Affordable Care Act (ACA)
The State Health Policy reform innovation selected is the Affordable Care Act (ACA). This law was enacted in 2010 and is a healthcare reform meant to provide affordable health insurance to all citizens. The law is also known as Obamacare. The Affordable Care Act (ACA) expands Medicaid by providing subsidies to people purchasing health insurance through the marketplace. This law also requires every American to have health insurance and all insurance companies to create certain essential health benefits to avoid discrimination against people with pre-existing conditions.
Rationale For the Policy
The primary purpose of the Patient Protection and Affordable Care Act (ACA), the main goal is to make health insurance more affordable and accessible for Americans. The policy accomplishes its purpose by creating new health insurance exchanges and offering subsidies for people who purchase health insurance through expanding Medicaid and businesses (Adamson et al., 2019). The policy also every American citizen to have health insurance or pay the penalty.
The ACA does this by creating new health insurance exchanges, providing subsidies for people who purchase health insurance through the exchanges, and expanding Medicaid. The ACA also requires all Americans to have health insurance or pay the penalty (Adamson et al., 2019). This has necessitated every American citizen to have insurance pushing the policy to be challenged severally in court.
The main reason for creating the Affordable Care Act (ACA) was that most American citizens were uninsured (Adashi et al., 2022). In a report by the Commonwealth Fund in 2014, about 29 million Americans, which make up nine prevent of adult American citizens, lacked insurance coverage through a government or employer program like Medicaid or Medicare. This made up the highest rate of uninsured people worldwide (Adamson et al., 2019). This report indicated that America had the second uninsured adult rate globally after Mexico. The high rate of uninsured Americans is a significant problem because it means that people who are sick or have an accident cannot get health insurance and cannot afford to pay for care (Adashi et al., 2022).
Two critical issues faced by many residents of America, namely high healthcare costs and inadequate accessibility to medical facilities, were targeted through the implementation of ACA. Focusing on ensuring cost-effective coverage for all citizens while maintaining a standard of superior healthcare outcomes remains one of its fundamental goals (Adashi et al., 2022).
Adoption of the Affordable Care Act
With Obamacare or the Affordable Care Act being ratified in 2010 by the United States Government, it was chiefly intended to extend reasonable healthcare alternatives for each citizen residing within its borders (Adamson et al., 2019). Introducing a series of measures to bolster access, The ACA includes provisions that expand Medicaid while instituting health insurance marketplaces and individual mandates (Adashi et al., 2022). To complement these steps in enhancing accessibility, The ACA provides for improving quality through the implementation of accurate metrics and establishing quality councils tasked with clinically probing healthcare facilities.
The stages leading up to the inception of the ACA transpired gradually across a span of years, with an array of modifications made throughout. Ultimately, after undergoing appraisal at committees and on legislative floors within the House of Representatives, a final version emerged by March 2010 (Adashi et al., 2022). Subsequently, this concluding edition was ratified by President Barack Obama himself on March 23 of that year, with its auspicious inauguration scheduled for January 1, 2014.
Multiple government agencies work in concert to implement the Affordable Care Act’s key reforms efficiently (Eliason et al., 2022). Notably, the Department of Health and Human Services (HHS) spearheads major efforts involving expanding Medicaid coverage options, initiating health insurance marketplaces’ formation through legislation provided via ACA incentive programs while issuing quality metrics and improvement tools to inform care delivery practices (Eliason et al., 2022). Concurrently, Centers for Medicare & Medicaid Services aid state governments in coordinating funds to implement these new policies effectively while advancing access throughout national communities where most needed as mandated by federal legislature while concurrently bolstering regulation from an employer perspective.
The Funding Structure
Funding provisions critical to running America’s national health care policy -the Affordable Care Act (ACA)- consists of two elements namely; mandatory payments by taxpayers and collections through taxes paid by Americans earning above$200K ($250K family) (Eliason et al., 2022) . A significant portion of financing comes from regulatory fees placed annually on insurers- utilized in underwriting sick patient treatment costs through building reserve risk adjustment funds. The shortfall triggered by inadequate financial capacity is addressed using Washington-administered transfers (Eliason et al., 2022). A second segment addressing cost-sharing objectives subsidizes premiums for financially challenged households.
The ACA also imposes a tax on high-income individuals and couples who do not have health insurance. This tax is estimated to raise $1 trillion over the next decade. The ACA is funded through a combination of mandatory spending and tax revenue (Eliason et al., 2022). The health insurance providers’ fee and surtax are both mandatory spending, while the tax on high-income individuals and couples is a tax. As a result, the ACA is also reliant on Congressional approval to continue in force.
Ever since its creation, controversy has surrounded the ACA primarily because of hefty expenditures imposed upon businesses and individuals involved with healthcare services. The annual cost attributed solely to health insurance provider fees is anticipated to surpass $285 billion over a ten-year span if current trends continue unabated (Eslami & Semaan, 2023). Further adding to this overwhelming figure are surtaxes which are expected to escalate yearly until reaching an unprecedented sum of around $190 billion annually. These costs are likely to be passed on to consumers in the form of higher premiums. The tax on high-income individuals and couples is also unpopular because it will increase the cost of health insurance for those who can least afford it.
Impacts of Affordable Care Act (ACA)
The US government implemented the Affordable Care Act or Obamacare in March of 2010 with a significant focus on mitigating rising healthcare expenses along with expanding insurance coverage available to American citizens (Eslami & Semaan, 2023). The ACA requires that all Americans have health insurance and provides subsidies to help people pay for health insurance. The ACA also requires that all insurance plans cover certain essential benefits, such as preventive care, hospitalization, and prescription drugs.
The ACA has had a significant impact on the health care landscape in the United States. The number of Americans who have health insurance has increased from 36 percent in 2010 to 47 percent in 2016 (Eslami & Semaan, 2023). The cost of health care has decreased since the enactment of the ACA, largely because more people are now insured and because the ACA has made it easier for people to find affordable coverage. The ACA is controversial, and there are several ways in which it could be repealed or modified. However, so far, the ACA remains firmly established as a major piece of legislation in the United States.
The ACA has impacted people in different ways. Some people have gained health insurance coverage under the ACA, while others have found that their costs for health care have decreased because they now receive coverage through their employer or through a government program like Medicare or Medicaid.
Ethical Outcomes
One of the many changes wrought by the passing of the Affordable Care Act (ACA) has been its impact on American healthcare ethics. A notable area where positive ethical outcomes have been observed is in improved access to medical insurance across society. Upward of 48 million people within America had no form of medical coverage prior to this legislation’s introduction; however, through government-supported financial assistance, those previously uninsured individuals are now able to enjoy broader healthcare coverage (Ginossar et al., 2019). One notable effect of the implementation of the ACA is evident in its enhancement of healthcare services. For example, it has generated an expansion of health care provider resources for people residing in regions with limited or no access.
Although considered progressive legislation aimed at improving access to medical care services for all citizens regardless of status or income levels, the ACA’s effects remain complex from an ethical viewpoint (Ginossar et al., 2019). One adverse outcome stem from its prohibitive nature whereby vulnerable populations continues struggling with attaining affordable coverage or purchasing substandard health plans resulting from insufficient funds (Ginossar et al., 2019). Coupled with this is a concurrent rise in insurance premiums and out-of-pocket expenditures that further burden already struggling patients facing difficulties prioritizing healthcare amidst critical daily living demands.
Conclusion
The Affordable Care Act has had a positive impact on healthcare ethics by improving access to medical insurance. However, there are some negative aspects, such as the prohibitive nature of the legislation, that make it difficult for vulnerable populations to get affordable coverage. The rise in insurance premiums and out-of-pocket expenses also makes it difficult for patients to prioritize healthcare. Despite these challenges, the ACA has made a positive impact on healthcare ethics.
References
Adamson, B. J. S., Cohen, A. B., Estevez, M., Magee, K., Williams, E., Gross, C. P., Meropol, N. J., & Davidoff, A. J. (2019). Affordable Care Act (ACA) Medicaid expansion impact on racial disparities in time to cancer treatment. Journal of Clinical Oncology, 37(18_suppl), LBA1–LBA1. https://doi.org/10.1200/jco.2019.37.18_suppl.lba1
Adashi, E. Y., O’Mahony, D. P., & Cohen, I. G. (2022). And Then There Were Three: The Decimation of the Affordable Care Act (ACA) CO-OPs. The Journal of the American Board of Family Medicine, 35(4), 867–869. https://doi.org/10.3122/jabfm.2022.04.210533
Eliason, E. L., Spishak-Thomas, A., & Steenland, M. W. (2022). Association of the affordable care act Medicaid expansions with postpartum contraceptive use and early postpartum pregnancy. Contraception, 113, 42–48. https://doi.org/10.1016/j.contraception.2022.02.012
Eslami, M. H., & Semaan, D. B. (2023). Increased Medicaid eligibility of Affordable Care Act: Evidence of improved outcomes for patients with peripheral artery disease. Seminars in Vascular Surgery, 36(1), 58–63. https://doi.org/10.1053/j.semvascsurg.2023.01.004
Ginossar, T., Van Meter, L., Ali Shah, S. F., Bentley, J. M., Weiss, D., & Oetzel, J. G. (2019). Early Impact of the Patient Protection and Affordable Care Act on People Living With HIV. Journal of the Association of Nurses in AIDS Care, 30(3), 259–269. https://doi.org/10.1097/jnc.0000000000000079
Simes, J. T., & Jahn, J. L. (2022). The consequences of Medicaid expansion under the Affordable Care Act for police arrests. PLOS ONE, 17(1), e0261512. https://doi.org/10.1371/journal.pone.0261512
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