Affordable Care Act (ACA)

The Affordable Care Act (ACA) was signed on March 23, 2010. The law injected vast adjustments to the health insurance structure, including expanding coverage and creating health insurance marketplaces (Borgschulte & Vogler, 2020). The law is sometimes referred to as “Obamacare” because of Obama’s support for and leadership in enacting it. The unwieldy name “Patient Protection and Affordable Care Act,” which Congress gave the bill when first introduced in 2009, can also be shortened to “Affordable Care Act.”

Issues ACA Addresses

The Affordable Care Act attempts to reform the U.S. healthcare system by addressing its main problems: high costs, lack of access, and quality issues. The ACA includes many different provisions that expand insurance coverage, regulate the health insurance industry and improve service delivery. The ACA’s primary focus is expanding insurance coverage to more Americans. It accomplishes this by requiring individuals to purchase health insurance and providing tax credits to help offset the cost of premiums for low-income people. In addition, Medicaid has been expanded to cover more low-income adults (Baumgartner et al., 2020). These provisions aim to reduce the number of uninsured Americans, which currently stands at around 30 million.

Another primary goal of the ACA is to reduce healthcare costs and improve quality throughout the system. To achieve these objectives, the legislation takes steps to reform Medicare and Medicaid payments and increase accountability in both public and private insurance programs (Borgschulte & Vogler, 2020). Efforts are also being made to improve coordination among healthcare providers to receive more consistent care across all settings.

Shareholders of the Policy

The ACA was passed by the U.S. Congress and then signed into law by President Obama in March 2010. Since that time, the law has helped millions of Americans access affordable health care coverage, lowered the rate of uninsured people by half, and reduced the growth of health care spending (Borgschulte & Vogler, 2020). The ACA’s major provisions came into force in 2014.

What Type of Policy is ACA?

ACA is a Law. It is a law passed in 2010 to reform the healthcare system in the United States. The significant changes that the ACA makes include: it required employers to offer health insurance to all their workers, providing tax credits to those who need help paying for their health insurance premiums, limiting insurance companies to provide coverage to individuals with preexisting conditions, and Expanding Medicaid eligibility for low-income adults (Baumgartner et al., 2020). Overall, the goal of this law is to make healthcare affordable for more Americans.

The Framework of ACA

The Policy is allocative. The ACA allocates services to consumers of health care who cannot access it without the ACA. The mandate requires consumers to purchase insurance, while the subsidies and tax credits make it affordable. There is also a similar mandate for healthcare providers in the form of Medicaid expansion. This is designed to increase access to care and decrease costs (Borgschulte & Vogler, 2020). The Medicaid expansion mandates that states expand their Medicaid programs to cover more people with low incomes; this increases access in the states who have decided to participate in the Medicaid expansion.

The ACA does not have many regulatory policies. One example of a regulatory policy included in the ACA was a series of payment reforms designed to change how insurance providers pay doctors and hospitals. These policies included bundled payments instead of fee-for-service, which would hopefully eliminate some unnecessary treatments and tests done simply because they were profitable under the fee-for-service plan (Abramowitz, 2020). Overall, the ACA has not shown much in terms of regulatory changes but instead has been mainly focused on increasing access through allocative policies such as those mentioned above.

Intent, Consequences, and Impact of ACA

The Affordable Care Act sought to improve quality and ensure health insurance is affordable in the United States. The ACA was created to help lower healthcare costs, improve quality of care, provide more Americans with access to affordable health insurance, shield the insured from abusive insurance practices, and scale down the growth in U.S. healthcare spending (Baumgartner et al., 2020). In addition to ensuring that all Americans have access to affordable healthcare coverage, the ACA established new regulations for private insurance companies (Adamson et al., 2019). For example, the law forbids insurance companies from declining coverage or imposing higher deductions if someone has an initial condition.

The Policy has three main objectives:

• Affordable health care:

The law offers subsidies to help Americans with low to moderate-income levels pay for health coverage.

• Medicaid program expansion to include more individuals:

The ACA expanded Medicaid eligibility to include individuals receiving salaries slightly above those supposed to be covered under traditional Medicaid, as well as groups, like adults without dependent children, that previously were not covered.

• Initiate better innovations based on medical care delivery to reduce the costs of services:

The ACA encouraged the induction of Accountable Care Organizations (ACOs) intended to tie provider reimbursements to quality metrics and reduce the growth in healthcare spending. Companies and other organizations are also allowed – but not required – to provide employees a voucher to purchase private insurance instead of offering a traditional insurance plan.

The Policy has resulted in about 20 million more Americans having health insurance coverage. At the same time, many of these people have access to health care services for the first time. The Policy significantly expanded health insurance coverage through two significant reforms: Medicaid expansion and subsidized private insurance plans through state-based exchanges. The ACA’s impact on doctor’s visits, prescriptions, and other access measures to health care services is relatively straightforward (Eguia et al., 2018). According to recent surveys, adults who are now insured through the ACA report increased access to care, fewer problems paying medical bills, reduced or elimination of cost-sharing payments, and improvements in their ability to manage chronic conditions. However, there is less evidence that gains in insurance coverage have led to improvements in the social determinants of health factors like education, housing and neighborhood conditions, employment, access to food, and the built environment, which have a much more significant impact on health than clinical care.

Conclusion

In my opinion, the Affordable Care Act is a good policy because it had given millions of Americans access to health insurance that they could not afford before and also improved many aspects of our healthcare system. However, as with any policy, some flaws need to be addressed. It provides too much generous coverage that increases demand for care while doing too little to increase supply or lower costs. In addition, the ACA’s taxes and penalties encourage people to work less and businesses to hire fewer workers. We need a more straightforward and patient-centered system that gives everyone access to affordable health care without hurting jobs or the economy. One way to do that would be to allow states to develop their versions of the ACA and implement them in addition to federal law.

References

Abramowitz, J. (2020). The effect of ACA state Medicaid expansions on medical out-of-pocket expenditures. Medical Care Research and Review, 77(1), 19-33.

Adamson, B. J., Cohen, A. B., Estevez, M., Magee, K., Williams, E., Gross, C. P., … & Davidoff, A. J. (2019). Affordable Care Act (ACA) Medicaid expansion impact on racial disparities in time to cancer treatment.

Baumgartner, J., Collins, S., Radley, D., & Hayes, S. (2020). How the Affordable Care Act (ACA) Has Narrowed Racial and Ethnic Disparities in Insurance Coverage and Access to Health Care, 2013‐18. Health Services Research, 55, 56-57.

Borgschulte, M., & Vogler, J. (2020). Did the ACA Medicaid expansion save lives?. Journal of Health Economics, 72, 102333.

Eguia, E., Cobb, A. N., Kothari, A. N., Molefe, A., Afshar, M., Aranha, G. V., & Kuo, P. C. (2018). Impact of the Affordable Care Act (ACA) Medicaid expansion on cancer admissions and surgeries. Annals of surgery, 268(4), 584.