ACA Health Policy on the Political Arena

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Introduction

One should focus on several aspects to unveil the issues of ACA health policy, its current challenges, and future use. First, one needs to research the policy background, especially the one of ACA law (2010) and the contribution of partisan aspects to it. Then, one must explore the challenges associated with the policy and the stakeholder situation. Next, the policy options and trade-offs will give a direction for the further development of the policy. It could be formulated into a set of recommendations for the institutions. Thus, the recommended measures will indicate specific implications for population, politics, economics, and health organizations. In the end, the said aspects will allow forming an elaborate analysis of the ACA health policy perspectives.

Overview and Significance of the Healthcare Reform Policy (2010)

Healthcare reform policy of the Democratic government, later known as “Obamacare”, is a complex phenomenon with advantages and disadvantages. Starting with the Affordable Care Act (ACA) of 2010, the reform was positioned as a set of political, economic, and health measures meant to improve the quality of healthcare. The main improvements should have included the expansion of insurance coverage and the Medicaid system, as well as the rise of Accountable Care Organizations (ACO).

On the one hand, the policy achieved significant results, and, according to Skinner, & Chandra (2016), its prime goal of expanding insurance coverage has been met. On the other hand, the reform possesses some notable limitations. Furthermore, it has remained in the center of political struggle between the Democratic party, the reform initiator, and the Republicans as the opposition. Thus, while the reform has produced positive outcomes, it still has a room for reforming.

History of the ACA Policy

ACA policy was one of the main points promoted by Barack Obama during his presidential election campaign. As soon as he was elected, the legislative procedure of the act was put into the motion. In 2009-2010, the law was being developed, primarily by the Democratic majority, although, according to Béland, Rocco, and Waddan (2014), their partial help was present in preparing the bill. In the end, the bill successfully passed the procedure of approval by the Senate and House of Representatives and was signed by President Obama on March 23, 2010.

However, the implementation phase of the law has faced several obstacles which hindered the ACA’s performance on a state level. The researchers note that “ACA dispersed governing authority to a patchwork of state governors, legislatures, and regulatory agencies” (Béland et al., 2014, p. 52). It opened enough space for the opponents to reject the reforms, especially in the states dominated by Republicans. These states, particularly, the southern ones, openly voiced against the ACA and refused to implement most of its features.

The problem of the Medicaid expansion was critical since the states’ government notably rejected the feature. The federal government tried to make the states abide by using a financial penalty. However, as noted by Béland, Rocco, and Waddan (2015), the decision of the Supreme Court allowed avoiding such a fine without breaking the law. As a result, the increase in insurance coverage is demonstrated mainly by the states supporting the central government initiative. According to Blumberg and Holahan (2016), the tendency effectively limited “the ability of the law to increase insurance coverage in that region” (p. 539).

A new chapter of the ACA history began after the end of Democratic dominance when Republicans seized the majority in the Congress, and Donald Trump won the presidential elections. Although Republican attempts of repealing the law started on the first stages of its implementation, they have become especially frequent. However, the ACA law turned out to be a challenge. As Wilensky (2017) notes, a simple majority is not enough to push the cancellation of the bill the Senate. Thus, Republicans managed to change only several aspects of the law without replacing it entirely. Mainly, their actions included non-budgetary regulations — the bills of limiting Medicaid expansion and the reduction of individual mandates of insurance coverage.

Current Challenges of the ACA Law

Judging from the process of ACA rise and the repeal attempts, one can highlight the main challenges associated with the law. Most of them are connected to the perspective of being replaced. After all, the situation of ACA’s results appears as a complex issue. While ACA produced notable improvement in enhancing the insurance situation, it possesses setbacks. According to Blumberg and Holahan (2016), several categories of the population remain uninsured, either due to the resistance of their state government or financial ineligibility. However, the researchers argue that the total repeal of the law would lead to the disastrous outcomes which could negate previous achievements (Holahan & Blumberg, 2017).

Thus, the first challenge lies in the development of alternative programs and methods to fix the errors of the ACA. However, if one considers the political struggle aspect, the second challenge of approving such changes also appears. According to Wilensky (2017), while the ACA can be modified into a fitting strategy for the Republicans, their Democratic opposition will try to block their attempts. Thus, the changes for the ACA are further complicated by the power conflicts. Also, as Greer (2015) notes, the law “is a thoroughly American approach” (p. 474), raising the question about the use of other countries’ experience.

Stakeholder Analysis

To analyze the composition and the position of stakeholders affected by the law, one needs to divide them into two distinct groups. One of them consists of political actors, who, according to Béland et al. (2015), “play leading parts” in the law’s passage, implementation and changes (p. 720). The second one includes the parties directly connected to the healthcare field — healthcare workers, customers, specialists, and advisors.

Regarding the first category, it was already implied that the political forces of Democrats and Republicans remain as influential stakeholders. The researchers note that the constitutional core of ACA makes it specifically dependent on the current government decisions (Béland et al., 2015). Moreover, the parties possess specific principles which affect the law’s future. For example, according to Wilensky (2017), the insurance subsidies offered by the Democrats’ ACA law can be changed into refundable credits, consistent for the Republican policy. Thus, the political dominance over the formal law procedures cannot be underestimated.

Another side of the coin is the position of the groups related to the healthcare policy. As the study of Housten et al. (2017) shows, stakeholders of various levels can provide feedback regarding the practical sides of the law. Furthermore, they may direct the recommendations on the risks of the policy, creating a base for the improvement strategies. Also, the general population may be able to influence the further advancements of the law by using their experience to rely on a chosen political power.

Healthcare Policy Options and Analysis of Trade-Offs

In the light of these contradictions, one can find several sets of options which depend on the political directions. Technically, they may be divided into two groups which represent the course of Democrats and Republicans respectively. The first one implies the further improvement and extension of the reform grounded on the ACA. The decisions may consist of gaining support in the opposing states, enhancing the insurance coverage gains and propagating the benefits of Medicaid expansion. However, Republican politics would offer another set of solutions — the abolishment of the ACA to replace with the alternative program.

Nevertheless, both parties should consider the reform’s outcomes, including the benefits for Republicans and disadvantages for Democrats. Thus, the characteristic feature of their option should be the use of ACA’s current position for the sake of healthcare reforming.

The trade-offs also seem like a significant component of the discussion since they are based on the parties’ political and economic preferences. Nowak, Saltzman, and Cordova (2016) state that there is a trade-off in the increase of insured population, in exchange for the crowd-out of employer-sponsored insurance and more government spending. Furthermore, one can find more trades in insurance coverage, like the creation of financial barriers. According to Selden, Lipton, and Decker, (2017), this may create problems in paying medical bills or the reduction of taken medicine due to the cost. The mentioned features once more prove the necessity of changes for the ACA healthcare policy.

Current Health Policy Recommendations

Due to the mentioned controversies of the health policy around ACA and “Obamacare”, the situation with the policy guidance remains complicated. However, if one considers the advantages and disadvantages of the ACA, as well as its status in the political arena, one may be able to come up with a set of recommendations. These recommendations are supposed to guide further improvements in the health sphere and reduce the risks. Moreover, the federal government, state governments, and current market would all possess specific roles necessary for success.

The topics of recommendation can be narrowed down to several aspects. Firstly, one should fix the individual mandate penalties, which, as stated by Karpman, Blavin, and Zuckerman, is considered “the most unpopular feature of the ACA” (as cited in Holahan & Blumberg, 2017, p. 5). Secondly, it is necessary to reduce the crowding of the employer mandate, which, as researchers note, only creates complications without further improvement (Holahan & Blumberg, 2017).

Thirdly, one should implement measures for removing the financial barriers of insurance coverage. After all, according to Polite et al. (2014), ACA insurance still has problems with reaching to the population below the federal poverty level. Also, it creates borders between the current and new Medicaid beneficiaries. Finally, one of the most crucial tasks is reaching the consensus between interested parties. Jointly, they could work upon a compromise project which would neither reject all the ACA features, but still reform it.

Recommended Roles for Government and Market

For each of the tasks, the governmental institution and current market have their roles. The federal government should focus on achieving compromises with the opposition and making a draft of ACA reformation guidelines. Also, there is a goal of compromising with opposing state governments by negotiating about the terms of approval. Thus, the state governments could develop their suggestions and become responsible for implementing the approved changes. In the end, the current market dynamics would show the effectiveness of the deployed projects, both countrywide and in each state. Such a tendency would produce new recommendations to enhance the advantages and minimize risks.

Implications of the Healthcare Policy Recommendations

The recommendations are meant to be applied for the several fields connected to healthcare, so that they may achieve positive effects. Therefore, it is necessary to evaluate the possible implications. They should be focused on the population, economics, and healthcare organizations, which show both causes and consequences of healthcare changes. Furthermore, because of the healthcare political nature, the political actors would be affected as well. Finally, one should apply two core values of Saint Leo University, which seem the most crucial for the tasks.

Analysis of Population Health Implications

The insurance coverage, which relatively succeeded after the ACA approval, can be spread between more vulnerable categories of the population. According to Holahan & Blumberg (2017), “A major criticism of the ACA—from both supporters and opponents — is the continued presence of high nongroup cost-sharing requirements…” (p. 8). Thus, a rational policy of improving the ACA would widen the insured population, as well as reduce the oversized spending on several services and taxes.

Analysis of Economic Implications

Secondly, the economics would also benefit from the use of recommendations. After all, healthcare is still a part of the labor market, which remains interested in raising the economic affordability of the customers. Blumberg and Holahan (2016) note about Medicaid, that “Federal dollars flowing into expansion states have a positive macroeconomic effect, increasing state GDP, tax revenues, and employment” (p. 542). Thus, the improvement in affordability and penalties may lead to an advancement in the economic values across the country.

Analysis of Political Implications

The politicians should be content with reaching some of their goalsse if they agree on concessions with the political opponents. As already said, the Republicans tried to rebuke ACA law entirely but failed. According to Wilensky (2017), the Democratic opposition could halt the progress of solely Republican policy objectives even in the minority. However, because of the opposition, they can implement changes only through compromises with the Republican government. So, both sides of the political struggle are interested in applying their suggestions through the dialogue with each other.

Analysis of Implications for Health Care Organizations

The medical organizations, as one of the main targets of ACA changes, should benefit from the recommendations as well. According to Skinner and Chandra (2016), the Medicare system of ACA may be viewed as a tool for disrupting the monopolies of traditional healthcare organizations. Thus, the inclusion of more population categories into the system could lead to the evolution of older healthcare organizations into the modern versions.

Application of Two Saint Leo University Core Values

Finally, one should note that the recommendations are highly compatible with several core values presented by Saint Leo University. Firstly, the responsible stewardship should be in line with the opposing sides’ compromises, for the sake of common good and improvement of healthcare. Secondly, the community principle parallels the recommendation of expanding the insurance affordability since it allows learning from the previous advantages and disadvantages and changing as a result.

Conclusion

Healthcare policy, which was initiated by the Affordable Care Act (ACA) of 2010, produced several positive outcomes, including the expansion of the insurance coverage. However, it has become a field of confrontation between the initiators, Democratic party, and the opposing Republicans. Moreover, the setbacks required bringing the changes to the law in the future. So, the debates around it demand a closer look at the policy history, challenges, options, and recommendations.

In the process of ACA development, it faced no opposition on the federal level because of the Democratic government in power. However, several Republican state governments rejected the features of ACA and were supported by the Supreme Court verdict. After the change of government, Republicans managed to undo some ACA postulates, although they failed to replace it. Thus, the political struggle around the ACA change or repeal remains at the center of the health policy challenges.

The influence of the political parties and the population deployed in healthcare as the stakeholders can be considered essential. Regarding future options, there may be two directions representing the political spectrum. From the Democratic side of view, the most significant task would be the improvement and modification of the ACA policy. However, for the Republicans, the law must be replaced by a new one, more suitable for their objectives. Both sides have a rational point because of the ACA disadvantages — trade-offs between insurance coverage and financial barriers.

The possible recommendations for changing the healthcare policy might include fixing the individual and employer mandates, as well as improving insurance accessibility. All the measures require reaching a political consensus between the parties. Thus, the central government must work upon the compromise and creation of the changing guidelines. The state governments should bring suggestions for their modifications, and the current market could show the efficiency of the decisions.

One must state the specific implications of the given recommendations. Firstly, the population would benefit, especially those still vulnerable to insurance coverage. Secondly, the economics could get an increase in finances, the customers’ number, and the employment rate. Thirdly, through the compromise, both Democrats and Republicans would reach at least some of their goals. Fourthly, the medical organizations may improve their modernization process. Finally, most of the suggestions appear in line with Saint Leo University core values of community and responsible stewardship.

References

Béland, D., Rocco, P., & Waddan, A. (2014). Implementing health care reform in the United States: Intergovernmental politics and the dilemmas of institutional design. Health Policy, 116(1), 51-60.

Béland, D., Rocco, P., & Waddan, A. (2015). Polarized stakeholders and institutional vulnerabilities: The enduring politics of the patient protection and Affordable Care Act. Clinical Therapeutics, 37(4), 720-726.

Blumberg, L. J., & Holahan, J. (2016). Early experience with the ACA: Coverage gains, pooling of risk, and Medicaid expansion. The Journal of Law, Medicine & Ethics, 44(4), 538-545.

Greer, S. L. (2015). Reflecting on “The 2010 U.S. health care reform: Approaching and avoiding how other countries finance health care.” Health Economics, Policy and Law, 10(4), 473-477.

Holahan, J., & Blumberg, L. J. (2017). Instead of ACA Repeal and Replace, Fix It. Web.

Housten, A. J., Furtado, K., Kaphingst, K. A., Kebodeaux, C., McBride, T., Cusanno, B. & Politi, M. C. (2016). Stakeholders’ perceptions of ways to support decisions about health insurance marketplace enrollment: A qualitative study. BMC Health Services Research, 16. Web.

Nowak, S. A., Saltzman, E., & Cordova, A. (2016). Alternatives to the ACA’s affordability firewall. Rand Health Quarterly, 5(4). Web.

Polite, B N., Griggs, J. J., Moy, B., Lathan, C., duPont, N. C., Villani, G., Wong, S. L., & Halpern, M. T. (2014). American Society of Clinical Oncology policy statement on Medicaid reform. Journal of Clinical Oncology, 32(36), 4162-4167.

Selden, T. M., Lipton, B. J., & Decker, S. L. (2017). Medicaid expansion and Marketplace eligibility both increased coverage, with trade-offs in access, affordability. Health Affairs, 36(12), 2069-2077.

Skinner, J., & Chandra, A. (2016). The past and future of the Affordable Care Act. JAMA, 316(5), 497-499.

Wilensky, G. R. (2017). The future of the ACA and health care policy in the United States. JAMA, 317(1), 21-22.

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