ACA Strengths, Weaknesses, and Health Care Reform Ideas

Introduction

The Affordable Care Act (ACA), also known as Obamacare, set about reforming the health care system in America in order to enable more people to obtain access to health care. The ACA arrived with a number of strengths and weaknesses. Altogether, the Act affected patients' access to and quality of health care, and it also impacted the cost of care system-wide. This paper discusses the ACA's strengths and weaknesses while describing its impact on health care in America. It also provides a discussion of how the current health care system could be changed and improved from the standpoint of access, quality, and cost.

Strengths and Weaknesses of the ACA

While the ACA's biggest supposed strength is the 20 million people who obtained health coverage as a result of the Act, one of its main weaknesses is the fact that it has done little to reduce the bureaucratic red tape that causes problems for providers, facilities, and health care workers in various ways. The "competitive grants for regionalized systems for emergency care response" (ACA, 2010, Sec. 1204, 124 STAT., p. 518) that were instituted by the ACA to ensure that federal dollars went to places where they would be used most effectively sounds good on paper—but the reality is that Accountable Care Organizations (ACOs) that have emerged as a result have placed restrictive conditions on many providers, which in the end harms patients (Alpert, 2013). EMS workers, for instance, must adhere to new rules that determine where they take patients, as some facilities will not accept them because of ACA and ACO restrictions stemming from the patient's history and the facilities' history in treating that patient. So while the 20 million newly covered patients is touted as a strength of the ACA, the reality is that conditions apply. Eckstein (2013) summarizes the problem succinctly when he states that "government-provided health insurance rates of reimbursement do not lend themselves to a successful business model, especially one in which lives are on the line" (p. 2068).

Other strengths of the ACA included its goal of eliminating "lifetime and annual limits on insurance coverage" while ensuring that health care providers would offer patients "preventive services" to help stave off health issues (Jacobson-Vann, 2011, p. 100). The ACA was also meant to guarantee greater "access to health insurance for individuals with preexisting medical issues," and to compel states to have the necessary "flexibility to establish health care programs for low income non-Medicaid eligible clients" (Jacobson-Vann, 2011, p. 100). In short, the ACA's intentions were its main strengths, but the reality of the situation has revealed its weaknesses: ideals do not necessarily translate into good or effective policies.

The real weaknesses of the ACA were that its policies were undermined by the very essence of subsidization that sits at its core. By subsidizing health care, the ACA continues the escalation of the cost of care. While the ACA was meant to increase preventive medicine, the fact that it continues to subsidize treatments has ensured that treatments are what get implemented most often—since treatments rather than prevention are what generate profits (Goldhill, 2009). In other words, if the ACA truly intended to make health care affordable, it would have done the one thing that alone could reduce costs: get government out of health care—that is, end subsidization.

The big strength that the ACA was able to tout—its granting of access to care to 20 million people—did not really address the issue of quality or cost. In fact, by guaranteeing that access, it actually diminished the likelihood of both quality and cost being managed efficiently. Thus, its main strength is also, in effect, its biggest weakness and the factor that has most undermined the ACA from the outset.

Conclusion

Access to care, quality of care, and cost of care are all intertwined in the health care industry. The fact that it has become an "industry," however, is precisely the issue that causes access, quality, and cost to be so problematic. The government supports the industry—because government and business have become intimately linked in the U.S.—instead of stepping back and allowing providers to actually put people before profits. Putting people before profits in an "industry" is the surest way to go broke in the current environment, especially in a market that is manipulated and controlled by a centralized bureaucracy. Ending that bureaucratic chain and promoting real preventive care is the best way to address the health care challenges of today.

References

ACA. (2010). Sec. 1204, 124 STAT. U.S. Government Publishing Office. Retrieved from https://www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf

Alpert, A. et al. (2013). Giving EMS flexibility in transporting low-acuity patients could generate substantial Medicare savings. Health Affairs, 32(12), 2142–2148.

Eckstein, M. (2013). The ambulance industry struggles to go the distance. Health Affairs, 32(12), 2067–2068.

Goldhill, D. (2009). How American health care killed my father. Retrieved from https://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-killed-my-father/307617/

Jacobson-Vann, J. C. (2011). Slipping through the cracks of the Breast and Cervical Cancer Prevention and Treatment Act of 2000—a tragic case of failed access to care. Journal of Nursing Law, 14(3), 96–106.

Somanader, T. (2016). A look at six years of the Affordable Care Act. Retrieved from https://obamawhitehouse.archives.gov/blog/2016/03/23/look-six-years-affordable-care-act