¶ … 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...

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)

DISCUSSION

Several components of the ACA, including the individual mandate are currently under review by the U.S. Supreme Court and have become contentious issues in the current 2012 presidential campaign already. "The law's challengers -- 26 states led by Florida, the National Federation of Independent Business and several individuals -- present the central question as one of individual liberty" (ACA, 2012, The New York Times). Opponents of the law counter that it is unconstitutional to 'force' citizens to buy healthcare coverage against their will.

However, some naysayers believe that the bill does not go far enough in terms of its outreach, and would prefer a universal system of care, similar to that which exists in Great Britain or Canada. With or without the passing of the ACA: "All health care spending in the United States is projected to grow at an annual average rate of 5.8% for the period 2010 through 2020, 1.1 percentage points faster than expected growth in Gross Domestic Product (GDP). By 2020, health care spending is projected to be 19.8% of GDP, nearly one-fifth of economic output, increasing from 17.6% in 2010. All health care spending will reach $4.64 trillion in 2020, nearly half of which will come from government sources" (Fleming 2011). Without the provisions of the ACA, healthcare spending is projected to grow only fractionally less.

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…