Health Care Reform in the United States

Health Care Reform:

In March 2010, after protracted public and political debate, the Patient Protection and Affordable Care Act (PPACA) was enacted into law by President Barack Obama. This legislation was one of the many health care reforms initiatives that have sought to rectify major features of the health care system in the United States such as service delivery, care coordination, and financing. Since its enactment, PPACA is considered as a milestone along the historical continuum of health care reform in America. Generally, health care reform in the United States is an issue that has continued to evolve based on the ever-growing health care needs of the population. However, this issue has been characterized with several challenges that are mainly influenced by the public's response to reform efforts.

Principal Features of U.S. Health Care System:

The Patient Protection and Affordable Care Act (PPACA), which is commonly known as the Affordable Care Act was enacted into law in March 2010 though its full implementation occurred in January 2014. The full implementation is characterized with several initiatives including commencement of operations of state health insurance exchanges, Medicaid expansions, flow of individual and small-employer group subsidies, and execution of individual and employer responsibilities (Rosenbaum, 2011, p.130). Notably, the implementation of this act was based on some principal features of the health care system in the United States.

Some of the principal features in the U.S. health care system that influenced the enactment of this legislation include improving quality of health care services, lowering the costs of health care, increasing access to affordable care, enhancing the accountability of insurance companies, and establishing new consumer protections ("Key Features of the Affordable Care Act by Year," n.d.). These are principal features of the United States health care system because the country's health sector has been described as a complex and disorganized set of arrangements to provide care to the population. As compared to other developed countries, the U.S. health care system was far more expensive but still unable to meet the increasing health demands of the population.

The enactment of this legislation faced several challenges including the enactment of state measures and laws that would challenges or opt out of the wider health reform initiatives. Secondly, this act was enacted at a time when the country was experiencing several ambiguities in health care reforms. Third, the law attracted opposition from some segments of the public on the basis that its provisions would contribute to higher costs of drugs and shortage of health care professionals or personnel.

The conditions or principal features of the U.S. health care system were the basis for the historical reform efforts that have been undertaken in the country. These conditions were a reflection of the huge number of the uninsured and underinsured population and the fact that many small businesses do not provide health insurance to their employees. They also reflected the notorious high costs of private health insurance, which made health coverage relatively unaffordable. Therefore, the policy process and political environment focused on these pitfalls in the health sector that needed to be addressed in order to improve accessibility and affordability of health care.

Important Feature of the U.S. Health Care System:

One of the most important features of the health care system in the United States is health coverage given the huge number of uninsured and underinsured people. Health coverage is one of the means of health care financing in the United States that has evolved through a series of social interventions (Bodenheimer & Grumbach, 2012, p.5). Each of these social interventions solved a problem but ended up creating its own problems requiring more intervention. While health care financing has evolved in the history of the U.S. health sector, it is an important feature because of its significance in determining accessibility and affordability of health care services in light of the high costs of health insurance. Therefore, health care financing or coverage is an important health policy and reform that could help improve the accessibility and affordability of care services to the population.

Significant Challenges in Enactment of PPACA:

While the enactment of the Affordable Care Act has in increasing the quality and affordability of health coverage, the legislation has encountered several challenges since it was signed into law. One of the major challenges that have hindered its full implementation is the numerous state actions and laws prohibiting the execution of some of its provisions. Since its enactment, various states have developed laws to restrict, change or oppose certain provisions of this act. Consequently, certain states have opted out of some of the provisions of PPACA and hindered its full implementation.

The nature of the policy-making process is relatively difficult since it is coupled with varying opinions and divisive issues. In most cases, the policy-making process is usually characterized with controversies and debates that are based on political affiliations. For instance, while PPACA received huge support from Democrats, it was largely criticized and attacked by Republicans even after its enactment into law (Leflar, 2013). Republicans capitalized on PPACA's public unpopularity and continued to highlight the challenges associated with its full implementation. These challenges have shown why health reform in the United States has been so difficult, especially in light of the controversies surrounding health reform initiatives and measures undertaken to prevent full implementation.