The healthcare system is one of the most critical components of any nation that demands the full commitment of all stakeholders in order to provide high-quality services to all individuals regardless of their socioeconomic condition. The delivery of healthcare services in the United States includes a diverse range of stakeholders, including insurers, governments, healthcare workers, payers, researchers, educators, states, and the private sector. The healthcare system in the U.S. is often criticized for a lack of coordination among stakeholders, which results in inefficiencies and complications during service delivery. While the United States provides great medical treatment, the service delivery system and health care economics provide several obstacles to both consumers and practitioners. Analyzing the historical development of the U.S. healthcare system leading to Patient Protection and ACA is a critical way to what problems have existed. Also, looking into the pros and cons of ACA will highlight the current status of the U.S. healthcare system.
The issue of health insurance has always dominated the U.S. health system and patient care. While private health insurance dates all the way back to the nineteenth century, social insurance was not introduced until the 1990s (Nakahama, 2020). The first framework of such insurance was intended to provide compulsory health insurance for working-class and low-income people, but was opposed by a variety of groups, along with the commercial insurance industry. Historically, private insurance companies paid for medical services on a fee-for-service basis. In the 1930s, rising healthcare costs and the adverse economic impact of the Great Depression prompted the establishment of prepayment services. Medical care’s limited accessibility and rising costs have led to a widespread implementation of prepaid hospitalization plans. In the 1940s, the first physicians began offering prepaid medical services. The Social Security Act of 1935 laid the groundwork for a welfare medical program, allowing the state to pay directly to nurses, physicians, and health care institutions following its expansion in the 1950s. Simultaneously, insurance companies introduced new types of insurance in response to rapidly rising healthcare costs, including extended-care, major medical, vision, and dental insurance. Following the implementation of Medicare and Medicaid, which resulted in a dramatic increase in healthcare costs, health maintenance organizations (HMOs) were formed to contain costs. These organizations offered medical services for a fixed annual fee and placed a premium on outpatient care. In the 1970s, the ERISA law was enacted, encouraging self-insurance and encouraging employers to directly insure their employees to save money. In the 1990s, rising healthcare costs support development to turn to managed care, and preferred provider organizations (PPOs) were formed as a less restrictive hybrid of fee-for-service and HMOs. Then in 2010 came ACA.
President Obama signed the Patient Protection and Affordable Care Act into law on March 23, 2010. It is most often referred to as the Affordable Care Act (ACA) or, more colloquially, as Obamacare (Cutler, 2015). The ACA drastically altered the United States’ healthcare system by lowering the amount of money families and individuals paid for uncompensated treatment. Every American is required to have health insurance, and the act offers aid to those who cannot pay it. Since the law affects such a large number of Americans, it is beneficial to understand the legislation’s history and how it affects yourself and your family. Additionally, you may discover more about your ACA-compliant health insurance plan alternatives with eHealth now. Our trained brokers will assist you in determining the most appropriate plan for an individual and their family.
One of Obamacare’s advantages is that it boosted the number of Americans with health insurance. Within the first five years after the Affordable Care Act’s implementation, almost 20 million Americans gained access to health insurance (Rapfogel et al., 2020). One may claim that prior to the implementation of Obamacare, the majority of low- and middle-income earners lacked health insurance. The bulk of these folks were unable to get health care due to the high cost. Additionally, insurance firms prejudiced against women and those who suffered from chronic diseases. Females were assessed at a greater rate than males. Obamacare restored rationality to the insurance sector. It is critical to remember that the Affordable Care Act does not provide insurance. However, “the law controls private insurance firms to guarantee you obtain greater rights and safeguards, and thereby, assists tens of millions gain access to good quality, affordable care.
Persons with pre-existing medical issues now have access to health insurance under the Affordable Care Act. Before the establishment of the ACA, it was difficult for persons fighting cancer and other pre-existing diseases to acquire health insurance (Goodrich & Conway, 2013). A bulk of the insurance firms rejected to furnish medical protection for these conditions. Today, ACA assures that there is no restriction on the highest sum of funds that an insurer may spend on a patient. Before the Aca, some patients were compelled to delve into their wallets after exhausted the insurance cover. The insurers had the flexibility to set the maximum amount that they may spend on a patient who is suffering from a chronic ailment.
The Affordable Care Act includes several screenings and preventative care. Individuals are just needed to spend a small sum of money for the facilities. The ACA functions under the notion that if individuals are cognizant of their healthcare, they can avert major health concerns in the future. For example, diabetes screening encourages patients to adopt new measures, thereby saving costly and uncomfortable treatment later. The Affordable Care Act has cut the cost of prescription medications. Presently, senior folks may purchase medications at inexpensive costs. ACA intends to cover more inexpensive and prescription pharmaceuticals to assure that they are accessible to all individuals.
On the other hand, ACA has several disadvantages. Obamacare’s critics believe that the legislation is too invasive. They argue that individuals should be allowed to choose whether or not they need health insurance. All Americans must have health insurance under the Affordable Care Act. Americans who do not have health insurance must apply for an exemption or face a penalty. The Affordable Care Act resulted in tax increases (Song, 2021). The government increased taxes in order to fund the Obamacare program. Taxes imposed an additional burden on residents who were already trying to satisfy basic requirements and provide basic services. Aca is alleged to have resulted in employment losses. The majority of businesses have reduced their working hours in order to avoid covering their employees. Despite the growth in full-time positions, businesses have implemented a plan to reduce working hours. The change has impacted the earnings of the vast majority of employees. The Aca resulted in an increase in the level of premiums paid by individuals. Insurance firms increased prices to accommodate those with pre-existing illnesses. Consequently, health insurance has become prohibitively costly for those who previously had it.
Having weighed the pros and cons of ACA. I support the program. The ACA is starting to create equality in health insurance coverage by making health coverage more accessible and affordable and therefore increasing the number of Americans covered, by financing community-based public health prevention programs, and by investing in research and monitoring on key health measures. Before ACA, individual market insurers commonly established price and benefit restrictions and rejected coverage to individuals based on their health condition, a process referred to as medical underwriting. Numerous non-elderly persons have a previous condition, and before ACA, they risked prejudice based on their medical background if they attempted to get insurance on their own. All in all, ACA has increased insurance coverage for millions of Americans, saved countless lives, and enhanced the health care system. The legislation has made a significant difference in the lives of those who were formerly uninsured, have low incomes, or have prior illnesses, to name a few.
Cutler, D. M. (2015). From the Affordable Care Act to Affordable Care. JAMA, 314(4), 337. https://doi.org/10.1001/jama.2015.7683
Goodrich, K., & Conway, P. H. (2013). Affordable care act implementation: Implications for hospital medicine. Journal of Hospital Medicine, 8(3), 159–161. https://doi.org/10.1002/jhm.2015
Nakahama, T. (2020). InsurTech and Private Health Insurance in the United States. Hokengakuzasshi (JOURNAL of INSURANCE SCIENCE), 2020(648), 648_69–648_86. https://doi.org/10.5609/jsis.2020.648_69
Rapfogel, Ni., Gee, E., & Calsyn, M. (2020, March 23). 10 Ways the ACA Has Improved Health Care in the Past Decade. Center for American Progress. https://www.americanprogress.org/article/10-ways-aca-improved-health-care-past-decade/
Song, Z. (2021). Making the Affordable Care Act Marketplace More Affordable. JAMA Health Forum, 2(5), e210276. https://doi.org/10.1001/jamahealthforum.2021.0276