Category: Affordable Care Act

Health insurance continues to stir controversy in the world’s top problems. The primary reason for the controversy is the high cost of insurance premiums and the economic recession, particularly during the Covid-19 pandemic period (Vaida, 1). Although medical contingencies can strain the financial base of individuals, empirical research studies from health-related databases have asserted that health insurance should not be mandatory. Firstly, the inflated costs of paying the insurance premiums have an adverse impact on people’s financial stability. Secondly, health insurance doesn’t cover the entire medical costs such as chronic disease care, so a more comprehensive health benefits package will aid in better health outcomes. Thirdly, there is no correlation between health insurance and mortality or an individual’s health status. There is a strong defense for mandatory health insurance, but the costs outweigh the benefits for reasons like high costs, care for terminally ill patients, and conflicting analysis on health insurance.

Health insurance is extremely expensive especially for unemployed youths and low-income earners. Approximately 45% of the Uninsured Americans asserted that the high cost of insurance premiums has led to the withdrawal from health insurance (Young, 1). For example, during the Covid-19 pandemic and economic shutdown, millions of citizens lost their income-generating jobs, which reduced their ability to meet basic needs and pay insurance premiums. Therefore, lack of sustainable jobs or investment opportunities hinders an individuals’ ability to pay for the inflated insurance costs. Arguably, there are numerous cost-efficient programs to cater for medical care such as the cost-sharing programs which encompass fair charges like copayments, coinsurance, and deductibles. The alternative healthcare plans offer more comprehensive and flexible payment plans that suit individuals with low-incomes.

Chronic illnesses have constantly resulted to adverse health impacts and widened the health insurance gap among global populations. There is a growing dilemma and frustration among citizens who paid for health coverage but cannot access medical due to the high costs of terminally ill diseases (Young, 3) For instance, a patient diagnosed with Cancer may require weekly radiotherapy or chemotherapy sessions to treat their conditions, but the medical expenses may exceed the insurance coverage. Although the Affordable Care Act (ACA) suggests that all American citizens are entitled to expansive healthcare, health insurance is delimited on the quality of care and extent of coverage it offers (Clemmitt, 3). Some patients may be forced to wait in long queues for their treatment because the insurance package is limited to certain healthcare providers. Therefore, some insured patients are left in distress after depleting their health coverage limits and may be forced to conduct medical appeals or fundraisers to meet the accumulated health costs. Such health insurance issues expose middle-income earners to ideological challenges that relate to medical coverage decisions.

There is no correlation between healthcare coverage and the individual’s health status or mortality rates. Since the enactment of the Affordable Care Act, the number of uninsured citizens has risen from 10.7% to 13.3 % indicating the insurance gap with the health insurance services (Vaida, 5). For instance, people still have access to comprehensive health benefits from the government’s initiative for affordable medical care. Therefore, the disruptive and expensive health premiums or deductibles are not as important for low-income earners. The population can still access and utilize the healthcare services offered, thus they may not be at risk of poor clinical outcomes or high mortality to inaccessible healthcare. Similarly, the federal health policies have diversified the approaches to equitable medical care, which surpasses the limited privileges that accrue from high insurance premiums. The policies have also resulted to improved health infrastructure in most health institutions, such that everyone may utilize the services without discrimination or biases. Therefore, the entire population is assured of future medical security despite their economic status or academic influences, thus the life expectancy of the entire population is increased and the mortality rates are significantly reduced.

Health insurance is an integral aspect of healthcare management and future clinical planning. The actual family or individual spending on healthcare may result in financial strains and economic instability in the governments’ resources (Young 9). For example, health insurance allows an ailing patient to receive treatment and medications on affordable or free terms if their insurance is still valid. It is an off-exchange plan for the insured against medical emergencies with may require heavy investment but they are not able to meet the costs, so the insurer meets their medical expenses. Originally, lack of health insurance may result in a 2.5% tax penalty on the individual’s income or expensive medical costs; however, after the enactment of the Affordable Care Act (ACA), the consumer debt for health insurance was removed (Vaida, 6). Health insurance offers numerous benefits to the insured such as hospitalization or daycare coverage, domiciliary expenses, and ambulatory care plans; which result in better health outcomes for the insured. However, I believe the expansive costs associated with health insurance have reduced the number of medically insured citizens, especially during the recessive period experienced at the Covid-19 outbreak.

The defense arguments against Healthcare insurance in society include; high costs, lack of coverage for terminally ill patients, and mismatch between health insurance and mortality rates. The inflated insurance premiums and high costs of living in the recent past have adversely affected people’s ability to secure health insurance. Coupled with the huge disconnect between health insurance and an individual’s health care status, people have opted to seek alternative approaches for their healthcare investments other than the health insurance policies. Similarly, once the health coverage exceeds the set limits, individuals or households may be forced to seek alternative sources of finances to meet their medical expenses. Such reasons invalidate the dire need for health insurance among the global populations. Moreover, the prevailing federal legislation in healthcare has positively enhanced the utilization and access to healthcare services among the American society. Therefore, the millions of citizens anticipate healthy future and disease-free clinical outcomes, despite their withdrawal from health insurance coverage. Ultimately, the resultant impact is financial stability of households and a keen focus on personal development or economic growth away from the disruptive insurance premiums.

Drug in the United States is an enormous business. Consumptions for social insurance, well-being research, and other well-being things and administrations have risen forcefully in late decades, having expanded ten times since 1980, and now cost the country more than $2.6 trillion every year. The issues confronting the U.S. social insurance framework are not new; they have been talked about throughout the previous 60 years. The issues have not been unraveled in light of the fact that, because of fears of government association, we have been hesitant to force focal arranging and the board on the framework. The U.S. Open uses of medicinal services are about as vast as an offer of GDP as European nations, yet the administration financing is a lot more wasteful. As noted before, the United States spends considerably more cash per capita on medicinal services than some other modern countries. The US per capita well-being consumption was $7,960 in 2009, the most recent year for which information was accessible at the season of this composition. This figure was around 50 percent higher than that for the following two most noteworthy spending nations, Norway and Switzerland; 80 percent higher than Canada’s use; twice as high as Frances’ use; and 2.3 occasions higher than the United Kingdom’s use (Organization for Economic Co-activity and Development, 2011).

An inflow of government assets under the Affordable Care Act gives salary that will be spent in the more extensive economy. In this way, for each dollar spent by the legislature, there is a multiplier impact that will broadly affect the state’s Gross Domestic Product (GDP). The BEA has incorporated evaluations of these multipliers for a wide range of ventures including medicinal services. The information likewise incorporates assessments for the work effect of this extra spending. We apply Arkansas’ RIMS II multipliers for mobile medicinal services administrations and clinics to the COMPARE model’s yield to decide the ramifications of the expanded spending on complete gross yield and work.

This Issue Brief uses new research on the work and medical coverage advertise elements of the Affordable Care Act to experimentally analyze the vital systems of Obamacare and distinguish their belongings, consequently revealing some truly necessary insight into the annulment and-supplant banter. It additionally gives a model to analyze what medical coverage included in the U.S. could look like over the long haul i.e. after the business sectors get an opportunity to subside into another enduring state in light of the arrangements of the Affordable Care Act without nullification. Understanding the impacts of explicit components of the Affordable Care Act, for example, the individual command and premium appropriations is vital to foresee the impacts of any arrangement that tries to supplant all or part of the present framework. This Issue Brief outlines in rundown level detail the effect of these Affordable Care Act components, including a portion of the frequently dismissed advantages of extended inclusion, particularly to businesses, which policymakers ought to consider in the majority of their forthcoming discussions over expenses and the streamlining of activities. (Gruber, 2003)

The ACA exchanges impressive assets to low and direct-salary families by sponsoring medical coverage and extending access to Medicaid. These approaches increment absolute assets for focused family units and decrease their presentation to the money-related dangers related to high hospital expenses. The development of Medicaid can possibly give generous advantages to the populace under 138 percent of the neediness level. This fragment of the populace is excessively uninsured and in this way has restricted access to social insurance administrations. The extension of Medicaid would prompt a considerable reduction in mortality. It is discovered that expresses that had extended Medicaid since 2000 saw a decline in balanced mortality of 19.6 per 100,000 for the whole populace. Likewise, it confined the decrease for the recently secured populace and assessed a decline in mortality of 2,840 for each 500,000 every year (or 568 for every 100,000). These qualities will differ significantly relying on the basic well-being of the recently safeguarded populace. There are different impacts of Medicaid extensions that we didn’t measure in view of vagueness in the writing or inadequate information. The writing on these impacts and notes that past mortality, the impacts of protection extensions on results are variable and conflicting. (Sommers, Baicker, Epstein, 2012)

The Affordable Care Act has had the capacity to convey medicinal services inclusion to millions more Americans than at any time in recent memory, lessening the uninsured rate to 8.6 percent. Be that as it may, the milestone enactment has conveyed a few issues to payers.

Benefits have generally diminished for insurance agencies because of the way that they should now oversee social insurance costs for individuals with prior ailments and spread the whole expenses of preventive administrations. While the Affordable Care Act has begun to help ease social insurance variations among US natives, the state and government protection trades have not made payers extremely cheerful. More youthful grown-ups and more advantageous patients have been bound to assume the assessment punishment of the individual command than to buy inclusion on the medical coverage trades, because of high costs, which has left payers with a pool of more seasoned and more diseased populaces. Some national payers have begun to venture once again from working through the open commercial center in light of these difficulties. (Moisse, 2011)

While the new changes have been helpful to those with lower to direct salaries, the advantages haven’t been as incredible for working-class Americans. Indeed, protection premiums have expanded for the individuals who were at that point safeguarded. These days, insurance agencies are required to cover a lot more extensive scope of conditions. This may appear to be something to be thankful for at first look, yet this adversely affects premiums. Also, charges have ascended so as to pay for a portion of the arrangements in the Affordable Care Act. This incorporates charges on pharmaceutical deals and therapeutic gadgets. Be that as it may, these assessment increments have been balanced by the duty credits working-class families are qualified for, in the event that they enlist.

Be that as it may, there is additionally a less unmistakable and eventually weighty social expense of insurance for Americans. The people and networks that have been prohibited from protection are not arbitrary. Indeed, even after the ACA extended access to protection, individuals with lower livelihoods and African Americans and Latinos remained excessively bound to be uninsured. Insurance puts a strain on people, suppliers, and social insurance markets, and the results go past well-being and human services. They sway the public activities of people and networks, also. A 2003 report from the Institute of Medicine proposed to such an extent: notwithstanding contemplating the financial impacts of insurance, analysts need to think about how insurance may ‘strain social connections among network individuals and nearby organizations.’ Research on the social impacts of insurance and well-being strategies intended to extend access to protection is sparse, yet ongoing work merits our consideration. (Moisse, 2011)

By driving down the number of individuals who are uninsured, the Affordable Care Act controls costs for everybody. Be that as it may, the law doesn’t stop there. With its first-since-forever customer assurances for everybody who has protection, the Affordable Care Act gives you and your family the true serenity that originates from realizing that You have budgetary insurance in the event that you face extreme sickness. On the off chance that you have a prior well-being condition, safety net providers can never again drop you or deny covering you. You can remain on your parent’s arrangement until you turn 26. Likewise, Insurers can’t charge higher premiums on the off chance that you are a lady and safety net providers can’t sell unacceptable plans that don’t pay for fundamental medicinal services benefits.

The region where Obamacare has been the most noteworthy is in giving more access to human services to a bigger segment of American family units. Individuals with prior conditions presently have better access to medical coverage. Likewise, individuals who had ceaseless medical problems won’t need to stress over their backup plans dropping them, which was frequently the situation before the ACA was established. Things like screenings are additionally progressively being secured by protection plans. Obamacare put weight on insurance agencies to cover essential screenings as a deterrent measure. The reason behind this is it lessens the weight of human services cost on citizens by diminishing the number of patients, in the end, looking for broad medicines later on. (Salahi, 2012)

One noteworthy arrangement of the ACA is progressing, refundable duty credits, going from $2,000 to $4,000, in light of age instead of pay and which begin to decrease after a person’s pay surpasses $75,000 or a family’s pay surpasses $150,000. These credits are instead of the salary-related appropriations right now accessible in the ACA for individuals who are not on Medicare or Medicaid, who don’t have manager-supported protection, and whose pay is under multiple times the government destitution line. A 30% additional charge could be required by safety net providers on people who don’t keep up nonstop protection inclusion and who need to buy protection sometime in the future. This is instead of the much-defamed singular command. (Turner, 2017)

The amount Obamacare costs relies upon numerous elements. Fortunately, there are various apparatuses accessible to help individuals comprehend their premiums. A portion of the components that impact cost incorporate where individual life, how a lot of cash they make, the off chance that they are hitched, the event that they have kids enlisting, and whether their companion gets medical coverage through their boss. People or families with center or low salaries can get Obamacare endowments (otherwise called premium assessment credits) to help counterbalance the expenses related to human services. People hoping to improve their feeling about what their social insurance expenses might be can utilize this adding machine. (Turner, 2017)

There is additionally worry among moderate Republicans in both the House and the Senate that the Medicaid coordinate decrease happens excessively quickly. As opposed to returning to the base Medicaid coordinate rates, these congressmen need some tradeoff between the higher rates and the base rates. For different traditionalists, be that as it may, the decreases don’t happen quickly enough. (Kavilanz, 2010)

Meanwhile, the ACA is a tradition that must be adhered to and will remain so until elective enactment is passed. It benefits Republicans not to intensify the agitate and interruption that has been continuous in the trades until elective enactment is set up and prepared to be executed. Controlling the White House, House, and Senate, even with unsafe edges, will make it hard to persuade the American open that any issues with human services aren’t the Republicans’ duty.

Giving consideration to present and new Medicare and Medicaid enrollees will come at a significant expense. Appraisals demonstrate that the Centers for Medicare and Medicaid Services (CMS) will diminish installments to emergency clinics by $158 billion for more than 10 years to help settle the expense of the recently protected. Generally speaking, well-being uses are anticipated to diminish by $600 billion over a similar time span. The creators of the law looked back on a portion of the expense of the ACA through Title 9 arrangements. These incorporate new Medicare charges on high-pay workers, and new expenses on pharmaceutical producers, healthcare coverage suppliers, and restorative gadget makers. The ACA does not order charge rebuilding for administration repayment, however, gives the Secretary of Health and Human Services approval to alter ‘disvalued’ expense calendars or strategies and administrations that have encountered high development or advances in innovation. Changes in installment structures will unmistakably impact how doctors practice and how care is conveyed. Notwithstanding the American College of Surgeons (ACS) proposal to organize possibly cost-sparing medicinal risk change with the section of the ACA, no arrangements were incorporated. The execution of autonomous boards and administrative changes are other ACA methodologies to set aside extra cash. (Kavilanz, 2010)

The sponsorships in the Affordable Care Act are intended to protect individuals in the program from premium increments. The CBO anticipated that month-to-month premiums for a mid-go plan in the program will increment by 15 percent by 2019, and by around 7 percent every year through 2028. One purpose behind the rising premiums is the activities of President Donald Trump. A year ago, Trump bested subsidizing for the cost-sharing decrease installments made to back up plans under Obamacare to enable Americans to manage the cost of wellbeing costs. The non-installment of those endowments, less authorization of a standard expecting individuals to have protection and restricted challenge made guarantors raise their premiums by around 34 percent in 2018, contrasted with 2017. That expanded the expense of the endowments to the central government, as per the CBO.

In the United States, where medicinal services are seen as to a greater degree a ware than a right, the guarantee of growing access to health care coverage, particularly openly financed protection, is social and redistributive. The most essential job of the government is to ensure its natives, particularly the individuals who are generally defenseless. So as to accomplish this, those of us with protection need to comprehend the issue of growing access to protection as our issue. Rather, the social truth of the huge number of uninsured Americans the individuals who were uninsured preceding the entry of the ACA, the individuals who stayed uninsured well after its execution, and the individuals who may lose inclusion because of nullification is one of avoidance and underestimation from human services, however from our general public overall. (Rosenberg, 2011)

As we consider the eventual fate of ACA, we ought to likewise ponder exactly what social insurance intends for Americans. Medicinal services aren’t only a product that we purchase or a qualification that we gain. It is additionally a social establishment, much the same as family and instruction. Social organizations direct standards and desires for conduct and proceed to shape our characters, sentiments of having a place and citizenship, and our feeling of pride and self-esteem.

References

1. Moisse, K. (2011, April 7). Hospital errors are common and underreported. ABCnews.com. Retrieved from http://abcnews.go.com/Health/hospital-errors-common-underreported-study/story?id=13310733#.TxxeY13310732NSRye.
2. Rosenberg, T. (2011, April 25). Better hand-washing through technology. New York Times. Retrieved from http://opinionator.blogs.nytimes.com/2011/2004/2025/better-hand-washing-through-technology.
3. Robert Costa and Amy Goldstein, “Trump Vows ‘Insurance for Everybody’ in Obamacare Replacement Plan,” Washington Post, January 15, 2017, Retrieved from https://www.washingtonpost.com/politics/trump-vows-insurance-for-everybody-in-obamacare-replacement-plan/2017/01/15/5f2b1e18-db5d-11e6-ad42-f3375f271c9c_story.html?utm_term=.f53544ba4a26.
4. Kavilanz, P. (2010, January 13). Health care: A “gold mine” for fraudsters. CNN Money. Retrieved from http://money.cnn.com/2010/01/13/news/economy/health_care_fraud.
5. Turner G-M. CBO is Wrong and Its Numbers Shouldn’t Deter Needed Reform. Forbes. (May 26, 2017). Retrieved from https://www.forbes.com/sites/gracemarieturner/2017/05/26/cbo-is-wrong-and-itsnumbers-shouldnt-deter-needed-reform/#14f3ab125871.
6. Kaiser Family Foundation (KFF). State Decisions on Health Insurance Marketplaces and the Medicaid Expansion. (2014). Retrieved from http://kff.org/health-reform/state-indicator/state-decisions-for-creating-health-insurance-exchanges-and-expanding-medicaid/.

The Affordable Care Act, known as Obama Care, is a United States federal statute enacted by the 111th United States Congress and was signed into law by Barak Obama on March 23, 2010. The Affordable Care Act (ACA) has accumulated a lot of debate since its execution in 2010. It was a major shift in government control of healthcare shifting from private healthcare to a form of social medicine.

The Affordable Care Act violates our right to Religious Freedom. It forces Christians to go against their moral sense and financially support things such as abortions, which go against Christian belief. For instance, Hobby Lobby is a Christian company that has refused to take part in Obama Care because it abstains from its religious beliefs. Hobby Lobby has continued to work hard and fight against the Affordable Care Act refusing to give them immunity based on their religious beliefs. Joshua 34:15 says, “And if it seems evil unto you to serve Jehovah, choose you this day whom ye will serve; whether the gods which your fathers served that were beyond the River or the gods of the Amorites, in whose land ye will dwell: but as for me and my house, we will serve Jehovah” (Joshua, 24:15, NIV). God gives us the freedom to make decisions regarding our own future. Government is not above the Christian principles upon which it was founded and cannot force Christians to do something that violates their consciences (Hazlitt). Religious freedom is what protects our rights to live, speak, and act according to our beliefs both publicly and privately.

The Affordable Care Act causes more government control – forcing compliances and individual mandates. The individual mandate began its effect on January 1, 2014. It is a requirement that most American citizens and legal residents have to have health insurance and the people who do not have health insurance must be able to obtain it or must pay a penalty. Government subsidies are a big contribution when it comes to government control. A government subsidy is a sum of money granted by the government to a public body to assist an industry or business so that the price of a commodity or service may remain low or competitive (Dictionary). Freedom means that we have the power to say, think, and speak without any type of restraint. However, the Affordable Care Act is holding us in the bondage of being able to make our own decisions. They say that they allow us to make our own decisions; however, if you do not make the decision that they want you to make then penalties come with it. When we do not have the ability to make our own choices based on our future, then we are in bondage and servitude (Hazlitt). Bondage is a form of evilness. 1 Corinthians 7:23 states “Ye were bought with a price; become not bondservants of men” (1 Corinthians 7:23, NIV). God provided us with freedom so that we can make the best decision for ourselves along with the future ahead of us. For instance, we can choose to pay for health insurance or we can choose to not pay for health insurance and have to deal with the future consequences. God provided us with the ability and freedom to be able to work and provide for ourselves.

The Affordable Care Act takes away Christians’ responsibilities to help and care for the sick. The government’s job is to protect individual rights and freedom and enforce laws. They are not responsible for taking care of those who are in need because if they do so then they can intrude upon the lives of American citizens. The government, family, and church each have their own separate responsibilities and roles from each other. The role of the government is to protect its citizens and establish order within a society, and not to care for the sick (The Family Leader).

The Affordable Care Act has also caused an obscene amount of debt. The Affordable Care Act has increased our national debt to a point where the Affordable Care Act will be one-fifth to one–sixth of our national economy (The Family Leader). Our nation is increasingly spending money, which is causing us to grow more and more into debt. It is a sin to be in debt and it carries a burden on our economy. We should be smart with our money. Romans 13:8 states “Owe no man anything, save to love one another: for him, that loved his neighbor hath fulfilled the law” (Romans 13:8, NIV).

Bibliography

1. Hazlitt, H. (1979). Economics in One Lesson: The Shortest and Surest Way to Understand Basic Economics. New York, NY: Crown Publishers.
2. Holy Bible: New International Version. New York: American Bible Society. 1978. Print.
3. Merriam – Webster. Dictionary. https://www.merriam-webster.com/
4. “7 Things the Bible Says About Obamacare.” The FAMiLY LEADER, thefamilyleader.com/7-things-the-bible-says-about-Obamacare/.

Mendoza describes ex Ante and Post Moral Hazard in his work titled “Information Asymmetries and Risk Management in Healthcare Markets: The US Affordable Care Act in Retrospect. Ex ante is Latin for “before the event” (CFI, 2021). Essentially, ex-ante is the ability to predict an event before it happens. Ex post is the Latin word for “after the event” and in this case represents results from a given project or investment. Mendoza provides an in-depth explanation of the initiative for the universalization of private health insurance. This should be taken into consideration because of the other countries that adopted the model. Previous

American presidents considered universalization after 1965 but realized that budgetary and financial stress could be on the horizon. One example of an ex-ante as a moral hazard would be if all citizens obtained free health care and were live carelessly regarding their health. If every person in the world would no longer have a reason to continue to stay healthy, they would take full advantage of the healthcare system.

Explain whether you agree or disagree with the author that the ACA was an answer to healthcare accessibility

I do agree with Mendoza’s stance on the Affordable Care Act because of the number of people that now have access to health care. If the Affordable Care Act would ever repealed, up to 20 million people would lose coverage (Rapfogel et al., 2020). There are many examples of the ACA being utilized by the public in ways they were previously not. The Affordable Care Act has a guaranteed issue which means that insurance companies cannot turn away individuals who have pre-existing conditions. The Affordable Care Act has also lowered the costs for senior citizens that are receiving Medicare making it more accessible to that demographic. In total, 20 billion dollars have been saved on prescription drugs (Repfogel et al., 2020). Without the Affordable Care Act, senior citizens would pay out of pocket for their prescription medications. Senior citizens, in my opinion, should be fairly treated as well as well cared for and should never struggle to obtain the medications they need to survive. These are just two ways that the Affordable Care Act has helped the public gain access to its benefits.

Explain whether you believe or do not believe that ACA will improve patient care

I personally believe that the Affordable Care Act will improve patient care. Before the Affordable Care Act was passed, women faced barriers to receiving the proper care. Women were sometimes charged 1.5 times more than men for health insurance policies (Rapfogel et al, 2020). Women faced discrimination in ways that are labeled as gender rating. I believe that the Affordable Care Act has supported women and will in turn improve their care.

The Affordable Care Act has in some ways forced healthcare providers to be more culturally competent. Underserved communities located in rural populations rely heavily on federally funded health centers. In order for healthcare providers to give their patients the care that they deserve, it is important that they first understand the needs, beliefs, and culture of the patients they treat (Orenstein, 2015). Being culturally competent is crucial because the provider and patient relationship is based solely on trust and openness. David Orenstein states that closing the cultural gap between patients and doctors will reduce the racial and ethnic basis that exists in the healthcare system (Orenstine, 2015). I feel as though healthcare professionals should be required to attend cultural competency classes before finishing their degrees. This will ensure that they understand their patients on a different level and offer them the care they deserve in the first place.

Discuss what you think President Biden should do with the ACA

President Joe Biden should continue to protect the Affordable Care Act. The Affordable Care Act was originally signed by President Obama in March 2010. Joe Biden stood behind President Obama as vice president when the Affordable Care Act was enacted. Because of the Affordable Care Act, 100 million people can rest assured that the insurance company will charge higher premiums due to pre-existing health conditions. Republicans do not agree with the stance on the Affordable Care Act and have continuously tried to repeal it through congress. I think that Joe Biden having people enrolled in the program if they receive Supplemental Nutrition Assistance Program or if they are located in low-income communities is efficient. This will ensure that the individuals in these communities will have an affordable option, and they should not feel as though they are being forced to choose between feeding their families or obtaining health insurance. I think that President Joe Biden and his current administration should do everything in their power to allow the Affordable Care Act to exist in the United States.

Overall, the Affordable Care Act has given Americans the opportunity to take charge of their health and live healthier lives. Individuals that were previously uninsured, living in low-income areas, or have pre-existing conditions have been impacted positively by the Affordable Care Act.

Discuss what strategies you would recommend in dealing with the economic realities of health care based on your own research

First and foremost, the Affordable Care Act was created to “reduce the proportion of uninsured Americans by expanding both private and public insurance coverage, reducing the costs of health care for individuals and the government, and improving the quality and scope of health benefits (Mendoza, 2016).” I think that healthcare facilities should stop seeing patients as just numbers they will potentially profit from. The Harvard Business Review offers a valid point, we should move away from using patients as supplies in order to profit from any visits.

Abstract

This proposal is focused on healthcare legislation and how to allow equal and unbiased access to healthcare coverage for everyone. It will explain a variety of issues that are currently in our healthcare system today and will give ideas on how some changes need to be made for this healthcare system not to fail in the future. Issues that will be discussed and outlined in this proposal are, Affordable Care Act (ACA), Medicaid, fair enrollment, insurance and healthcare providers, and many others that play a role in our system. The main goal of this legislative proposal is to find a way to make healthcare more equally fair for all.

Introduction

Healthcare has been an issue that has been around for ages though so many presidents trying to change the system in the way they think and believe is fair for all Americans. Our current healthcare policy has only had a small difference due to the changes that have been made to the Patient Protection and the Affordable Care Act which was introduced to America, but even with this law that was passed on our system still has much more to change for it to be better. This proposal will discuss our current healthcare policy and also what our future holds when it comes to healthcare and actually making a difference in our policy. In conclusion, this legislative proposal will speak on new ideas and better decision-making that will help make this healthcare policy in America better.

Current healthcare system

The current healthcare system is based on a fee-for-service structure that is controlled by complex payment controls implemented by third-party payers (Steiner, 2014). The systems’ economy to this day is a very closed free market system something that has not changed. The government has a big part of control over the healthcare insurance policy and also the provider markets (Steiner, 2014). Many are against the idea of making insurance coverage universal because of reasons such as state, local, and federal government spending account for over a certain percentage of national health expenditures (CMS, 2015). One of the main questions that have always been a challenge in our current healthcare system today is whether healthcare coverage is a basic right or a privilege. (Bauchner, H., 2017). This is when Obama passed and wanted to make changes to our healthcare system and learn from previous presidents on how to make certain changes to this system. The Affordable Care Act was used to increase some of the health insurance competition within themselves by putting insurance exchanges and controlling the provider’s profit using the Medical Loss Ratio (Feldman, Buysse, Hubner, Huffman,& Loe,2015). The Medical Loss Ratio is used for a specific percentage of health insurance that is well spent on medical care to improve health care quality (Feldman, Buysse, Hubner, Huffman,& Loe,2015). The Affordable Care Act is continually working to make changes and improve the quality of care for individuals.

Problems with the current system

There are still current issues with our healthcare system, this includes on the Patient Protection and Affordable Care Act which they were unable to resolve. The current healthcare system is based on a fee-for-service that is controlled by complex payment controls implemented by a third-party payer (Steiner, 2014). Improving the quality of the services provided can decrease revenues for healthcare providers, which is greater than the cost savings that they are able to achieve (Nix & O’Shea, 2015). The PPACA has taken precautions to reward providers who improve their quality of healthcare, but there hasn’t been the same for rewarding the patients who make sure to receive good quality healthcare (Nix & O’Shea, 2015). An issue that has also not yet been resolved with our healthcare policy system has been the competition among healthcare providers (Barros, Brouwer, Thomson, & Varkevisser, 2015). There are those that don’t think about the quality of care for their patients and only think about the cost and other things (Barros, Brouwer, Thomson, & Varkevisser, 2015). These providers should think more about their patients and how they care for them and try to make things the least costly, this can have a huge impact on healthcare. We would want to give all Americans the opportunity to have insurance, but these current issues need to be paid more attention to.

Future of Healthcare

If the healthcare policy is left as it is currently, the future is not looking so good for the generation to come. Especially when it comes to making changes to the current healthcare market due to the economy failing in the future. There needs to be a change with healthcare providers cutting down the ability to charge higher rates, large insurers, and cutting down the cost for that public payers as well as small insurers (Zeng, Liu, Ma, & Fu, 2018).

Legislative proposal

This legislative proposal’s main goal is to focus on what are the necessary things that need to be improved to ensure that our healthcare policy becomes better not only for today but also for the future. I will speak on different topics to elaborate more on each of them and speak on both insurance providers and healthcare providers. In order to make sure we improve the quality of healthcare insurance. Policymakers should take what has been given already which is the Affordable Care Act and continue off this policy (Obama B., 2016). They should continue to apply the health insurance marketplaces, and delivery system, reform, and increase federal financial assistance for those that enroll in the marketplace (Obama B., 2016). Making a public plan in areas where the healthcare policy is lacking and making prescription drugs a bit less costly (Obama B., 2016). This proposal will touch base on some areas where our healthcare policy could improve.

Insurance providers

For the part of insurance providers, it comes down to what would be more beneficial when it comes to The Affordable Care Act and the people in order to take action for the insurance companies and what they should be following with healthcare coverage (Bhatt & Beck-Sague, 2018). These insurance companies can first look into the stabilization of the common cost of living for the people, this should be taken into consideration because healthcare coverage should look beyond this when it comes to patient health. The medical loss ratio is used to see the quality care of healthcare, and a specific percentage needs to be used for the improvement to follow (Bhatt & Beck-Sague, 2018). Insurance providers should take action to look beyond these points for better healthcare quality care in the future.

Healthcare providers

In this section, I will explain how the healthcare providers which include those who work with patients, can improve the quality of care that patients receive from these places. There are programs that can reduce costs and show appreciation for not only healthcare providers but also patients. The program’s main focus will be on quality care, how the practitioners work, and establishing a student loan repayment program. The purpose of a healthcare provider is to focus on their patients and make sure they receive the best care. In our current healthcare policy there is one program that has been enforced to practiced healthcare quality care which is the Patient Protection and The Affordable Care Act, these programs have taken the steps to address issues such as cost, mandates for efficiency, and all Americans to purchase health insurance and the new funds to expand Medicaid funding (Travis, Morris, Mayer, Kenter, Breaux, 2016). Lastly, tax incentives could be another good use to benefit our healthcare reform, but this will all depend on how it is being used because it can also be something negative as not motivating people to get health insurance. The Affordable Care Act has taken into use tax incentives when it comes to the reduction of healthcare costs (Morrow, Stinson, Doxey, 2018). This option would be more useful for a certain age group in this case the elderly when it comes to injuries or any sickness.

Medicaid

Expanding Medicaid in America would be something very essential and useful for our current healthcare policy. Many would not agree with this due to many different reasons. Medicaid expansion has been used in The Affordable Care Act but has definitely been talked about due that politicians want to shut it down (Courtemanche, Marton, Ukert, Yelowitz, & Zapata, D, 2016). In order to improve quality care for maternal and child health Medicaid expansion is a huge part of The Affordable Care Act (Courtemanche, Marton, Ukert, Yelowitz, & Zapata, D, 2016). Medicaid is offered only to a certain qualified group, which covers most expenses such as maternal services that is beneficial for women. This insurance coverage at times is taken for granted for many reasons, which should change there should be a stricter requirement to have this type of health insurance. One way that it can be checked on more with who gets Medicaid there should be a drug screening test in order to qualify for this insurance. There are many people who fraud and take advantage of using Medicaid that does not deserve to have this type of insurance. Some of these people don’t even need Medicaid it should be offered to those who truly need and deserve it.

National Board of Practice

Patients should be receiving the best care and quality when it comes to their health. The national board of practice needs to consider the best care for the patients this is where they fail to pay attention when it comes to our current healthcare policy. The National Health Policy should be advanced in this due that they usually attend many different conferences around the state on becoming better providers for patients (National Health Policy, 2018). For better quality and to improve this for our current policy, there should be surveys for patients to either take at clinics or be able to take home so the national board of practice can view and see what they need to improve on. Patients should be the number one importance to these practices and be more of a focus to better their quality care. Lastly, quality is something very important when it comes to these patients and the usefulness of the insurance.

Summary

In conclusion, we need to step in changing our current healthcare system because if we don’t take this seriously our future generation when it comes to healthcare coverage is not looking good. We should look into other states and grab some ideas from each other to better ourselves as one, both parties need to work together to come up with a better healthcare policy for all Americans. This proposal speaks on some major issues, but not as a whole on what really is going on with our current healthcare system. This proposal attempts to give some ideas on how to make things better for us all. The quality of care is a very important thing we should start with in improving healthcare. One of the major issues of making health coverage available for all is the cost and how to overcome this challenge should be the main focus.

References

1. Bauchner, H. (2017, January 03). Health Care in the United States: A Right or a Privilege. Retrieved from https://jamanetwork.com/journals/jama/fullarticle/2595503
2. Barros, P. P., Brouwer, W. B., Thomson, S., & Varkevisser, M. (2015). Competition among health care providers: helpful or harmful? The European journal of health economics: HEPAC: health economics in prevention and care, 17(3), 229-33.
3. Bhatt, Chintan B,M.B.B.S., M.P.H., & Beck-Sagué, C. M., MD. (2018). Medicaid expansion and infant mortality in the united states. American Journal of Public Health, 108(4), 565-567. doi:http://dx.doi.org.ezproxy.liberty.edu/10.2105/AJPH.2017.304218
4. Courtemanche, C., Marton, J., Ukert, B., Yelowitz, A., & Zapata, D. (2016, November 07). Early Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non‐Expansion States. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1002/pam.21961
5. Feldman, H. M., Buysse, C. A., Hubner, L. M., Huffman, L. C., & Loe, I. M. (2015). Patient Protection and Affordable Care Act of 2010 and children and youth with special health care needs. Journal of developmental and behavioral pediatrics: JDBP, 36(3), 207-17.
6. Morrow, M., Stinson, S. R., & Doxey, M. M. (2018). Tax Incentives and Target Demographics: Are Tax Incentives Effective in the Health Insurance Market? Behavioral Research In Accounting, 30(1), 75-98. doi:10.2308/bria-51929
7. Nix, K. A., & O’Shea, J. S. (2015). Improving healthcare quality in the United States: A new approach. Southern Medical Journal, 108(6), 359-363. Retrieved from 10.14423/SMJ.0000000000000299
8. Obama B. (2016). United States Health Care Reform: Progress to Date and Next Steps. JAMA, 316(5), 525-32.
9. Steiner, E. (2014). The changing world of family medicine: The new view from Cheyenne Mountain. Annals of Family Medicine, 12(1), 3-5. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3896529/pdf/0120003.pdf
10. Travis, R., Morris, J. C., Mayer, M., Kenter, R., & Breaux, D. A. (2016). Explaining State Differences in the Implementation of the Patient Protection and Affordable Care Act: A South/Non-south Comparison. Social Science Quarterly, 97(3), 573-587.
11. Zeng, X. X., Liu, J., Ma, L., & Fu, P. (2018). Big Data Research in Chronic Kidney Disease. Chinese medical journal, 131(22), 2647-2650.
12. 2018 National Health Policy Conference. (2018, February). Retrieved August 15, 2018, from http://www.academyhealth.org/events/site/2018-national-health-policy-conference

The Patient Protection and Affordable Care Act, also known as The Affordable Care Act (ACA), is a policy, or federal statute, signed into law by Barack Obama on March 23, 2010. The enactment of this policy serves as one of the largest changes to the American healthcare system since the passage of Medicare/Medicaid in the mid-60s (Cohen et. al, 2015). Because of its importance in the overall landscape of daily American life and medical infrastructure for generations to come, it’s equally important that the policy is analyzed, and its impact is understood so that it can be improved upon in the future and dealt with properly in the present.

01. Definition and Overview of the Affordable Care Act

What is the Affordable Care Act?

The Affordable Care Act is a federal statute, also known as a law or policy, that is meant to streamline the current market-based U.S. medical and health insurance system/industry with one that attempts to ensure that all citizens are covered under some type of insurance plan and can receive the medical coverage they need (Congressional Budget Office, 2011).

What is the nature of the problem being targeted by the Affordable Care Act?

The problem being targeted by the Affordable Care Act is the fact that the U.S. medical infrastructure is market-based which often has the effect of leaving people who don’t fit the insurance companies’ requirements without any way to seek medical care. The problem was presented by the 111th Congress, which is responsible for the policy along with former President Obama (Kaiser Family Foundation, 2013). There needed to be a way to create some type of universal health care without dismantling the insurance industry. This becomes a dual problem because people need to be able to go to the doctor when they are sick but there would be great economic consequences to dismantling an entire industry within the country and would require a very large overhaul.

What is the control of the Affordable Care Act?

There are several other policies that are together with the Affordable Care Act, the basis for the social benefits system of the United States, especially considering that a lot of the policy is simply an expansion of previous social policies such as Medicare and Medicaid. It is essentially a single-payer healthcare system that is supported by an expansion of the previous social healthcare services, while also introducing new regulations to insurance companies to ensure maximum coverage (Kaiser Family Foundation, 2013).

Choice Analysis

One of the biggest problems within an analysis of this policy is the maintenance of the single-payer market system over simply instituting a universal healthcare system. Because of a previously instituted policy, 1986’s Emergency Medical Treatment and Active Labor Act or EMTALA, everyone who comes into an emergency room must be treated and when they can’t afford to pay, the government eats the cost (Butler, 1989). This could be used to argue that the government already eats the cost of universal healthcare, and in fact, eats a larger cost because it pays market cost instead of having already previously defined a budget. This system expands social services but maintains a single-payer healthcare system.

The Affordable Health Care Act attempts to match this by instituting several provisions and allocations such as subsidies, tax breaks, and the previous mention expansion of social benefits, which are regulations forcing insurance companies to accept people they otherwise might not have based on pre-existing conditions or more arbitrary factors. There were also clauses issuing tax penalties against employers who do not pay for their employees’ insurance to incentivize companies to maintain paying for their employees’ insurance. Because this was not a truly universal healthcare strategy, US citizens couldn’t simply be signed up for the plan and instead how to figure out their new medical coverage by themselves, essentially through their own research, but the overall reforms instituted restrictions on price and exploitative tactics, and to increase the overall quality of the US medical institutions. The social bases of allocating these resources were the belief that this would be an all-around better alternative for the lower class (Butler, 1989).

02. Historical Analysis

What policies were developed earlier to solve this problem?

The interesting thing about this policy is that it was the same one proposed by the Republicans, through work done by The Heritage Foundation when they rejected Bill Clinton’s proposal claiming it would do too much damage to the nation’s towering debt (Butler, 1989). This single-payer healthcare system has always been the Republican compromise to universal healthcare, and the current rejection of it by its originating party is a little strange.

How has The Affordable Care Act developed over time?

The Affordable Care Act has a nearly 30-year-old history within the government. It has had many names including 1993’s Health Equity and Access Reform Today Act and the Healthy Americans Act. The overall structure of the policy hasn’t changed much at all, but it has been denied multiple times. Often, it will get bipartisan support but then lobbyists make it clear that they won’t support the politician’s campaign next election, and the policy fails to go through (Cohen et. al, 2015).

What does history tell us about effective/ineffective ways to deal with this problem?

History doesn’t tell us a lot about this situation because unfortunately, this seems to only be a problem in the U.S. Other first-world nations have already instituted their own versions of these programs, and every single one of the nation’s attempts to pass the current policy took decades and was constantly foiled by the very industry it was trying to preserve. But overall the past, present, and future point to universal healthcare (Cohen et. al, 2015).

To what extent does the current policy consider lessons learned from history?

It is the exact same policy with the exact same pitfalls it always had. This time it managed to get through and was immediately gutted by the new Congress. The policy does not aim to avoid the mistakes of the past, and in fact, repeats them almost in their entirety.

Are we repeating mistakes from the past, if so, why?

We are repeating mistakes simply because no one can do anything differently. If the insurance companies are the ones stopping you from reforming their industry then simply take them out of the equation, and do not try to work with something that has no incentive to work with you. If you want to create universal health coverage for Americans in some way, then you can’t take orders from the people who will be put out of business by what you are trying to accomplish. The medical infrastructure of the country should not be trying to turn a profit and that’s the biggest mistake from the past.

03. Social Analysis

The problem the Affordable Care Act is trying to solve

The problem that the Affordable Care Act is trying to solve is the fact that there are millions of Americans without health insurance, and no medical coverage, which means when the time comes for them to seek out medical assistance, they can’t afford it and do not receive the help they need. This is compounded by the fact that this sort of problem affects the most vulnerable members of society with even more adverse circumstances, causing them a lot of damage in the long run. The goals of the Affordable Care Act were to alleviate as much of that suffering as possible while maintaining the current industry mostly as is.

What are the major social values that relate to the problem and what conflicts exist?

The major values that affect and relate to a problem like this are the ideas of whether one should help people in need or make it the individual’s responsibility to look after themselves. If they cannot provide for themselves, they can’t have anything. Or the notion that you should help other people when you can, the idea of pooling resources together to provide something better than anyone could have on their own. It’s basically a conflict between being in a society where you work together with people and living in a culture that is “dog eat dog.”

What are the goals of the Affordable Care Act?

The goals of the Affordable Care Act are to provide coverage for all US Citizens under a single-payer healthcare system, which would function as if it were like universal healthcare. This would prevent “free-loaders,” or people paying for things they thought they should not have to pay for, such as other people’s expenses (Cohen et. al, 2015).

What are the hypotheses implicit or explicit in the Affordable Care Act’s statement of its problems and goals?

The hypotheses are essential that it’s more important to provide affordable coverage than provide real medical benefits nationally. This means that some entity wants to make money from the healthcare industry. Also, affordable means that you still pay, and that there is still money made somewhere. The nature of the policy makes it clear that it would rather preserve an industry than create medical infrastructure in its nation that can last for generations.

04. Economic Analysis

Macroeconomic Analysis

On a macro level, the government did not see nearly the impact that some people thought there would be. If the program was handled responsibly with proper allocation of resources, it had no real negative or positive macro impact which is actually very good because it seems to be what the government wanted. Essentially, this is a reform on the current policy that would simply provide coverage for many Americans. There were complaints at a state level involving the expansions of social services, but the government did its best to match the states for expenses following the expansion.

Microeconomic Analysis

On a micro level, for individuals, this was a successful reform for the insurance and healthcare industries. It reduced the cost of medical work for a lot of people and overall did a lot of good for the most vulnerable members of society. On a micro level, this affects the taxes of the 1% but at negligible damage to their bottom line. This allows everyone more economic freedom and could be considered a boost to the economy. It’s important to note that this had a net beneficial effect on the lives of many underprivileged Americans while not doing damage to the other classes in the attempt, and that is an economic success on a micro-level.

Opportunity Cost

It’s honestly a bad opportunity cost simply because it’s a policy that has been trying to get through for decades and has been stopped by the very industry that it would put out of business. It would be more effective to simply negate the industry and institute a state solution that provides infrastructure instead of coverage. This system keeps an unnecessary middleman alive for the sake of not doing surface damage to the economy. On one hand, it would be a hit to a lot of people for the insurance industry to be liquidated, but a lot of those people can be transitioned to government work, and subsidies can be provided for those who were affected badly by investments. Overall, it’s a high-cost system but still better than the previous system.

05. Political Analysis

Who are the major stakeholders regarding this policy?

The major stakeholders in this policy are the insurance companies, their shareholders, the American people, and the politicians who need them for re-election. Each of these groups is either trying to get the most they can out of the situation or are altogether unhappy with how things are going. The insurance companies know that universal health care would be the end of their industry and their shareholders certainly don’t want that either. The American public is being pulled in two different directions that are really the same direction. This means that the Affordable Care Act is the same policy the Republican party had been pushing for decades but when the Democrats presented it to them, they denied it because their voters, frankly, disliked the Obama administration.

How has The Affordable Care Act been legitimized? Is that basis still considered legitimate?

A lot of the basis for its legitimacy is the fact that it really did get millions of Americans covered with insurance, added to the fact that for most of its political career, it was exactly the compromise most of the government wanted. The fact that the current reform would wipe away that progress only legitimizes its success even more.

What are the political aspects of the implementation of this program?

The most political aspect of the implementation of the program is its long life as a Republican policy that then got morphed into a Democratic policy by the political climate of the time. So, it took a lot of time and effort for any part of the system to go through. There were a lot of committees and rumors, such as “death panels” that would decide whether your grandma was too old to be alive. There was a lot of political mudslinging over this, but it was mostly from politics and not the policy itself (Butler, 1989).

To what extent is The Affordable Care Act an example of national decision-making, incremental change or change brought about by conflict?

The Affordable Care Act is in a lot of ways all three. It appears it’s something the nation has wanted for a while, considering we have Medicare and social security already. Also, adding to the fact that many other first-world nations have universal healthcare systems, it’s no surprise that Americans might want their own sort of system. The policy itself presents incremental change toward the wider goal of protecting everyone with national coverage, not itself an end-all and be-all. Finally, there has been a lot of fighting politically, socially, and nationally over health care so if wasn’t caused by conflict then it certainly stirred conflict up.

06. Social and Economic Justice

Upon reviewing the NASW Code of Ethics pertaining to social and economic justice for oppressed and at-risk populations, discuss what social and economic justice is accomplished through this policy.

The social and economic justice accomplished with this policy regarding the NASW Code of Ethics is that more people were given the coverage that they desperately needed to be able to seek out medical help when needed with no great personal cost to the most vulnerable members of their society. According to the Congressional Budget Office (2018), most of the cost of providing people coverage was made up for within the taxes of the top 1% of income earners, which was not enough to damage their overall security while maintaining our ethical standards not to do harm to others and in fact improve their lives.

What are the gaps?

The gaps are that there are caps to this sort of infrastructure, meaning that a company wants to turn a profit, not ensure that every American is to receive the health care they need. This means that there will always be gaps in coverage in the spaces where the business thinks it couldn’t turn a profit. It seems unethical to deny someone proper assistance because you wouldn’t be able to make any money from it. If it’s not in insurance companies’ best interest to pay out to their customers, if it’s in their best interest that they get paid and no one ever goes to the doctor at all, then they shouldn’t be the healthcare system.

07. Policy Evaluation

What are the outcomes of the Affordable Care Act in relation to its stated goals?

The Affordable Care Act in relation to what was previously in place has greatly improved. Its stated goal was not for a truly universal healthcare system within the United States, but its goal was mostly to provide some type of insurance so that Americans may seek out medical care when they needed it. According to the Congressional Budget Office (2018), around 22 million people who previously would not have had coverage currently do. While one can always state that it would be preferable to have real universal coverage, that is a huge challenge, and considering all the challenges this sort of system faced just trying to become a policy, it is not surprising this sort of compromise was made.

What are the unintended consequences of the policy?

Some of the unintended effects of the Affordable Care Act are the changing of previous policies so that some people simply didn’t have the sort of coverage they had before and were left to sort it out using the provisions allocated by the Affordable Care Act. It also had strange political consequences, despite ACA being a Republican design it was dubbed “Obamacare” and attributed to him, though the policy is much older that his administration.

Is the policy cost-effective?

The policy is not cost-effective because it maintains a market system that is more expensive than any universal system while trying to maintain an expanded social service that wasn’t really equipped to handle the problems it already had. It succeeds in maintaining a status quo with improvements and regulations, but it is the fact that it doesn’t go far enough and keeps the market and all the expenses that go along with private companies. It also hopes that a fearful industry will not do its best to find profit where it can because its business model is becoming obsolete and considering most of the first world has universal health care systems, has been outdated for a while.

Current Proposals for Policy Reform

Current proposals for policy reform included the left-wing and right-wing varieties, the left-wing wants the policy to go even further and simply become a universal health care system, with many such systems being proposed, seeming to be copies of the Affordable Care Act in some respects. The Republicans, however, have already instituted their reform known as the AHCA, or the Affordable Health Care Act, which is essentially a stripped-down version of ACA that would reduce the gains made by the previous policy. This could potentially leave more people uninsured. It mostly operates as a tax break for the wealthy, recovering the money lost in the previous policy reforms (Congressional Budget Office, 2018).

A proposed policy that identifies the gaps in the policy under review

A proposed policy that addresses the gaps in the current one will always simply be a system of universal healthcare, like those of the other first-world nations, covered by taxes. Most would be easy to obtain if many major businesses in the U.S. paid taxes, instead of trying to work around markets and people’s attempts to make money. It could be argued that ACA was simply a step in the right direction but not what the nation was hoping for. This sort of policy is truly meant to reduce inequality amongst the American people, and if that is the aim then it should try its best to do so and not just make a halfhearted attempt.

References

1. Cohen, Alan B.; Colby, David C.; Wailoo, Keith A.; Zelizer, Julian E. (June 1, 2015). Medicare and Medicaid at 50: America’s Entitlement Programs in the Age of Affordable Care. Oxford University Press.
2. Butler, Stuart M. (1989). ‘Assuring Affordable Healthcare for All Americans’ (PDF). The Heritage Foundation.
3. ‘CBO’s Analysis of the Major Health Care Legislation Enacted in March 2010’. Congressional Budget Office. March 30, 2011.
4. ‘Health Coverage & Uninsured’. Kaiser Family Foundation. June 20, 2013.
5. CBO-The Distribution of Household Income, March 19, 2018.
6. ‘Analysis Of A Permanent Prohibition On Implementing The Major Health Care Legislation Enacted In March 2010’. Congressional Budget Office.
7. ‘Chart: Comparing Health Reform Bills: Democrats and Republicans 2009, Republicans 1993’. Kaiser Health News. Maggie Mertens, 2010

“The Brookings Institute is a nonprofit public policy organization based in Washington, D.C. …[and their] mission is to conduct in-depth research that leads to new ideas for solving problems facing society at the local, national, and global level”(Dews, 2017). They are made up of over three-hundred experts who are a part of government and academia from all around the world “…who provide the highest quality research, policy recommendations, and analysis on a full range of public policy issues” (Dews, 2017).

Alice Rivlin, Henry Aaron, and Bill Galston are three the experts at Brookings Institute, and they all believe that repealing and replacing Obamacare would be nearly impossible for various reasons. Alice Rivlin said that Republicans are having trouble creating a replacement because “…while they ‘could agree on trashing Obamacare…they did not have a common intellectual basis for designing a replacement and they still don’t’”(Dews, 2017). Henry Aaron lists three reasons that Republicans will not be able to keep true to their promise of repealing and replacing Obamacare, which is that Obamacare has been successful and not a failure, the goals they made in discussing repeal are not possible, and the fallout from a political stance would be overwhelming. Lastly, Bill Galston says that the benefits that Medicaid has brought are helping those who voted for someone who wants to get rid of them. “The states won by Donald Trump in 2016, Galston writes, ‘disproportionately benefitted from the expansion of Medicaid that was one of the building blocks of Obamacare, and they will suffer disproportionately from Medicaid cuts’”(Dews, 2017).

If Obamacare were repealed without a replacement, it would be disastrous for the country as a whole. Alice Rivlin, Loren Adler, and Stuart Butler summarized that on top of the millions of Americans who would lose coverage, “‘risks nearly destroying the individual market altogether if no replacement emerges’”(Dews, 2017). The hope of a replacement is not good enough, the program needs to be replaced if it is repealed. Henry Aaron and Robert Reischauer argued that “‘repeal [of the Affordable Care Act] without having an agreed upon plan for replacement in place is a recipe for calamity’”(Dews, 2017). They claim that if the Affordable Care Act is repealed but not replaced, more people would be without insurance than if the act had not been passed in the first place (Dews, 2017).

Personally, I think that the Affordable Care Act has been one of the best advancements in healthcare in recent years for America. The coverage gap between low and high-economic status is ridiculous to me. I think that it should be required for all countries to have universal healthcare because even thinking about the fact that thousands of people die every year because they cannot afford the medication, medical procedure/device, or care they need is heartbreaking. The Affordable Care Act is a step in the right direction. Millions more people are now insured due to its enactment and people who were already insured with low coverage now have a lot more variety in the coverage they receive and where they can go to receive treatment. The Affordable Care Act has its goal in the title, which is to make care more affordable. It has done that successfully for the most part, it has made care more affordable for lower economic classes and it has made prescription drugs more affordable. No program is perfect and that includes this one, it has things it needs to work on, but I think that the benefits have substantially outweighed the negative effects.

As I said previously, I think that the Affordable Care Act is an amazing piece of legislation and has helped countless people. However, it has several flaws that need to be worked on. The major issues that need to be focused on are “…offsetting the negative impacts of repealing the individual and employer mandates, loosening age rating restrictions in the individual market, and doing more to encourage states to apply the Section 1332 waivers” (Dews, 2017). Section 1332 waivers are waivers that allow states to experiment with other ways to provide their residents with healthcare coverage that delivers more or equal to the same amount of healthcare coverage that is provided by the Affordable Care Act (Tolbert and Pollitz, 2018).

My patient was Scotty Jones, who is a 39-year-old black male who is an opioid addict. He worked hourly pay at a local St. Louis, Missouri Taco Bell and made minimum wage, and has a yearly income of $15,000. He has an estranged ex-wife who is no longer in his life, which has led to his opioid addiction. He reached out to get help and asked for resources on where to start the process of getting clean for a higher quality of life.

The healthcare system in the United States is a combination of public and private insurers, as well as for-profit and charitable healthcare providers. The federal government funds services for veterans and low-income families, including Medicaid and the Children’s Health Insurance Program, as well as the state Medicare program for adults 65 and older and certain people with disabilities. Aspects of local coverage and the safety net are managed and paid for by states. Employers are the primary providers of private insurance, which is the most common type of coverage. The United States is a combination of the Beveridge and Bismarck healthcare models.

Before the Affordable Care Act was implemented in 2010, uninsured Americans faced extreme hardship when seeking affordable medical care. The Kaiser Family Foundation, a nonprofit organization that focuses on national health issues, explains, “The Affordable Care Act (ACA) expanded Medicaid to nonelderly adults with income up to 138% FPL”(KFF). Individuals had to fall into particular categories prior to this extension, which essentially excluded many low-income adults. Scotty Jones, our patient, is an hourly worker, which means he is paid hourly for his services rather than being paid a set salary. Our patients will be covered as a result of the Affordable Care Act’s expansion of Medicaid.

Scotty Jones had options through Medicaid and the Affordable Care Act to make the changes he wants to achieve. However, just because it is available doesn’t mean it is easy to attain. Table 1 shows the extremely high increased rates that would be faced when trying to pay for pharmaceuticals, which in turn may make him less likely to get the medications that he needs.

Since Scotty dropped out of high school, he may have a lower level of education. Had he stayed in school, he would put themselves in a better financial situation, making them more qualified for jobs that would allow benefits such as health insurance (Virginia Commonwealth University Center on Society and Health, 2014). Nonetheless, the United States healthcare system should still be taking into account and accommodating those who do not know about or are unsure of how to get Medicaid and the affordable care act. Because of this, I would rank Scotty Jones’s experience with the United States healthcare system on the lower end, around a 4/10.

If Scotty Jones lived in the United Kingdom, his healthcare experience would have been considerably different. “All English residents are automatically entitled to free public health care through the National Health Service, including hospital, physician, and mental health care.” ( Roosa Tikkanen et al., England: Commonwealth Fund 2020) The United Kingdom uses the Beveridge model. William Beveridge first developed the Beveridge Model in 1948. This model, which originated in the United Kingdom and has since spread to most of Northern Europe and the rest of the world, is frequently centralized through the creation of a national health service. The government operates as a single-payer system, removing market competition and holding prices low. Since health insurance is funded by income taxes, it is free at the point of treatment, and the patient does not have to pay any out-of-pocket costs after an appointment or procedure because of their tax payment. A substantial portion of the healthcare workforce of this system is made up of government employees. Health as a human right is a fundamental tenet of this model.

Since all residents automatically get healthcare in the UK, Scotty Jones would not have to get Medicaid through the affordable care act. Scotty Jones would have free public healthcare, funded by his taxes. This would include preventative screenings, inpatient and out-of-patient care, physician services, and more. Since physician visits are covered, Scotty may have been more likely to go to visit the doctor, who could potentially point him in the right direction of getting help for his opioid addiction. For this reason, I believe Scotty Jones may have more success in aiding his opioid addiction, and I would rate his experience a 7/10.

If Scotty Jones resided in Japan, his healthcare experiences would be affected. Japan uses the Bismarck model. Otto von Bismarck developed the Bismarck model, a more decentralized type of healthcare, near the end of the 19th century. In this model, healthcare is funded by both employers and employees.

Introduction

Employers face the challenge of balancing cost in their organization. One of the most considerable costs of running a business is the compensation of their employees. On average, benefits cost adds around 30% to an employer’s total compensation (Vogenberg & Santilli, 2018). The impact of rising healthcare costs and the national healthcare issue have been at the forefront since the Affordable Health Care Act was established in 2010 (HHS, 2019). Americans spent a substantial amount of cash in their healthcare since the inception of Medicare and Medicaid nine years ago. Government policy is responsible for significant increases in healthcare costs in America. However, service providers managed to increase prices for their services, as the services rendered benefit to Americans without healthcare insurance. The rest of the population rely on healthcare service sponsored by companies. According to Duggan, Goda, and Jackson, (2019), America spent approximately $3.5 trillion on healthcare in 2017 based on statistics found in the American Medical Association. The study also noted the five factors that affect healthcare delivery as a steady growing population, aging citizens, medical service utilization. Others were disease prevalence or incidence, and service price and intensity. While all the factors above significantly affect healthcare, increase in population, and aging population remain the two most influential of the elements.

Cooper and Gardner (2016) did a research to determine the contribution of each factor above to increase in healthcare costs. The study found out that service price and intensity included the rising cost of pharmaceutical drugs contributed to more than 50 percent of the rise. The other half of the growth varied from the health condition of the population and type of healthcare service they acquired. In a working environment, the issue of the aging population does not have much effect on an employer, as the majority of employees are young and energetic. Despite that fact, the wage bill for healthcare has been on the increase from the employers’ perspective, raising questions over the possible causes of the rise and the potential impact on the employee benefits (Warshaw, 2017). The research paper seeks to determine the possible causes of an increase in health care costs and its immediate effect on the employee benefits with special consideration of the national healthcare issues and the changes affecting the employers in their effort to offer their employees’ healthcare cover.

Hypothesis

The hypotheses developed in this research are that (a) the rising healthcare insurance premiums have been a significant contributor to the increasing cost of health care services since the inception of the Medicare and Medicaid services in America; (b) the Ambulatory costs have been on the increase by double since Medicare and Medicaid services implementation in America; (c) employers are required to increase their resources by at least 30 percent to cover the increase in the healthcare costs for their employees accordingly; and (d) employees are required to pay an equal sum of money towards their healthcare cover; thus, their healthcare expenses are going to increase by at least 30 percent.

Research Question

The rising healthcare premiums require employers to increase their total healthcare expenditure to cover their employees’ health as per legal requirements. Besides the healthcare premium increase, ambulatory increases by a given percentage require readjustment of the employee’s expenses as far as healthcare is concerned. A potential average of a 30 percent raise in their earnings are channeled to healthcare. Given that employees must pay an equal amount to their benefits legally, employers might find other channels to reduce their expenses by minimizing allowances and benefits to the employees. Therefore, the research seeks to answer the question ‘what are the possible effect of the rising healthcare costs on other benefits owed to the employees by the employers?’

Literature Review

According to Vu, et al. (2016), the Affordable Care Act (ACA), reforms sought to achieve the Triple Aims goal for the Centers of improving the quality and satisfaction of patient care as per the vision of Medicaid and Medicare Services (CMS). Additionally, ACA intended to improve the population health and reduce the overall costs used for healthcare services. As a result, ACA and CMS have made partnerships with various service insurance companies in a way to distribute the risks associated with the Triple Aim goals and increase coordination of care to Americans. The ACA and CMS intended to reduce the cost of healthcare for all Americans, including the employers and service providers. The researchers sought to examine the impact of ACA on the health of Americans based on the programs that resulted from the coming together of hospitals and insurance companies offering their services. The research sought successful major mergers and best practices on the wellness programs in America for nine years. The researchers also included 44 eligible articles in their analysis to come up with the result they managed from the study. The research result showed that despite the increasing healthcare costs in America, the joint ventures prevent hospitals and other healthcare centers from trading-off quality at the expense of cost reductions (Himmelstein et al., 2019). Therefore, the quality of service delivery ought to remain consistent despite efforts to reduce the overall cost of healthcare for all people.

Duggan, Goda, and Jackson, (2019), noted that ACA reduces labor markets owing to the increased employee benefits and increased liabilities to pay more for their healthcare costs. Employers reduce their workforce to reduce their liability and avoid more employment opportunities to newcomers, thus affecting the overall labor markets. On the other hand, the employers will need to network more to add more investors on board to reduce their burden of paying more fees for healthcare purposes, thus enhancing collaborations amongst business partners.

In Essays in Health and Labor Economics, Anand, (2013) examines the connection between employers-sponsored health insurance service and its impact on the labor economic outcomes. The researcher first determines the effect of escalating health insurance costs on remuneration and employment in society. The author then seeks to assess the impact of ensuring employee premiums are tax-free on their wages and its impact on the overall amount that employees contribute to their healthcare. The researcher uses data from the National Compensation Survey (NCS) to obtain relevant information about the relationship by which establishments in America respond to the rising health insurance costs through adjusting employee benefit and employment. The research found out that establishments offering insurance covers for healthcare reduced the cost of healthcare by $0.52 for every dollar increase on healthcare insurance cost.

Further, Anand noted that establishments primarily relied on employee premium contributions, in addition to the rise in premium prices. The establishments meant that an increase in employee premium would directly affect the level in which the establishments could reduce employee expenditure for their healthcare (Cooper & Gardner, 2016). Further, the scholar notes that an introduction of the Section 125 plan does not trigger enough efforts for the employers to adjust employee benefits. Also, employment that would significantly reduce the cost of healthcare insurance and overall fees for their employees.

Larg, Moss, and Spurrier, (2019) conducted research that sought to understand the cause for the increasing cost for managing obesity condition in America and its link to other associated conditions. The researcher wanted to understand the effect of overweight and obesity on an acute municipal hospital for in-patients as expenditures keep escalating in South Australia over a given period as compared to other factors for the increase. The results of the research noted a considerable increase in spending of $30.5 million per year in South Australia. The growth had a significant change from the former 4.7 percent to 5.4 percent of the total expenditure on acute public in-patient spending. The increase accounted for 7.8 percent of overall expenditure growth while a 62.4 percent increase recorded at the rise in average cost per separation. While obesity is not the study of this research, it denotes the many illnesses that increase the total expenses on healthcare for employees. The researcher challenged the common perception about the effect of overweight on the overall expenditure for in-patients in Australia by attributing that consistent estimation of the attributable cost related to overweight could lead to tracking and comparing the condition with other controllable expenditure drivers that may as well require some attention.

Hornberger et al., (2015) researched the “cost-effectiveness of florbetapir –PET in the Alzheimer’s disease (AD)” based on the Spanish societal perspective noting that the prevalence of the AD and other illnesses associated with dementia put stakeholders into high risks, especially the elderly. The researcher notes that the management of AD is complicated due to disease-specific features that make it terrible to diagnose correctly during the milder stages of the illness. About the ACA. (2019) disease-specific features of the AD depend on the person and the scene that patients undergo while being diagnosed. The ACA reveals that age differences pose severe challenges as older people are at higher risk to complicate the illness as compared to younger people. Additionally, gender difference significantly hampers the effective with which standardization in treatment and diagnosis of the disease could take effect. Therefore, Hornberger et al., (2015) wanted to evaluate the potential long-term clinical as well as economic outcomes for the healthcare system to implement the florbetapir-PET-adjunctive to the regular clinical assessment (SCE) as opposed to just adopting the standalone SCE in assessing patients with cognitive impairment of patients with suspended AD. In that regard, the researchers noted that adjunctive florbetapir-PET adoption led to an increase of the quality of life years (QALYs) by 0.008 years and increased the cost by 36 as opposed to the standalone SCE. Therefore, diagnoses of AD illnesses will likely be more accurate with the inception of the new technology that seeks to improve the overall quality of healthcare services to the people.

Crawford, (2014) wrote an article that focused on a financial incentive plan for workers’ wellbeing as was introduced by Hallmark Cards Inc. 2011 through its business-to-business subsidiary connections. The report notes a significant decrease in the formerly rising cost of healthcare services that the company provided. The company provided incentives to motivate the employees from engaging in various aspects of physical activities that would generally reduce their chances of getting ill. On the other hand, research by Trumble and Pattath, (2013) reveal the economic gains for all employers who engage their human resource in office-based physical activities as they reduce the overall cost of maintaining a healthy workforce altogether. The article reveals the health benefits of employees taking time to engage in physical activities in a bid to promote healthy living (Gombocz, 2013). Besides avoiding to pay some considerable amounts of money to hospitals for their ailing employees, the employers are likely to benefit from healthy employees who spend more time at their workstations as they are healthy, thus increasing productivity and reducing hiring costs.

On the contrary, Cooper and Gardner, (2016) researched “Extensive Changes and Major Challenges Encountered in Health Insurance Markets under the Affordable Care Act” in which they note that despite the changes in the ACA and the changing terrains in the healthcare sector. Additionally, the various laws coming into place to streamline operations make it apparent that the increasing costs of healthcare remain a severe issue that needs serious attention from future researchers. The Republicans have tried to come up with laws that tend to reduce the cost of healthcare in hospitals and homesteads, but contemporary statistics indicate a steady increase still (Gorin & Moniz, 2017) notwithstanding. Gombocz, (2013) conducted a research about the “Changing the model in Pharma and Healthcare – Can we afford to wait any longer?” in which the changing models in the Pharma might have adverse consequences on the economy and businesses. When the economy fails, many companies will close done, and employees will be rendered jobless. On the other hand, when the economy thrives, many businesses will thrive as well as increase employment opportunities so that as many people can secure employment.

Further, Trumble and Pattath, (2013) in their article about the rising costs of healthcare in America note a significant effect on employment opportunities given that many employers will trade employment opportunities with the increasing cost of healthcare to cover their current employees at the expense of growing the business to higher levels and offering other jobless individuals an employment opportunity.

Recommendations

While many research works have been conducted about the potential impact of employee benefits and economic aspects of society, the cost of managing healthcare remains steadfast and increasing by the day. Employers are likely to trade other benefits for healthcare with the inherent laws that require their adherence to the code where health factors of their employees are concerned. Additionally, the imminent laws that prohibit hospitals from trading quality healthcare service to the people for reducing their costs also hinder the service providers from engaging constructively, thus working with other service providers that might have profitable returns as opposed to the civil servants. Based on the research works done on the subject and the literature review above, this research paper could make the following recommendations.

Firstly, employees will need to engage in office-based physical activities to reduce chances of contracting lifestyle-related illnesses and improve their health altogether. Moreover, employers need to create a conducive environment and working schedule that will allow employees to engage in physical activities. Most importantly, employers should implement the florbetapir –PET of AD has proven to be cost-effective in reducing the amount of money spent on employee health cover and compensation to reduce the overall amount of their healthcare expenditure.

Secondly, the government needs to reduce the number of laws that make service delivery stringent that some stakeholders seek for some loopholes to avoid adherence to the legal standards. Moreover, the government should reduce the legally required fees for the employer and employee contributions as it would encourage employers to offer more benefits to their employees.

Thirdly, employers will need to engage in more cooperation with other interested stakeholders to subsidize the cost of healthcare. By so doing, they will manage to reduce the amount required to pay for the services as well as that of the employee. Furthermore, eeduced expenses for the employees will lead to higher levels of job satisfaction, thus leading to lower rates of turnover and higher productivity. Therefore, employers need to design strategies to ensure higher satisfaction levels for their companies.

Conclusion

The increasing cost of healthcare put employers in a tricky position as they face the dilemma to handle several requirements for the organization to remain in operation. Statistics show that healthcare costs increase lead to an increase of 30 percent of the overall healthcare cover that institutions need to maintain for their employees. While the rate of inflation is much higher than expected, it leads to businesses having to strategize financially for operational purposes. The Affordable Healthcare Act seeks to reduce the burden of healthcare from the shoulders of ordinary people. Institutions are required to ensure their workforce have a health insurance cover that can enable them to access quality healthcare services at any given time of their need.

The rising healthcare insurance premiums have been a significant contributor to the increasing cost of health care services since the inception of the Medicare and Medicaid services in America. Besides the insurance premiums, the Ambulatory costs have been on the increase by double since Medicare and Medicaid services implementation in America. Moreover, employers are required to increase their resources by at least 30 percent to cover the rise in the healthcare costs for their employees accordingly. Since employees are required to pay an equal sum of money towards their healthcare cover, thus their healthcare expenses are going to increase by at least 30 percent, it is essential to ensure that the recommendations above are taken into account and implemented fully.

Moreover, Employers will need to engage in more cooperation with other interested stakeholders to subsidize the cost of healthcare. Interested stakeholders contribute some reasonable amount channeled to the healthcare docket in the form of grants, subsidies, and reduced cost of medical services from manufacturing to the retail points. By so doing, they will manage to reduce the amount required to pay for the services as well as that of the employee. Once the employers and the relevant sponsors agree on sharing responsibilities to reduce the burden from the clients’ shoulders, the product will interest the workers to put more effort into their work. Reduced expenses for the employees will lead to higher levels of job satisfaction, thus leading to lower rates of turnover and higher productivity. Therefore, employers need to design strategies to ensure higher satisfaction levels for their companies.

References

1. Anand, P. (2013). Essays in health and labor economics. Dissertation Abstracts International Section A: Humanities and Social Sciences, 74(5-A(E)), No-Specified. Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=psyc10&NEWS=N&AN=2013-99210-440
2. Cooper, R. W., & Gardner, L. A. (2016). Extensive Changes and Major Challenges Encountered in Health Insurance Markets under the Affordable Care Act. Journal of Financial Service Professionals, 70(5), 53–71. Retrieved from https://search-ebscohost-com.library.esc.edu/login.aspx?direct=true&db=bth&AN=117675169&site=eds-live
3. Duggan, M., Goda, G. S., & Jackson, E. (2019). The Effects of the Affordable Care Act on Health Insurance Coverage and Labor Market Outcomes. National Tax Journal, 72(2), 261–322. https://doi-org.library.esc.edu/10.17310/ntj.2019.2.01
4. Gombocz, E. A. (2013). Changing the model in Pharma and Healthcare – Can we afford to wait any longer? In Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics) (Vol. 7970 LNBI, pp. 1–22). https://doi.org/10.1007/978-3-642-39437-9_1
5. Gorin, S. H., & Moniz, C. (2017). An Affordable Care Act Update: Can the Republicans Really Reform It? Health & Social Work, 42(2), 69–70. https://doi-org.library.esc.edu/10.1093/hsw/hlx014
6. HHS. About the ACA. (2019). Retrieved 27 July 2019, from https://www.hhs.gov/healthcare/about-the-aca/index.html
7. Himmelstein, D. U., Lawless, R. M., Thorne, D., Foohey, P., & Woolhandler, S. (2019). Medical Bankruptcy: Still Common Despite the Affordable Care Act. American Journal of Public Health, 109(3), 431–433. https://doi-org.library.esc.edu/10.2105/AJPH.2018.304901
8. Hornberger, J., Michalopoulos, S., Dai, M., Andrade, P., Dilla, T., & Happich, M. (2015). Cost-effectiveness of Florbetapir-PET in Alzheimer’s disease: A Spanish societal perspective. The Journal of Mental Health Policy and Economics, 18(2), 63–73.
9. Kaye, H. S. (2019). Disability-Related Disparities in Access to Health Care Before (2008–2010) and After (2015–2017) the Affordable Care Act. American Journal of Public Health, 109(7), 1015–1021. https://doi-org.library.esc.edu/10.2105/AJPH.2019.305056
10. Larg, A., Moss, J. R., & Spurrier, N. (2019). Relative contribution of overweight and obesity to rising public hospital in-patient expenditure in South Australia. Australian Health Review, 43(2), 148–156. https://doi-org.library.esc.edu/10.1071/AH17147
11. Loney, T., Carter, J. M., & Linnane, D. (2012). The active workplace programme: An initiative to increase physical activity in office-based employees. Society of Petroleum Engineers (SPE). https://doi.org/10.2118/152441-ms
12. Trumble, R., & Pattath, P. (2013). Rising Healthcare Costs – Challenges and options for businesses. Journal of Compensation & Benefits, 29(6), 19–27. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=92610125&site=ehost-live
13. Vogenberg, R., & Santilli, J. (2018). Healthcare Trends for 2018. American Health & Drug Benefits, 11(1), 48–54. Retrieved from https://search-ebscohost-com.library.esc.edu/login.aspx?direct=true&db=rzh&AN=128026730&site=eds-live
14. Vu, M., White, A., Kelley, V. P., Kuca Hopper, J., & Liu, C. (2016). Hospital and Health Plan Partnerships: The Affordable Care Act’s Impact on Promoting Health and Wellness… [including commentary by F. Randy Vogenberg]. American Health & Drug Benefits, 9(5), 269–278. Retrieved from https://search-ebscohost-com.library.esc.edu/login.aspx?direct=true&db=rzh&AN=117396462&site=eds-live
15. Warshawsky, M. J. (2017). The Implications of the Rapidly Rising Cost of Employer-Provided Health Insurance for Earnings Inequality. Benefits Quarterly, 33(3), 52–62. Retrieved from https://search-ebscohost-com.library.esc.edu/login.aspx?direct=true&db=bth&AN=124438606

In December 2017, Congress passed the Tax Cuts and Jobs Act, which eliminated the individual mandate penalty, effective January 1, 2019. The tax bill included a provision that revoked the individual mandate that was part of the 2010 Affordable Care Act (ACA). The individual mandate requires most Americans (other than those who qualify for a hardship exemption) to carry a minimum level of health coverage. Under the ACA, individuals can purchase healthcare insurance that meets the minimum healthcare coverage standards required by law from licensed agents or on or offline directly from insurance companies regardless of pre-existing conditions. Section 6055 of the Internal Revenue Code, adopted through the ACA, requires employers with 50 or more full-time employees and government programs to offer ‘minimum essential coverage’ and report proof of health insurance coverage for anyone employed with that company or who is in a government program. Organizations that do not report the coverage information will face high penalties. This is still in effect for 2018, which means if an individual does not carry the minimum level of health coverage, then they could face a penalty of 2.5% of total household income or $695.00 per person, whichever one is higher. The IRS has announced that it will reject electronic filings of taxes for 2017 that do not claim coverage or an exemption or include payment of the penalty.

The Independent Payment Advisory Board (IPAB) would have consisted of a panel of 15 members, appointed by the president with recommendations from congressional leaders and confirmed by the Senate. IPAB would impose cuts (get spending under control) in Medicare payments to doctors if cost increases exceeded a certain amount. This panel would have had the power to do this even over a presidential veto. “The IPAB would have taken away Congress’s power to make the cost-saving choices it wanted or its choice to avoid them” (Sanger-Katz, 2018, para. 8). Congress could accept the plan or create an alternative that saved the same amount. Medicare spending growth was low after the implementation of the ACA, and no one was ever appointed to the IPAB. The IPAB was sometimes referred to as the ‘death panel’ because its decisions could lead to the rationing of healthcare. The idea of IPAB was abolished in 2018 as part of the Budget Act.

One of the aspects that made the Affordable Care Act so controversial is that citizens are required to purchase a health insurance plan or pay a fine. Twenty-eight states challenged the mandate. Federal district court judges in Florida and Virginia ruled it unconstitutional because it was forcing individuals to purchase a product that they may not want. This did not sit well with many people, including economist Michael Tanner, who felt like purchasing healthcare should be a choice. “We should all eat better and exercise more, but that doesn’t mean we should be doing morning exercises out in the square like they do in North Korea. Freedom sometimes means the freedom to be stupid” (Montopoli, 2009).

Another aspect that makes the ACA controversial is that before the Affordable Care Act, insurance companies were allowed to refuse coverage to patients with pre-existing conditions. With the ACA, they were not allowed to refuse coverage or charge a higher premium for pre-existing conditions. This was done to provide everyone with affordable healthcare coverage. This caused a problem for insurance companies because they had to take losses on paying for their care. Many young adults were opting to pay the tax penalty, leaving insurance companies to pay the medical costs of the older, more sick generation. “As a result of high financial losses on the exchanges, some national insurers, like UnitedHealthcare and Aetna, have decided to either drop out of the exchanges completely or cut back on the number of regions they’re serving” (Gruessner, 2016). Payers will need to recover their loss through increasing premiums. The end result will be higher-priced premiums for those of us who carry health insurance through our employers.

Some people suggest that universal healthcare is the solution. Universal health care is a system that provides quality medical services to all citizens, regardless of their ability to pay. Universal healthcare in the UK is funded by income taxes deducted through payroll; the same deduction that we call FICA here in the US which funds our Medicare. The advantage of this is that the government controls the cost of medical care and medications through negotiation and regulation. Individuals would receive the same standard of care at a low cost. One of the disadvantages is that people who lead healthier lifestyles will not have any financial incentives and will pay for the costs of those who may not be as careful with their health. I have a cousin who is British and who does not seek medical services using his universal healthcare benefit, even though he contributes to it. Instead, he opts to purchase coverage through his employer (doubling his cost for healthcare benefits) because he says that those who use universal healthcare have longer wait times to see a physician and are not provided with the same quality of care as those who have private healthcare insurance. You may wait longer to see an orthopedic doctor if you have a broken arm with universal healthcare than you would if you had private healthcare insurance.

In conclusion, it is important to understand the purpose of the ACA, which is to make health insurance more affordable for those who would not or could not buy health insurance due to either pre-existing conditions or due to high premium costs. The individual mandate requires everyone to carry a minimum level of health insurance. Those who elect not to purchase health insurance coverage face a tax penalty through tax year 2018. While there are aspects that have made the ACA controversial, the fact remains that everyone has a right to access healthcare. It is a right, not a privilege, and everyone should contribute to it. We need a system that works for everyone, and we need to work together as a whole to resolve this issue.