The Patient Protection and Affordable Care Act (ACA), signed into law by President Barrack Obama in March 2010, represents the most far-reaching reforms to the American health care system since its inception. The ACA has three primary goals: (1) to overhaul the private health insurance industry, particularly for people and small-group buyers; (2) to broaden Medicaid to individuals with incomes up to 133 percent of the national poverty threshold; and (3) to transform the way healthcare choices are determined (McKenna et al., 2018). All three goals depend mostly on individual decisions as opposed to government control and are based on the assumption of rationality influenced by benefits but unrestrained by external limitations. The underlying premise is that people and organizations would operate within these changes to deliver a needed commodity (access to health care) at an affordable price (the amount an optimal provider would charge) funded by equitable risk-sharing (distributing the expense of essential services over a broad group). The outcome will be both economical treatment and patient protection.
The ACA incorporates many techniques to encourage general insurance coverage and prioritize certain populations. Dependency insurance coverage under a parent’s plan has become available to young people up to 26 (dependent coverage provision) (Miklluho-Maklai, 2020). Full-time workers at bigger corporations must be offered cheap and extensive health insurance (employer mandate). Those without employee state insurance (ESI) may be subject to a fine (the “individual mandate”) if they do not get insurance. However, premium tax breaks may be offered to offset the cost. Plans for these groups may be purchased via state-run marketplaces or the federally run Healthcare.gov website. All people below 65 years (the “nonelderly”) with yearly earnings up to 133% of the national poverty line are now eligible for Medicaid, although some states have not joined ) (Miklluho-Maklai, 2020). The goals of these amendments are twofold: first, to increase the number of people who can afford health insurance, and second, to reduce the cost of existing policies.
In addition, the ACA puts additional requirements on insurance firms and plans. For instance, insurance firms can no longer impose higher rates or refuse coverage based on prior illnesses. Coverage plans are required to cover a certain number of preventative treatments at no additional cost. The ACA mandates modifications to insurance-related levies and overall finance (Selker, 2021). Other clauses concentrate on optimizing care administration by simplifying services, embracing medical technology, bolstering the health care personnel, minimizing waste and fraud, and modifying compensation to motivate providers to control rates while enhancing the value of treatment.
It is difficult to evaluate the full and enduring effects of the ACA since its provisions are diverse and its possible results spread to patients, taxpayers, practitioners, and governments. The ACA’s benefit improvement objective was to enhance the sufficiency of coverage provided to clients, especially in the private market. However, several individuals have suspended their plans because they were not compliant with the new ACA regulations or because health insurance companies stopped providing them (Manchikanti et al., 2017). Many people whose policies were terminated located equivalent coverage via the marketplaces or in the private market, but others had to pay a higher premium.
Nonetheless, there is little doubt that the ACA has altered America’s healthcare system and will significantly influence the years ahead. The Affordable Care Act has resulted in increased insurance enrollment and greater accessibility of services, particularly among youthful people, the generally poor, less healthy demographics, and minorities (Glied et al., 2020). Despite progress in expanding access to medical care, substantial obstacles remain, including implementation across states, finance, and gaining public acceptance.
References
Glied, S. A., Collins, S. R., & Lin, S. (2020). Did The ACA Lower Americans’ Financial Barriers To Health Care? Health affairs (Project Hope), 39(3), 379–386. Web.
Manchikanti, L., Helm Ii, S., Benyamin, R. M., & Hirsch, J. A. (2017). A Critical Analysis of Obamacare: Affordable Care or Insurance for Many and Coverage for Few? Pain Physician, 20(3), 111–138. Web.
McKenna, R. M., Langellier, B. A., Alcalá, H. E., Roby, D. H., Grande, D. T., & Ortega, A. N. (2018). The Affordable Care Act Attenuates Financial Strain According to Poverty Level. Inquiry: A Journal of Medical Care Organization, Provision and Financing, 55, 46958018790164. Web.
Miklluho-Maklai J. (2020). The affordable care act (aca): Patient protection individual mandate and benefits. Nova Science Publishers.
Selker H. P. (2021). The affordable care act as a national experiment: Health policy innovations and lessons. Springer.