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The Affordable Care Act and Affected Stakeholders


The enactment of the Affordable Care Act can be listed among the most discussed events related to the U.S. healthcare industry. The implementation of this act has several consequences for the population and the authorities, ranging from decreases in the number of uninsured patients to changes in the volume of services available to various social groups. This paper is focused on the financial impact of the ACA on such groups of stakeholders as patients, nurses, and employers.

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Overall Financial Impact on the Groups

The first group of stakeholders impacted by the discussed act is presented by a wide range of healthcare consumers with different income levels and treatment needs. Consequently, taking into account the heterogeneity of its members in terms of available resources, the law’s financial consequences are extremely diverse. To analyze the financial impact of the act on patients, it is necessary to mention significant changes in the number of uninsured people and the introduction of penalties for being uninsured (Heintzman et al., 2017). The changes vary across different age groups and are rather positive for low-income families and younger patients who are regarded as privileged populations.

The next group of stakeholders who face the consequences of the ACA includes nurses responsible for the provision of services. The financial impact that the act has on nursing staff in the United States can be described concerning the amount of provided services and the changing demand for qualified nurses (Edmonds, Campbell, & Gilder, 2017). Changes in demand lead to fluctuations in wage levels, but the latter greatly depend on nurses’ qualifications, place of employment, and other factors (Edmonds et al., 2017). Therefore, it can be difficult to generalize on the impact of ACA on nurses’ financial position.

Apart from the groups above, the implementation of the ACA has a significant impact on large and small employers. As for the key financial consequences for companies, new rules related to employee coverage caused increases in plan costs, varying depending on the size of an employer (Sommers, Shepard, & Hempstead, 2018). The adoption of new healthcare insurance models is associated with significant expenses for many employers, which can have an impact on their preferred hiring strategies.

Benefits and Drawbacks of the ACA

Healthcare consumers are the key stakeholders of the discussed act, which means that the expected positive outcomes are focused on their well-being. According to Rudnicki et al. (2016), the positive effects of healthcare reform that they face can be reduced to access to services, some new rules for employers, and the costs of care. For instance, the act prohibits implementing insurance limitations based on pre-existing health conditions, which is beneficial to patients of the working-age (Rudnicki et al., 2016).

Some specific benefits related to care access exist for people younger than twenty-six who are allowed to use their parents’ insurance plans and pregnant women who are eligible to receive preventive care services for free (Armstrong, 2015). However, about drawbacks, people can be fined for not purchasing insurance plans, and the existing inequalities in healthcare access are reduced at the expense of wealthier citizens (Rudnicki et al., 2016). Therefore, the negative influence of the act is related to increased healthcare spending for some categories of people.

Nurses also face numerous drawbacks and benefits of the ACA due to their important role as intermediaries between physicians and healthcare clients. As for the key advantages, given the increasing number of insured citizens, experienced and newly graduated nurses have more opportunities to find a well-paid job. More than that, according to the study focused on nurses’ self-reports, positive changes include the ability to focus on community collaboration (Edmonds et al., 2017).

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About the existing disadvantages, almost one-half of nurses would grade the ACA with “C” (Edmonds et al., 2017). Such an opinion can be related to the increased patient loads resulting from the need to buy insurance. Importantly, the implementation of mandated insurance caused increases in the number of patients who have the advanced stages of some diseases or lack education about their condition (Heintzman et al., 2017). The growing amount of work and its potential effects on nurses’ job satisfaction and burnout rates can be called the key disadvantage that exists for the stakeholder group in question.

Speaking about companies in different industries, they also face some benefits and disadvantages due to their collaboration with the key stakeholders. The benefits exist only for the limited number of employers – for instance, businesses with less than fifty full-time employees are not obliged to offer insurance (Sommers et al., 2018). Additionally, the act makes some individual insurance options more affordable for employers, which is a significant advantage.

When it comes to drawbacks faced by employers, it is pivotal to mention the financial aspect of the question. The costs of insurance plans offered by employers rise because the exclusion of coverage for pre-existing conditions is now banned (Sommers et al., 2018). Potentially, it can be severe to the financial stability of some companies that employ more than fifty people and need resources for further development.


In the end, the actions discussed in the paper has both positive and negative effects for all stakeholder groups. Patients, the most heterogeneous group, experience different consequences based on their demographic characteristics and financial position, whereas the outcomes for employers strictly depend upon companies’ stability and the size of the workforce. As for nurses, they report increased patients loads, which can sometimes be a barrier to quality.


Armstrong, J. (2015). Women’s health in the age of patient protection and the Affordable Care Act. Clinical Obstetrics and Gynecology, 58(2), 323-335.

Edmonds, J. K., Campbell, L. A., & Gilder, R. E. (2017). Public health nursing practice in the Affordable Care Act era: A national survey. Public Health Nursing, 34(1), 50-58.

Heintzman, J., Bailey, S. R., DeVoe, J., Cowburn, S., Kapka, T., Duong, T. V., & Marino, M. (2017). In low-income Latino patients, post-Affordable Care Act insurance disparities may be reduced even more than broader national estimates: Evidence from Oregon. Journal of Racial and Ethnic Health Disparities, 4(3), 329-336.

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Rudnicki, M., Armstrong, J. H., Clark, C., Marcus, S. G., Sacks, L., Moser, A. J., & Reid-Lombardo, K. (2016). Expected and unexpected consequences of the Affordable Care Act: The impact on patients and surgeons – pro and con arguments. Journal of Gastrointestinal Surgery, 20(2), 351-360.

Sommers, B. D., Shepard, M., & Hempstead, K. (2018). Why did employer coverage fall in Massachusetts after the ACA? Potential consequences of a changing employer mandate. Health Affairs, 37(7), 1144-1152.

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