Policy analysis of the Affordable Care Act's provisions and impact

¶ … students complete a policy analysis Patient Protection Affordable Care Act (ACA) . The paper include unbiased discussion sides issues, impact existing programs/agencies, costs implement, relevant statistics, role government (federal/state) influence special interest groups.ID

RECCOMENTATIONS

Patient Protection Affordable Care Act (ACA)

The Affordable Care Act (ACA) is one of the most controversial bills passed by the U.S. Congress in recent memory. Its provisions include an individual mandate that all Americans purchase some form of healthcare coverage, if financially able to do so. While it continues to be a source of political controversy, the systemic structural problems of U.S. healthcare, such as its spiraling costs, remain unaddressed. Universal coverage through publically-supported insurance is politically unpalatable and even moderate reforms like the ACA generate rage in many segments of the electorate, despite the popularity of many of the ACA's actual provisions.

INTRODUCTION

The Affordable Care Act (ACA) was the result of many years of controversy regarding how healthcare is provided in America. The failure to reform America's healthcare system, which has been widely criticized as one of the most expensive and least efficient systems in the world, was one of the most notable failures of the early Clinton Administration. President Obama, the son of a woman whose life was taken by breast cancer, was determined to enact reforms during his administration. While the ACA does not provide completely equitable and universal coverage, it substantially expands the services available to consumers of healthcare.

In contrast to other major industrialized nations, Americans are not entitled to universal healthcare coverage as a right, nor are healthcare insurance companies heavily regulated. "The number of people without health insurance has increased steadily since the beginning of the century, now totaling about 47 million Americans...Medicaid and the State Children's Health Insurance Program help to fill in the coverage gap for millions, especially children" (Access to healthcare and the uninsured, 2012, NCSL). The ACA is designed to rectify this situation, if not in whole, at least in part, and also hopes to curtail the spiraling costs of care in general.

REVIEW OF LITERATURE

One example of how the Affordable Care Act expanded the right of consumers to healthcare was terminating the ability of healthcare companies to exclude individuals with pre-existing conditions to obtain healthcare. It also allowed young adults under the age of 26 to remain on their parents' health plans and banned arbitrary rate hikes and premium increases (The Patient's Bill of Rights, 2012, Healthcare.gov). It restricts health insurance companies from setting dollar limits on health expenses and demands that premiums be spent primarily on care, rather than administrative costs (The Patient's Bill of Rights, 2012, Healthcare.gov).

The ACA will substantially expand the options of ordinary Americans who, up to now, have largely done without health insurance. Taking effect in 2014, "Americans will have access to the same healthcare choices as Members of Congress. Individuals will be able to purchase insurance through Affordable Insurance Exchanges (competitive marketplaces where people will be able to compare plans and make the choices best for them). Members of Congress will also get their coverage through the exchanges" (Congress will have the same healthcare as the rest of us, 2012, Thanks Obamacare).

Although some of the provisions of the ACA are popular, even amongst the president's opponents (such as the allowance for young adults who have been particularly hard-hit by the recent recession to remain covered by their parent's insurance) the most controversial aspect of the new law is clearly that of the individual mandate. The mandate states "all individuals who can afford health-care insurance purchase some minimally comprehensive policy" (Klein 2012). This has been portrayed as an infringement of individual liberties by conservatives. Proponents of the individual mandate note that its dictates are relatively moderate. It affects "people for whom the minimum policy will not cost more than 8% of their monthly income, and who make more than the poverty line. So if coverage would cost more than 8% of your monthly income, or you're making very little, you're not on the hook to buy insurance (and, because of other provisions in the law, you're getting subsidies that make insurance virtually costless anyway)" (Klein 2012).

Part of the theory behind the individual mandate is to ensure that there is a larger risk pool for insurance companies. This will theoretically curtail healthcare costs. One the problem with American healthcare is that many of the 'well population' (young people without serious health conditions) ignore the need to buy themselves healthcare coverage if their employers do not provide it, because of the expenses they are facing (such as student loan debt, which has been climbing in recent years). Those who are covered tend to be more seriously ill and need more consistent medical care, driving up healthcare costs. So when the uninsured do get injured, they must rely upon emergency rooms and other financially inefficient means of providing care. They also do not seek consistent preventative care because of a lack of coverage, such as routine screenings for common chronic conditions.

The individual mandate is designed to protect against such 'freeloading' and is, the bill's proponents state, required to prevent individuals with preexisting conditions from being excluded. "Now that insurers can't discriminate based on preexisting conditions, it would be entirely possible for people to forgo insurance until, well, they develop a medical condition. In that world, the bulk of the people buying insurance on the exchanges are sick, and that makes the average premiums terrifically expensive. The mandate is there to bring healthy people into the pool, which keeps average costs down and also ensures that people aren't riding free on the system by letting society pay when they get hit by a bus" (Klein 2010)

CONCLUSION

Healthcare reform is one of the issues on which President Obama has staked the reputation of his presidency, and the fate of reform remains uncertain if the U.S. Supreme Court strikes down the law. Despite enacting a similar individual mandate in Massachusetts, Obama's Republican opponent Mitt Romney has come out against the ACA. However, Republicans are aware of the fact that many of the law's provisions currently enacted into law, such as allowing young people to remain on their parent's insurance, are quite popular. There has been an emotional groundswell of support against the bill, given the rise of anti-government sentiment in general in the United States. Concerns about government spending for entitlement programs like Medicaid and Medicare have also fueled rage against the bill. The complexity of the bill, its multi-tiered enactment, and the emotional issues it raises for many Americans suggest that the controversies surrounding the ACA will continue for many decades as Americans continue to figure out what the passing of the bill means to them personally.

RECCOMENDATIONS

Regarding the provision of healthcare, America is far from the envy of the world. "50% of U.S. personal bankruptcies are due to medical bills...Great Britain, Japan, Taiwan, Switzerland and Germany -- spend roughly half as much on health care as the U.S. spends, and have better outcomes" (Swenson 2009). Not all countries are completely nationalized -- some have private insurers, but private insurance companies are prohibited from profiting from basic care. All have mandates that citizens must buy health insurance, and provide financial support for citizens who cannot afford to do so.

The U.S. stands alone in the design and the waste generated by its healthcare system, and cannot afford to do so. The ACA was a step in the right direction to expand coverage, but its limits upon insurance companies were not enough to full reign in healthcare spending. All Americans must be insured and receive proper preventative care, and be forced if able to do so, to 'pay into the system.'