The Problem That Necessitated the Policy
It is essential to remark that the U.S. health care system is one of the most expensive in the world. The crisis that arose in 2008 particularly demonstrated the problem of the expensive cost of health care in the United States (Meinhofer & Witman, 2018). Consequently, many Americans were not prepared to pay for their needed treatment and medications. Therefore, the need emerged to create a law including a list of health care policies designed to extend health insurance to millions of uninsured Americans.
Widespread Problems and Evidence
The problem of the absence of health insurance is closely related to the financial issues of the population. The United States did not have comprehensive health insurance until 2010. In 2008, 16% of the U.S. population, or 47 million people, had no health insurance. This is due to the high cost of insurance, which is rising faster than wages or inflation (Meinhofer & Witman, 2018, p. 177). In 2005, about 50% of U.S. companies went bankrupt because of health care costs. This was because 59.7% of Americans have employer-provided health insurance (Meinhofer & Witman, 2018, p. 178). This is a significant problem because many people cannot pay for treatment and postpone it, which ultimately leads to higher health care expenses. In addition, serving large numbers of uninsured patients has caused the hospital or doctors to become bankrupt.
Meanwhile, the challenge was also for the uninsured working population. About 38 million working adults and more than 27 million people had part-time jobs. Thus, before the law was passed, 45,000 people died each year due to the absence of money for health insurance (McIntyre & Song, 2019, para 6). The main category of people who needed state support were low-income families and elderly individuals. The reasons for the issue are confirmed by a Gallup poll, which showed that 29% of U.S. residents identified the high cost of treatment as the primary healthcare problem and 22% insufficient access to healthcare services (Meinhofer & Witman, 2018, p. 179). Therefore, the increase in the number of deaths and the deterioration of public health are related to the poor financial security of citizens and the inadequate health insurance system.
Policy Description
The Functioning of The Policy
A number of provisions of the reform came into force in 2010 and established that insurance companies no longer have the right to refuse to insure sick people. In addition, there are restrictions on the cost of insurance for people with serious illnesses. Insurers also cannot refuse to provide a policy to children with a disease. Parents can include their kids in their insurance plans until they reach the age of 26 (Meinhofer & Witman, 2018, p. 179). Moreover, there is a special program for people who have lived without insurance and suffer from various diseases, where they can receive insurance on favourable terms. At the same time, the policy on the value of insurance and the cost of visits to the doctor is gradually being established. In the United States, insurance usually covers only part of the cost, for example, two-thirds, and patients are responsible for the rest.
In order to make the insurance system function better, the government granted tax incentives to small and medium-sized businesses that can provide insurance to their employees. In 2011, changes affected the social insurance system Medicare (Meinhofer & Witman, 2018, p. 183). Physicians working with low-income populations will receive a pay raise. Those who use their services will be entitled to an annual examination free of charge.
They will also receive a variety of supplementary assistance services. The indigent, who need constant care, will have the opportunity to live in specialized medical centres. However, pharmaceutical companies pay an annual tax, which is calculated based on their market share (Meinhofer & Witman, 2018). The innovation will not affect only the companies whose yearly income is not more than 5 million dollars. In 2012 programs began to improve the efficiency and control over hospitals, children’s clinics and nursing homes (Meinhofer & Witman, 2018, p. 180). Moreover, in 2013, taxes to support the Medicare system increased. As a result, in 2014, insurance became mandatory for most people living in the United States; otherwise, they would have to pay a fine (Meinhofer & Witman, 2018, p. 180). In the future, the reform will continue, and requirements for insurers and employers will increase. Therefore, the incremental implementation of the policy will gradually prioritize vulnerable populations.
The Affordable Care Act will provide all Americans, including LGBTQ+ Americans and poor people, with enhanced access to health insurance through an expanded, more substantial Medicaid program. It also includes new accessible insurance exchanges, quality and affordable health insurance markets. A collection of 10 classifications of services that health insurance plans are required to include under the Affordable Care Act (Meinhofer & Witman, 2018, p. 180). These include physician services, inpatient and outpatient hospital care, prescription drug payments, pregnancy and childbirth, mental health services, and more. Accordingly, these populations will gradually be afforded adequate health insurance coverage.
Policy Objectives and Administration
It is essential to mention the goals and consequences of implementing a health care policy. The short-term goal of the Affordable Care Act (ACA) is mandatory health insurance for the 32 million Americans who do not have health insurance. These are primarily middle-class Americans who are unable to purchase expensive commercial insurance. Nevertheless, their incomes do not allow them to take advantage of the government’s Medicaid subsidy program for low-income citizens (McIntyre & Song, 2019). The long-term objective of the law is a reform that will help reduce costs per individual patient, invest more money in medicine, and create several hundred jobs. The effect of the law has been to expand insurance policies and increase the overall health of U.S. citizens.
At the same time, the law is under the Health Insurance Portability and Accountability Act. This act regulates and develops public insurance in the United States (McIntyre & Song, 2019). The Affordable Care Act is passed with the understanding that the federal government provides the funding. Therefore, the government pays 100 per cent of the cost of coverage in Medicaid (McIntyre & Song, 2019). Moreover, the organization has the authority to promote many Affordable Care Act items, which enables it to evaluate and coordinate people’s insurance policies.
The Effectiveness of Policies
In order to assess the effectiveness of a law, it requires constant reversal according to officially established or unofficial criteria. There are two main criteria for evaluating the effectiveness of the law: improved health outcomes and cost savings. It is significant to mention that the first attempts to assess the effect of the law on the U.S. population were made by researchers in 2015 (McIntyre & Song, 2019). They investigated the affordability of health insurance for Americans. However, the researchers observed that five years is a short period, which does not enable them to accurately assess the law’s impact on the cost and quality of health care.
These criteria have also recently been applied, and it was found that the ACA has incredible potential to enhance the health of individuals with chronic conditions such as diabetes. Researchers evaluated the available data and concluded that uninsured adults between 19 and 64 with diabetes have less access to health care (McIntyre & Song, 2019, para 4). Accordingly, the ACA enhances people’s access to preventive health care. Generally, there is a rule that the basic provisions of the law are permanent and have no expiration date. Nonetheless, it is anticipated that the policy may be abolished by Congress or by a decision of the US Supreme Court declaring the legislation unconstitutional.
It should be emphasized that health care reform was in accordance with a scientific basis. Peter Orzag was formerly director of the Congressional Budget Office. Under Orzag’s leadership, the agency was engaged in a cost-benefit analysis of creating an effective health care system. At the same time, the policy was influenced by an article in “The Annals of Internal Medicine” by Elliot S. Fisher and David Wennberg (McIntyre & Song, 2019, para 5). After the publication of this article, Orzag assessed the possibility of increasing care for the uninsured population. In the long run, this would reduce government spending and provide every citizen with adequate health care (McIntyre & Song, 2019). Moreover, the Dartmouth findings, which presented a comparison of two Texas counties with considerable variations in Medicare spending, also became the scientific underpinning for the new legislation.
References
McIntyre, A., & Song, Z. (2019). The US Affordable Care Act: Reflections and directions at the close of a decade. PLoS Medicine, 16(2), e1002752. Web.
Meinhofer, A., & Witman, A. E. (2018). The role of health insurance on treatment for opioid use disorders: Evidence from the Affordable Care Act Medicaid expansion. Journal of Health Economics, 60, 177-197. Web.