Affordable Care Act – Issues and Recommendation

Affordable Care Act – Issues and Recommendation

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Table of Content

1. Introduction………………………………………………………………………………3
2. Purpose of the Act………………………………………………………………………..3
3. Historical Efforts to Create a Similar Act………………………………………………..4
4. Key Components of the ACA……………………………………………………………6
5. Positive Effects…………………………………………………………………………..7
6. Consequences of the Components…………………………………………………….…9
7. Current State of the Program……………………………………………………………10
8. Future State of the Program………………………………………………………….….10
9. Conclusion………………………………………………………………………………11
10. References……………………………………………………………………..……..…13

Affordable Care Act – Issues and Recommendation

The research paper focuses on the Affordable Care Act (ACA) that came into force in 2010 with the primary goal of increasing health cover nationally. The government has always aspired to provide health insurance to its people and this began with the development of the Medicare and Medicaid in the mid-1960s. Other Medicare and Medicaid, which are still applicable nationwide, other regulations, including MMA. CHIP, FEHB, and HIPAA were formed in a bid to increase coverage. The study shows how the introduction of the ACA had significant impact on health practice. The key components of ACA are clear that people have the right to affordable health cover, accountability, and quality services when receiving care. The definition of the ACA as it appears in its key components emerge as a policy that is destined to ensure that every American and non-nationals residing in the country have access to improved health care. The study affirms that the ACA is still in force and continues to change how people access health cover and will become prosperous in future by identifying and helping those who still lack cover due to different reasons.

Purpose of the Law

The ACA, also known as Obama Care the Patient Protection and Affordable Care Act (PPACA) was enacted in March 2010. The Act has three chief objectives. The first is to make cheap health insurance accessible to more people (Kongsrvedt, 2012). The law offers buyers with subsidies called superior tax credits that reduces costs for families with incomes ranging from one hundred and four hundred percent of the specified FPL (federal poverty level) (McIntyre & Song, 2019). However, one may still be eligible for the first-rate tax credit depending on 2021 guidelines even if their income is beyond four hundred percent FPL (McIntyre & Song, 2019). The other drive and goal for making the ACA was to offer health cover to all American adults with revenue levels below 138% of the national poverty rates. The other main purpose for introducing the law was to boost innovative medical care provision techniques formed to minimize the costs of health care overall (McIntyre & Song, 2019). Primarily, the act was designed to expand health coverage to millions of uninsured people in the U.S. The Act broadened eligibility to Medicaid, formed a health insurance marketplace, obstructed insurance firms from denying coverage because of pre-existing factors, and required proper plans to insure various key health benefits (McIntyre & Song, 2019). The health insurance marketplace also known as an exchange is run by the federal government and to be eligible one must not be incarcerated, be a U.S. citizen, or reside in the U.S. (Kongsrvedt, 2012). The policy that was formed as a type of employer-sponsored benefit program was created to permit workers to choose the types of gains suitable for their lifestyles (McIntyre & Song, 2019). Its introduction was aimed at making health insurance more cheaply, to foster consumer protections, and to escalate the number of individuals insured by health insurance.

Historical Efforts to Create a Similar Act

Before the introduction of the ACA, the government had made efforts to create policies that offer health cover to Americans. Prior to the establishment of the ACA, President Lyndon Johnson had introduced the Medicare and Medicaid programs in 1965 (Centers for Medicare & Medicaid Services, 2020). The initial Medicare plan was divided into Part A and Part B known as Hospital Insurance and Medical Insurance, respectively. Currently, these two components are referred to as Original Medicare. However, the Congress has made significant changes to Medicare. One evident change is that Medicare provided an opportunity for more people to become eligible for the health cover. For instance, Medicare was widened in 1972 to cover more people, comprising those with ESRD (end-stage renal disease) needing kidney exchange or dialysis, the incapacitated, and those beyond 65 years or above that benefit from Medicare insurance (Centers for Medicare & Medicaid Services, 2020). Furthermore, the changes introduced more benefits such as coverage on prescription drugs. Initially, Medicaid offered medical coverage to people receiving cash aid, but toward the policy covers a larger group. Medicaid now covers low-income families, pregnant women, people who require long-term care, and those with disabilities (Centers for Medicare & Medicaid Services, 2020). Thus, the introduction of the Medicare and Medicaid plans presented a suitable opportunity for Americans to access health cover.

However, various related initiatives were formed in the U.S. with the goal of increasing health cover to various populations. 2003 witnessed a momentous breakthrough in the enactment of Medicare because it was during this period that the Medicare Modernization Act (MMA) was formed. Evaluators believe that the MMA made the most significant impact on the Medicare in more than thirty-eight years (Centers for Medicare & Medicaid Services, 2020). As provided by the insurance policy, private health agendas verified by Medicare changed to be known as Medicare Advantage (MA) Plans. Another related initiative is the CHIP (Children’s Health Insurance Program) that was formed to deliver preventive care and health cover to the millions of uninsured Americans (Centers for Medicare & Medicaid Services, 2020). Most of the children hailed from working families that are not insured yet earned so much to qualify for Medicaid. Today, all states in the U.S. including the District of Columbia, and related territories follow CHIP policies.

However, Americans have also relied on other health cover policies that was formed before the ACA. One particular example is the Federal Employees Health Benefits (FEHB) initiative that was introduced in 1960. FEHB is a program through which the health of employees are offered to civilian state workers and annuitants of the U.S. government (Centers for Medicare & Medicaid Services, 2020). The state offers more than 70% of the measured mean premium of all health plans, not to surpass 74% of the premium for any single plan, which is measured differently for family and individual insurance. The FEHB initiative permits some insurance firms, workers unions, and insurance firms to sell health insurance plans to state workers (Centers for Medicare & Medicaid Services, 2020). Also, the HIPAA (Health Insurance Portability and Accountability Act) that was introduced in 1996 insures workers in the U.S. by making it possible for them to shift with their health coverage from one organization to the other. The initiative also permits employees to apply to different health programs to replace misplaced insurance and to make adjustments for changes in the family setup through adoptions, births, and marriages (Centers for Medicare & Medicaid Services, 2020). Moreover, HIPAA prohibits insurers from discriminating against applicants because of their health issues. In some scenarios, if an insurance firm refutes an employee’s application, the worker may apply for insurance outside the typical period of enrollment. Besides, HIPAA protects state laws that safeguard employees’ insurance rights. Nonetheless, ACA emerges as a comprehensive policy that seeks to provide more coverage to larger populations.  

Key Components of the ACA

It is possible to understand the key components of the ACA by examining the progress the Act made following its introduction of the law in 2010. In 2010 the law that provided a new light to Patient’s Bill of Rights came into effect, safeguarding consumers against possible violations by the insurance sector (Department of Health & Human Services, 2021). The introduction facilitated cost-free preventive care that reached many Americans. Following the introduction, people with Medicare got the chance to receive essential preventive services without charge, and also get a 50% discount on particular drugs (Department of Health & Human Services, 2021). Furthermore, the ACA directs that accountable health care firms and other related initiatives should assist medical practitioners work collaboratively to provide better services. In addition, the ACA advocates for unregulated participation in Health Insurance Markets, and also advocates for unrestricted access to health cover services at an affordable rate (Department of Health & Human Services, 2021). The key components of the ACA have had numerous benefits on benefitting groups.

Positive Effects

One of the positive effects of the ACA and its key components is that it has encouraged the introduction of new consumer protection measures, which increase health cover for Americans. The regulation has facilitated the putting of information for buyers online. The Act provides for where purchasers can compare health insurance protection alternatives and choose the plan that works best for them (Department of Health & Human Services, 2021). Another benefit associated with consumer protection is that the policy has eliminated lifetime restrictions on health insurance coverage. Under the regulation, insurance firms will be forbidden against imposing lifetime dollar regulations on major benefits such as hospital stays. Besides, the key components of ACA advocates for the establishment of consumer assistance initiatives at the state level (Department of Health & Human Services, 2021). Under the regulation, states that apply get federal financial aid to help establish or widen independent operating stations to assist purchasers navigate the private health insurance structure. These initiatives can assist buyers bring forwards any appeals or complaints, enroll in health insurance, and get relevant training concerning their responsibilities and rights in individual health coverage policies or group health plans.

The ACA and its key components have other positive effects on entire health insurance sector. The enactment of the policy while adhering to its fundamental provisions have played fundamental functions in enhancing quality of care and reducing costs. For example, small businesses now have access to health insurance tax credits (Department of Health & Human Services, 2021). It now emerges that approximately four million small firms have reach to tax credits to assist them offer insurance benefits to their employees. The initial phase of the provision offers a credit amounting to 35% of the contribution by the employer to the worker’s health coverage plan. Small and medium enterprises (SMEs) that operate in the not-for-profit sector also get to benefit because they get at least 25% credit (Department of Health & Human Services, 2021). Also related to enhancing quality of life and minimizing costs is that the ACA and its components advocate for providing relief to more than four million elderly citizens, especially those achieve the Medicare prescription medication. A report by the Department of Health & Human Services (2021) informs that an approximated 4 million elderly people will achieve the gap in prescription drug coverage as provided by Medicare in what is called the donut hole. Each suitable old person gets about 250 USD to sustain their income and needs. Moreover, the Act and its key components call for offering free prevention services with the objective of enhancing quality and minimizing costs. The law emphasizes that all new initiatives must address particular services such as colonoscopies without levying any fees. More fundamentally, the law has facilitated the introduction of preventive programs aimed at preventing diseases and illnesses as advocated for in the ACA’s key components. The Act facilitates the release of funds to enhance preventive practices. For example, about $15 billion was released in what was known as the Prevention and Public Health Fund to increase preventive measures and improve public health programs that keep American citizens healthy (Department of Health & Human Services, 2021). The many benefits emanating from the key components of ACA is the key reason why stakeholders strive to improve the functionality of the law.  

Consequences of the Components

It is possible to identify more consequences of the development of the ACA and its primary components. Americans are now able to access affordable care because the Act identifies the need for affordability as a critical component. Americans can now access insurance cover for people without cover yet they live with pre-existing conditions (Department of Health & Human Services, 2021). The ACA facilitated the introduction of the Pre-Existing Condition Insurance Plan that offers alternative coverage choices to people who have remained without insurance for not less than six months because of a preexisting ailment. States have the choice of running the initiative in their respective jurisdictions (Department of Health & Human Services, 2021). If a state decides not to follow this option, the Department of Health and Human Services in the state takes the obligation to establish a relevant plan. Another consequence of the ACA as identified in the key components is that it has broadened coverage for young adults. Under the law, young adults have the permission to use their parents’ health coverage plan until they reach twenty-six years old.  Nevertheless, in the context of existing group health insurance, the benefit is not applicable if the young adult receives health coverage at the place of work (Department of Health & Human Services, 2021). Furthermore, health insurance firms are now more accountable in their practices, thanks to the clear directives of the ACA and its key components. Insurance companies now have the obligation to reduce health care premiums. It is also possible to experience new consumer protection features as provided for in the key components of the ACA. The regulation ensures coverage of people taking part in clinical trials (Department of Health & Human Services, 2021). Insurers are banned from reducing or lessening coverage because a person opts to participate in clinical trials. More fundamentally, the provision provides room to eradicating yearly limits on insurance coverage.

Current State of the Program

The U.S. Supreme Court on June 17, 2021 on the applicability of the ACA showed that the health policy is still effective and all stakeholders should abide by its guidelines and provisions. The Court was dealing with an appeal that challenged the credibility and essence of the ACA and in its ruling it found that the Act has played significant roles in promoting overall health system and in particular insurance coverage since its introduction more than one decade ago (The Commonwealth Fund, 2021). The court ruled that many people, health practitioners and state agencies depend on the protections provided by the law and enjoy substantial financial relief due to its existence (The Commonwealth Fund, 2021). The judgement means that the ACA is fully operational and impacts significantly on people’s lives. Presently, nearly 14.9 million adults with health cover attribute it to Medicaid expansion by the ACA (The Commonwealth Fund, 2021). More people continue to buy cover through the initiative, especially through the individual market where at least eleven million people have enrolled in 2021 alone. Thus the Supreme Court decision has further reassured the constitutionality of the law, further dementing the program as the cornerstone of the country’s health system.

Future State of the Program

Examining the future of the ACA suggests that the policy is likely to continue impacting on how Americans get health cover and enjoy improved health care, but these beneficial outcomes will only prevail if implementers overcome existing constraints. The Commonwealth Fund (2021) reports that while many Americans have benefitted from ACA, at least thirty million children and adults in the U.S. still lack insurance and another forty million have plans that render them underinsured and likely to pay expensive hospital bills. Thus, to achieve success in future, implementers may have to identify alternative marketing techniques, especially through the use of enticing mechanisms that make every person to reach out for cover. Alternatively, implementers of the policy may have to introduce door-to-door campaigns to make the policy a success.  

Conclusion

The study is a critical analysis of the ACA policy that was introduced in 2010 during Obama’s presidency. The analysis reveals that before the introduction of the ACA, Americans relied on Medicare and Medicaid that were introduced in 1965 by President Johnson. Other regulations such as the MMA. CHIP, FEHB, and HIPAA were introduced before the ACA with the motive of offering health cover to different populations in the U.S. The study identifies the various components of the ACA and describes how they advocate for better services in terms of providing health cover and improving quality of services. Consumers now enjoy enhanced protection measures, preventive mechanisms, accountability, and collaboration that impact on health care delivery and provision of health insurance. Moreover, the key components of ACA outline the importance of offering affordable care and coverage for all Americans. The provision is set to increase the number of people getting fundamental health services without much impact from their economic background. The research reveals that the Act is still in force and impact the way people seek health insurance at affordable rates. Finally, the study shows that ACA will succeed in future if implementers overcome constraints that still leave many Americans uninsured. More people continue to seek health cover as provided for by the ACA and the trend seems to be rising. The judgement of the Supreme Court sets a clear trend showing that more people still rely on ACA for their health cover primarily because of its affordability.

References

Centers for Medicare & Medicaid Services. (2020). History: CMS’ program history. Retrieved from https://www.cms.gov/About-CMS/Agency-Information/History

Department of Health & Human Services. (2021). About the Affordable Care Act. Retrieved from https://www.hhs.gov/healthcare/about-the-aca/index.html

Kongsrvedt, P. (2012). Essentials of managed health care. Burlington, MA: Jones & Bartlett Learning.

McIntyre A., & Song, Z. (2019). The U.S. Affordable Care Act: Reflections and directions at the close of a decade. PLoS Med, 16(2), https://doi.org/10.1371/journal.pmed.1002752

The Commonwealth Fund. (2021). The Supreme Court upholds the Affordable Care Act: What it means and what’s next. Retrieved from https://www.commonwealthfund.org/blog/2021/supreme-court-upholds-affordable-care-act-what-it-means-and-whats-next