of some insurance plans to rise and forced insurers to make their provider networks smaller. In order to improve the act, it is possible to introduce federal subsidies for low-income individuals living in states which did not extend the Medicaid program. Additionally, states or the federal government can introduce a low-cost public option, an affordable insurance plan funded by the authorities.
References
Buntin, M., & Graves, J. (2020). How the ACA dented the cost curve. Health Affairs, 39(3), 1–8.
Chait, N., & Glied, S. (2018). Promoting prevention under the Affordable Care Act. Annual Review of Public Health, 39, 507–524.
Gaffney, A., & McCormick, D. (2017). The Affordable Care Act: Implications for healthcare equity. The Lancet, 389(10077), 1442–1452.
Morris, J., Mayer, M., Kenter, R., & Lucero, L. (2019). State politics and the affordable care act: Choices and decisions. Routledge.
Rapfogel, N., Gee, E., &, Calsyn, M. (2020). 10 ways the ACA has improved health care in the past decade. American Progress. Web.