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.
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
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
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
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
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
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
HHS. About the ACA. (2019). Retrieved 27 July 2019, from https://www.hhs.gov/healthcare/about-the-aca/index.html
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
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.
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
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
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
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
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
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
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.
The Patient Protection and Affordable Care Act (ACA), also known as “Obamacare” has elicited different argument in its support and against it. The conservative and the liberal have come out to express their applause and concerns on this piece of legislation.
Interesting to note is the wide use of different forms of language to pass their message to each other and to the nation at large. There have been contentious issues between the liberal and conservative parties in terms of morality and frames of the introduced health care reform.
The effectiveness and validity of the arguments do not depend either on premises or on conclusions, but on the right form of the statement. Within this context, in case the premise is false, the conclusion should be false as well and vice versa.
Alternative variants are not acceptable. This essay shall seek to determine how various forms of statements are employed to achieve certain purposes. The essay also delves into how effective this purpose is achieved.
Invalid reasoning is a form of reasoning that is characterized by the strong stand with very little or no reasoning at all. This form of reasoning has no input in terms of logic. It does seek to critically analyze the underlying issues to come up with its conclusions.
The examples of invalid reasoning are reflected in the right-wing representatives who focus on sound and strong conclusions with no reference to logical references. At a glance, their focus on unconstitutionality does not provide concrete examples from the U.S. constitution (Wilson 3).
However, the emphasis is placed on the rigid violation of human rights and excess pressure on the state and federal government on the citizens’ decision to buy private insurance.
In addition, the premise that “the health care reform act is simply a bad law” cannot be regarded as the right one (Wilson 3). In this respect, the effectiveness of argumentation in this case is low because it does not correspond to the conclusions made.
The opposite for invalid reasoning is Logical validity. This normally concerns itself with the form of an argument. Logically valid arguments are based on premises that are usually minimally relevant to the conclusion.
Also imperative to note is that if the premises are all true, then logically the conclusion must be true. The reason is that it is always impossible to have a valid argument based true premises and end up with a false conclusion. Arguments must be valid to give us a sufficient reason to accept a conclusion.
An example of the valid argument is represented in the article published in The New York Times where the author criticizes the reform because of the fiscal crisis. Hence, his argument is confined to the idea that the government will suffer extreme financial losses because a money deficiency for providing insurance to people belonging to the social layers below the poverty line (Rush to Abandon the Poor 2).
However, the article represented by Degolia, the left-wing representative, does not provide substantial premises for building the argument because it refers directly to the criticism of the right-wing policy (2). The article published by The Progressive focuses on moral dimension and real-to-life stories who failed to receive adequate treatment because of the inability to get health care insurance (Clinton 3).
The author makes a viable conclusion that corresponds to the initial assumptions. You’re mixing the introduction, which only needs to set up your discussion, with a body paragraph, which gets tangled up in the details
Effective reasoning involves a combination of different factors such as experience in order to come up with a conclusion. The decision derived from effective reasoning is also known as sound conclusion. It seeks to base its argument on the statistics that are available.
Effective reasoning is a proper means of challenging the invalid reasoning. For instance, in a New York Times Article titles Rush to abandon the poor, the author uses statistics to counter the Governor’s (from Texas) stand against the ObamaCare.
The author points out that over 6.3 billion people are uninsured in Texas. This is using the numbers that are available in order to advance an argument. The author explains the dire consequences of rejecting the ObamaCare on that ground.
While the governor had not relied on any sufficient evidence or experience for his stand, the author offers the reasons why it is important to accept the ObamaCare.
All the nonfiction works introduce various approaches and rhetoric devices to render the main thoughts and ideas concerning the implementation of ACA. Nonfiction reasoning reasons out of the belief that what he thinks about is true. For instance, in the ObamaCare, the nonfiction approach is that the rejection of the plan shall leave many people without insurance and therefore bring real adverse effects.
This is the belief among those in support of the plan. The adverse effects are real and non fictional. Despite the predominance of criticism of the law among the right-wing supporters and approval on the part of liberal parties, the argumentation techniques still vary.
This is of particular concern to the authors holding the central political outlook on the health care reform introduced by Obama.
Critical thinking normally refers to our ability to be able to think about complex ideas on our own and come up within conclusions that form the basis of our criticism or support in any argument. It encompasses thinking for ourselves as well as the ability to synthesize the contents and end up with a rational conclusion and deductions.
In such a manner, the author manages to reproduce a persuasive argument and introduce personal assessment of the situation. To support personal observations and reassure the audience in the validity of the argument, some authors apply to numeric data, as it is represented in the article published by Associated Press (1).
In this respect, the evidence shows that a combination of subjective and objective evaluations of the issue is effective because it performs two important functions – grabs the audience attention and engages them in the author’s personal opinion.
To understand the main concepts and critical ideas on the chosen readings, it is necessary to challenge the assumptions and read thoughts between the lines. The point is that all the presented articles introduce various rhetoric to persuade the audience in the messages they render, as well as to define whether their ideas are well organized and articulated.
As an example, Jasper argues, “Repealing ObamaCare is also absolutely necessary if we hope to avoid national economic collapse” (1). So, what is the connection between the Affordable Care Act and national economic collapse?
To explain the issue, the author refers to the analysis of other articles exploring the essence of the reform to conclude that “health care reform… is jam-packed with dangerous language that will provide federal bureaucrats with vast new powers that are compatible with totalitarian systems of government, but not with the American tradition of liberty” (p. 3).
To expand on the point, the author emphasizes that radical position on the reform contradicts the premises of the U.S. constitutions in terms of human rights and freedoms. In this respect, the author makes use of the language to persuade the audience that the given law can create serious challenges to the economic and social welfare of the U.S. nation.
In addition, the article is based on the approach of proving the issue from the contrary. Thus, the author first presents the idea of ObamaCare as an essential law and proceeds with heavy criticism of the latter.
Proving from the contrary is also reflected in the article by Kirsch (2). Specifically, the article discusses in detail all the benefits and the positive changes that the new law can bring into the healthcare.
However, the pitfalls of the reform are still discussed on the background of the highlighted advantages. In this respect, though the Act can provide people with a higher level of living for some layers of the population, the middle-class employees will face the most serious difficulties because the subsidies are not sufficient to allow the employees to purchase the private health care insurance.
At a certain angle, Kirsch applies to a sophisticated approach and takes a pseudo-neutral position to attract more readers to the issue. Similar techniques are represented by Lapointe who addresses until the problem as a third party criticizing both the Republicans and Democrats (3).
However, despite the criticism of the opposed parties, the article still provides arguments in favor the adoption of the Affordable Care Act. In such a manner, the author explains, “under the affordable care act of 2010, people with pre-existing conditions would no longer be defined coverage by insurance companies” (Lapointe 3).
Despite the fact that the article is published in the newspaper supporting conservative views, it still represents the legislation from a positive perspective. At the same time, the author introduces a contradictory point of views right after enlarging on the positive effects of the presented law. So, why does the author produce an extremely contrasting view with no exact position in regard to the ObamaCare?
Apparently, such a position has been chosen to encourage more audience to deliberate on the issue giving no political importance to the reform. Even the last sentence “America desperately needs healthcare reform, and Obamacare is the answer” does not actually provide a clear response to the exact position of the author toward the health care policies in the United States.
The articles under consideration also apply various modes of persuasion to endow their writing speech with a certain tone and to attract specific target audiences. Use of logos, pathos, and ethos vary from one work to another, but certain tendencies are still represented differently with regard to the authors’ political preferences.
Political affiliations and assumptions are explicitly represented through the three modes of persuasion being the major tool in delivering messages to the audience. An in-depth analysis of the readings has revealed certain tendencies in the techniques used by the representatives of liberal, central, and conservatives vies.
In particular, the representatives of the liberal, left-wing attitudes prefer using ethos to persuade the audience. As a proof, the authors apply mostly to existing facts and knowledge to base their personal evaluation on. In contrast, the articles published by the New Yorker, the New York Times, the Washington Post, and the Wall Street Journal pathos in combination with logos to provoke emotions among the target audience.
They rely on moral dimensions and highlight ethical concerns of the reform outcomes. For instance, Gawande (3) makes an accent on the moral conception of the story about a terminally ill patient who does not lose hope during treating lung cancer (3).
Using radical methods in treating cancer, the author as if calls the reader to think over new changes and shifts in the health care system. Because of the radical influences, it is purposeful to assume that the author supports the revolutionary approach that should be applied to improve the situation in the country.
Finally, the conservative proponents – the Washington Times, the New American, and The American Spectator – choose to use a double approach to persuading and capturing the attention of their audience and, therefore, they use a combination of pathos and ethos to enhance their articles.
While reading the article, the audience should clearly distinguish between personal opinion and exposition of knowledge and facts. To begin with the authors refer to facts and knowledge to enhance the objectivity to the ideas delivered in the article.
In such a way, they can capture the attention of the readers who are more interested in the presence of objective evaluation to the event and are skeptical in terms of the authors’ personal argument. In this respect, author’ personal opinion is represented as a subjective dimension in the article.
It is obvious that all newspaper articles seek to deliver a subjective opinion on the issue to determine the authors’ position, as well as identify the political beliefs they uphold. With regard to the chosen material for analysis, all the articles deliver subjectivity, but to a different extent.
Specifically, much subjectivity is imposed on the story represented by Gawande (3) who introduces a tragic story about women who has a serious form of lung cancer, but who remains optimistic and hopeful. Focusing on emotional dimension, the author makes use of personal opinion to enhance audience’s emotional engagement with the story.
In contrast, Jasper is more concerned with representing objective facts and focus on the logic of thoughts exposition. In such a manner, the author manages to persuade the audience that the article represents a strong chain of arguments and assumptions. In particular, the article refers to existing legislation passages to ensure that Obamacare policies cannot be justified in a constitutional way.
To contrast and compare, Gawande, a newspaper reporter has produced an emotionally colored story about a terminally ill patient with no reference to ObamaCare policy. In such a manner, the author emphasizes the necessity to introduce progressive and revolutionary changes to the medical sphere and medical treatment in general.
The writing represented by the Washington Post focus on the deplorable status of the uninsured citizens in the United States. In particular, the author generalizes the negative consequences and refers directly to the shortcomings of Medicaid expansion, which could still leave some layers of the population without health care insurance.
In this respect, much concern should be connected with the consistency and reasonableness of the presented policy. In such a way, the given work refuses to support the ObamaCare project because of large-scale negative outcomes.
Finally, the Wall Street Journal chooses a neutral position and addresses the debates between Liberal and Conservatives to objectively evaluate the pros and cons of the Affordable Care Act in terms of the racial discrimination policy. At this point, Taranto centers on the problem of political correctness that has come to the forth because of the radically introduced reform.
Hence choosing various approaches and tools for addressing the issues, the central forces remain neutral toward the reform by introducing the negative and positive outcomes of reform and by criticizing the accusation on the part of conservatives and liberals.
Explicit distinctions between personal opinion and facts are represented in the work by Taranto who introduces quotes for the readers’ objective evaluation and provides personal analysis for the audience to contrast and compare it with their own vision of the argument.
In conclusion, a critical analysis of the presented articles discovering the liberal and conservative views on ObamaCare policy has revealed explicit tendencies in expressing thoughts and delivering specific concepts.
In particular, liberal proponents are more concerned with radical and revolutionary changes that should occur in the country and, therefore, the articles supporting this position uphold the adoption of the Patient Protection and Affordable Care Act. Conservative supporters reject the reasonableness of the ObamaCare policy because of the significant economic and political consequences.
Their neutral position is taken by the newspapers that introduce the debate from third-party perspectives. In addition, presenting ideas is also followed by the distinct use of ethos, pathos, and logos.
In this respect, liberal wing is more concerned with using ethos; conservative activists prefer to make use of pathos. Finally, the central forces refer to mixed modes of persuasion.
Despite discrepancies in using rhetoric devices, all the authors have managed to use a combination of objective and subjective observations, which essential for attracting the target audience.
Works Cited
Associated Press. “States Could Leave Millions of Low-Income People Uninsured in a New Medicaid ‘Doughnut Hole.” Washington Post. 2012. Web.
Clinton, Kate. “Public Health Care Cures Worry”. The Progressive. 2009. Web.
The Patient Protection and Affordable Care Act is a significant step forward that caters for improving the health care in the United States. President Obama signed the Act into law in March 2010. The Act is now consistent with the advocacy principles that are adopted in the AAFP Congress of Delegates as from October 2009.
However, the implementation of the Act came amidst reactions from various states. Organizations together with other lawmakers came up with some opposing forces on the bill. The main idea behind their opposing forces was because of the key provisions in the bill. Some of the provisions within the bill claimed that individual fines from failing to purchase the insurance does not work within the scope of taxing powers of the Congress. Among the states that reacted over the act is Iowa, which used its legislators to sue the progress (DPC 3).
The Patient Protection and Affordable Care Act (PPACA) also known as the Obamacare plan, has various provisions contained therein to cater for the health needs of the citizens. There is inclusion of a parent clause that deals with prior policies on health and makes the Act to be exempted from the policies (Pipes 5).
The first provision is the guaranteed issue clause. This requires the health policies to be issued to the citizens without any discrimination regarding their medical condition. Pipes (161) further indicates that the law also requires insurers to exercise partial community rating whereby same premiums must be issued to applicants within the same geographical location or age (8).
Gender should not be considered a discriminating factor or prior existing conditions with the exception of tobacco use. This paper will examine the reaction of some states notably Iowa and Virginia. It will also evaluate the differences in their reactions and implementation of the Act.
Objectives
The study seeks to establish the economic impacts of the Patient Protection and Affordable Care Act on the public and the various states. Specifically this study will seek to:
Investigate the impacts of the act on the public
To investigate the impacts of the act on the various states
To find out reasons why the states of Iowa and Virginia rejected the act
The Patient Protection and Affordable Care Act
The Act states that all citizens who are not insured by their employer, Medicaid, Medicare or any other public insurance program, must ensure that they are under a private insurance policy failure to which they will pay a penalty (DPC 5). This is however not applicable to members of religious sects recognized by the Internal Revenue Service or have been ignored due to financial hardships.
The third provision requires health insurance exchanges to operate in every state in the country and ensure that citizens can choose from various policies and premiums. This means that there should be a variety of premiums available in the market. The Act also caters for low income earners. It provides for federal subsidies to be granted on a sliding scale to families between 100% and 400% of the federal poverty level (DPC 7). This is however subject to them purchasing an insurance premium through an exchange.
The Supreme Court however left a loophole in the legislation when it allowed some states to exclude themselves out of the Medicaid expansion (Pipes 18). These states are however required to set up their own parameters on the eligibility of the members. Most of the states under this category fall under the 133% threshold. Another provision requires states and insurers to set the policies’ standards and bans policies that cover the lifetime of a policyholder.
A range of taxes and offsets (DPC 8) funds the provisions under the Act. Most of the revenue is derived from expanded Medicare tax especially on incomes in excess of $200,000 and $250,000.
Other sources according to Gibson and Pranad (154) include a 40% excise tax on insurance policies, tax on pharmaceuticals, expensive diagnostic equipment, a 10% tax charged on the sales tax of indoor tanning services and a percentage from the annual fee charged on insurance providers. Offsets on the other hand are derived from expected savings from the costs related to Medicare Advantage programs.
Under this Act, the federal government was going to pay full costs for three years and then shift the costs gradually to the state (DPC 8). The cost was to be shifted in 10% installments over time. However, a few concerns were raised regarding the long-term viability of the model.
From an outsider’s point of view, this could be the best thing to ever happen to a country. The uproar created by the Republicans and citizens left many wondering what was wrong with this law. Due to the ruling in National Federation of Independent Business v. Sebelius, many states reacted differently to the Act.
The ruling contradicted many aspects that had been made clear to the people by the president and other relevant authorities with knowledge. This is despite the fact that the Act provides some incredible guidelines to achieve high-quality provision of healthcare in the country.
Reactions by the Iowa state
Iowa is one of the many states that reacted on the approval of the Act by the president. The state used the governor in signing a lawsuit against the federal health care. According to the governor, the lawsuit will challenge personal mandate of the healthcare bill, which forces Iowans to purchase health insurance from the federal government, which is mandatory.
Additionally, the law gives option for the expansion of Medicaid, which is quite costly making the residents of the state to cut on their other programs. The impact of the health care bill will completely disorganize the state budget thereby freezing significant activities. Considering that the governor is trying to process a five-year budget, inclusion of the law in the budget will affect the Iowa taxpayers.
Iowa people view the law as an impediment on their success in development. An additional expense on their income will alter their daily chores expenses thereby affecting the general development of the state. From the taxpayers’ perspective, they risk paying more taxes, which can be a substitute for other important activities (Danielson par 3).
On the contrary, some have positive hopes on the implementation of the law. From their perspective, the law will help the Iowa state to fulfill its goals of protection and promotion of health and welfare of the public. Considering that health care is a crucial factor in most regions, implementation of the law would help in solving health issues that concerns the society at an affordable rate.
Reactions by the Virginia State
Another state to react on the health care law signed by the president is Virginia. According to the people of the state, the healthcare reform requires people to purchase health insurance, which presents unconstitutionality in the nation. Another reason that the state reacted upon the law was the individual mandate of purchasing the law together with the direct dependent provisions that the law provides to the citizens (Kousser and Justin 42).
According to the sector of individual mandate, the law requires all the citizens to purchase the insurance by 2014 or face a penalty for not buying. From the legal point of view, the final language of the law misleadingly mentions the penalty tax, prior its name being a penalty in the draft language before passing the final bill.
The factor of penalty and tax is a paradox considering that the constitution requires the federal government to impose taxes with a penalty imposed to those who violate the constitution. In a law-abiding country, individuals should be given a chance constitutionally to accept some of the laws implemented by the government (Pecquet par 6).
Factors that led to the Different Reactions by the Two States
Even though a myriad of explanations were given as to why the law should be rejected, it is evident that the rejections were significantly fuelled by politics. This is due to the belief that a change of guard i.e. from a Democrat to a Republican, would likely amplify the probability that this law would have less strict federal requirements (Pipes 12).
It is therefore not by coincidence that most of the states that opposed the enactment of this law are made up of majority Republicans and conservatives. However, the reactions from Iowa were more explosive when compared to the reactions from Virginia (Steinglass 216). The Iowa Republicans were very vocal on the issue and were adamant to accept the law until the time their concerns were addressed.
Being at the helm of the specific states, the implementation of this law depended hugely on these people’s influence on the budget of the states and other forms of lobbying within the health sector. This is what some of the politicians from the two states had to say:
In Iowa, most of the Republicans were against the law. Being the majority, they were the ones who were charged with the responsibility of implementing the Act and much depended on their stand on the issue. For instance, Congressman Steve King stated that the Supreme Court’s ruling in favor of the Act was not in line with what lower courts had decided regarding the matter.
According to King, the lower courts had agreed that the individual mandate could not be treated as a form of tax and therefore could not be implemented by the Congress’ powers on taxation.
He also emphasized that the Supreme Court ruling was in contradiction with President Obama’s views since he had earlier stated on national television during a debate that the individual mandate was not a tax (DPC 8). That was the case before the law was passed into a bill. Subsequently, the government defended the mandate under Congress’ “taxing and spending power” (DPC 9).
Methodology
The purpose of this chapter is to present the details of the approach to the research. The approach should be illustrated to increase the validity of the research. The approach to the research was done considering a research onion. Therefore, the methodology chapter will be considered by a discussion of the philosophy of the research, the approach, strategy of the research, data collection, and the focus group.
Research Onion
The diagram below displays the research process, which resembles an onion.
A research onion was used to provide a description of the methodology of the research. The research onion presents a clear framework of the methodology employed. As shown in the diagram above, it has layers representing every item consulted. Through each layer, the research questions will be answered. Using the outer layer, there are various philosophies considered as shown bellow.
Gibson, Rosemary and Prasad, Janardan. The Battle over Health Care: What Obama’s Reform Means for America’s Future. Plymouth : Rowman & Littlefield Publishers, 2012. Print.
The United States of America’s political system is described as democratic with Republican and Democratic parties forming the majority. Since time in sundry, exercising democracy during elections, especially on campaign platform, has reached maturity. In any presidential election, it is apparent that a Democratic Party nominee faces off with a Republican Party nominee.
America’s presidential election results are often determined by policy inclination and practicality as perceived by the public and technocrats. Specifically, the politics of the Tea Party and the Affordable Care Act have closely interacted in the past in the opposition of the ObamaCare.
Directly, the Affordable Care Act is one of the tests of popularity of the Tea Party outfit against its opponents. Thus, the influence of the Tea Party in the Affordable Care Act cannot be dismissed. This analytical treatise attempts to explicitly discuss the Affordable Care Act (ObamaCare) and the Tea Party on the tenet of how these topics interact with each other.
The Affordable Care Act
Despite the controversy it courted, the ObamaCare (Affordable Care Act) has presented a comprehensive health policy which mainly adopts the redistribution economics to ensure that every American is covered under the scheme (US Department of Health and Human Services par. 11). Despite initial rejection by a section of Americans, the policy carried the day as it promised to make health very affordable to the low income groups. At present, the only challenge is implementation since it will have to cover very many people.
Through partnership with insurance companies, this policy has been described as basically what the Americans need after the just ending financial crisis characterized by reduced disposable income. This policy has been successful in Norway and its only determinant of success in America will be its implementation module. As proposed in the policy, the aspect of individual mandate has been supported by both houses and even President Obama’s opponent from the Republican Party.
The aspects of fairness, objectivity, and transparency define a policy. Objectivity minimizes biasness and prejudice when drawing a policy. On the other hand, fairness involves collective consultation with stakeholders and adopting consultative decisions. Transparency involves the aspects of proactive reviews that are consistent with the performance evaluation and monitoring system. Reflectively, the Affordable Care Act proposed by President Obama contains all these aspects within its scope.
This policy on healthcare is objective and targets to make healthcare provision affordable to the upper and lower economic ends citizens of America. It has specific projections and intentions that are multifaceted and based on recommendations of the expert and other stakeholders. The transparency aspect of this act is that it has the target monitoring unit and active reporting channel during implementation (Wittes 17).
Though very complex, the Affordable Care Act is intrinsic of the demand and supply in the market, social, and public demands against a backdrop of manageable cost constraints of health provision in America. The main components of the policy can be quantifiable for viability, ease of implementation, and realization of the intended goals which are reducing the cost of health provision and providing health insurance to all the citizens of America.
The ObamaCare Act has special interest on the multiple disadvantaged Americans who could not afford the private healthcare systems of the day. Multiple disadvantaged groups in health status refer to groups within the population that are victims to worst health risks due to healthcare policy discrimination.
Due to their low socioeconomic status, they are not able to afford quality Medicare. Disadvantaged groups strain to get healthcare services due to low income bracket. Often these groups exist within the larger population as is the case in America where low income and middle income brackets are more than 80% of the population. Due to their low living standards, these groups are the major beneficiaries of affirmative healthcare actions provided by the Affordable Care Act (IIzetzki 2).
The Affordable Care Act has two parts. The first part deals with health insurance. The second part is the Medicare insurance coverage which helps pay for the doctor’s services, outpatient hospitals care, and some other medical services that are not provided by part A. There is no need to pay a monthly payment (premium) for part A since taxes paid prior to the retiring from employment are earmarked for this cover. Part B, on the contrary, assists in the defraying the cost for these medical services when needed (IIzetzki 3).
The Tea Party
The tea party is a populist American outfit associated with libertarian and conservative inclinations on political and economic policy implementation and functionality. As a movement, this association has direct influence on political future of America and policies debated and passed by the congress.
Specifically, resounding interest surround the influence of foreign currency on the dollar as a protectionist assembly of tools for mass influence. This outfit offers its members a platform for awareness creation on the economic, social, health and political factors that directly affect the Americans.
Reflectively, several private individuals with republican, libertarian, democratic, and independent inclinations identify themselves with this outfit. This community perceive themselves as true Americans who would do anything to protect and reaffirm the constitutional founding upon which their nation was laid by statement. Tea party movement consists of members drawn from all professional fields. The members of this outfit are united by their perception on how the political leadership of the US is handling its duties and policies.
The Tea Party has remained in the front line in promoting democracy within the US through promotion of freedom of speech by sponsoring its members of parliament to pass critical bills and hold series of pro or anti government protests. Basically, sustainable democracy as enshrined in the beliefs of the Tea Party outfit offers a practical sketch map for intellectual development and political maturity.
Thus, this group endeavors to campaign for sustainable democracy which ensures reliable governance and democratic issue base confrontation of challenges affecting the citizens from insecurity, social justice, and respect of human rights. Reflectively, sustainable democracy as a concept of the Tea Party’s institutional approach is applicable in reforms and offers a solution based management of government institutions.
In the realms of social secularization, the transitional facilities of the Tea Party outfit assist the institutionalization of units of the American society to create an accepted mode of interaction. The operating mechanisms of these efforts are in the traditional and economic development of the US societal conditions promoting public interest. Interestingly, many of the Tea Party members oppose the ObamaCare (“Defund ObamaCare now” par. 7).
The Tea Party and the Affordable Care Act
Process evaluation examines actual implementation and development within a specific act such as the Affordable Care Act. Reflectively, the independent Tea Party has reviewed the quantifiable fulfillment of targets of the Affordable Care Act as unfair to the middle income household since they view the act as an opportunity for the government to collect more taxes.
On the other hand, impact evaluation examines long term changes that have surfaced as part of the success or failure of a project. It examines the long term effectiveness of policy based programs after implementation. The Tea Party members from the republican inclination are in the forefront of impeaching the Affordable Care Act because of the fear of letting the government to run their healthcare (“Defund ObamaCare now” par. 7).
Since the Affordable Care Act is an intriguing idea, the Tea Party focuses on a mirrored reflection of what a society would like to visualize from a string of intertwining ideas. Instead of adopting the impersonal consciousness, stepwise process, and absolute necessity assumptions aimed at creating a sustainable, friendly, and acceptable irksome feeling to the ObamaCare, the Tea Party has adopted a partisan approach in their criticism. In fact, it is only the minority members who seem to oppose the act in totality.
At quantitative level, the Tea Party outfit does not adopt the expected continuous process of embracing both ecological dimension and internal operation engine as a measure of variance between the benefits and demerits of the ObamaCare. Thus, it is apparent that the Tea Party is likely to lose its objectivity since their negative stand on the ObamaCare is not supported by any public poll. Thus, they cannot claim to be representing the interests of the true Americans in opposing the Affordable Care Act.
Personal reflection
Change advocacy is a necessity towards actualizing ideas acceptable to the society. Irrespective of the social and economic climate in which change agents operate, the questions to consider in change advocacy revolve around policy solutions, engagement, administration, and change argumentation. In the America society, citizens have adopted bureaucratic, ideological, legislative, and mass appeal to advocate for change.
The Tea Party outfit operates on the bureaucratic, mass appeal and ideological appeal when supporting or opposing government act. Under the bureaucratic arrangement, individual involved is often an expert with vast experience in the subject of change. For instance, in the new health plan proposed by the Obama administration, experts have presented a well researched optional approach into health provision to the government decision makers with an intention of convincing this group to accept their proposal.
In practicing ideological advocacy as a means of influencing change, individuals sharing the same ideology can mobilize together in protests and demonstrations to express their dissatisfactions to the decision making organs for appropriate actions as is the case with the Tea Party outfit.
Conclusion
The ObamaCare has given special attention to the disadvantaged groups in health services provision. The ObamaCare has made healthcare affordable and easily available to the poor Americans. However, the Tea Party is against this act since the bureaucrats have proposed better approach towards provision of affordable healthcare to the Americans.
Just like any other political or social outfit, the Tea Party has considerable influence on the successful implementation of the Affordable Care Act. From this discussion, it is apparent that individuals sharing the same ideology can mobilize together in protests and demonstrations to express their dissatisfactions on different government policies.
Works Cited
Defund ObamaCare now 2013. Web.
IIzetzki, Ethan. In its opposition to the Affordable Care Act, the Tea Party is not defending the ideals of the founding fathers, but subverting them. 07 Oct. 2013. Web.
US Department of Health and Human Services. Affordable Care Act. Cat. no. Washington, 2012. HHSgov. Web.
Wittes, Bejamin. Campaign 2012: Twelve Independent Ideas for Improving American Public Policy, Washington, DC: Brookings Institution Press, 2010. Print.
There has been a lot of attention from the media with regard to the recent Affordable Care Act in the United States. Little focus is given to how the new Act is going to affect the young and elderly receiving Medicare. This paper takes a critical look at the Affordable Care Act with an aim of analyzing its affordability, benefits, and quality as well as other key features.
Affordable Care Act
The Affordable Care Act (ACA) is the new law based on reforms in the United States health care. It refers to two separate Acts which are Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act 2010 (Rosenbaum, 2011). This Act gives an expanded Medicaid coverage to low-income Americans. The ACA provides access to care by providing coverage needed for the American citizens.
Once rolled in 2014, the ACA will allow millions of American individuals and families to access subsidized insurance coverage. The Act provides lower costs of insurance coverage, and makes insurers more accountable by setting standards be met (Rosenbaum, 2011). Furthermore, the act guarantees coverage for pregnancy and disability, or other pre-existing conditions.
The law gives Americans more access to insurance coverage as well as safe-guarding their rights. The legislation also removes dollar limits on the coverage and prohibits insurers from dropping coverage when individuals get sick on an unintentional application (Rosenbaum, 2011).
The Act also allows Americans to make appeals on insurers’ coverage decisions and allows individuals to take control over their health care issues. It sets new coverage options for young adults, senior adults, women, businesses, families with children, and people with disability. In addition to the above insurance related benefits, the ACA provides essential medical benefits such as preventive care, doctor visits, hospitalization, and prescriptions (Rosenbaum, 2011).
The ACA is projected to make Medicare more fiscally efficient through the application of cost savings. The law provides incentives to health care providers so that they can formulate strategies to provide high quality health care, and eliminate costs, wastes, and abuses in the Medicare (Family USA, n.d.). The Act will ensure that beneficiaries pay and receive high quality medical care. To achieve this, the law reins on unnecessary spending by health providers.
These reforms will save Medicare billions of dollars. The Act imposes financial penalties on hospitals when a patient acquires infections from the hospitals (Family USA, n.d.). This move will improve hospital care and save money spent on paying for health care. Finally, the Act will improve the health care delivery efficiency, by reducing wastages within the system. Therefore, the high quality care and efficiency created by the new law are among the many methods through which the Act is fiscally efficient (Family USA, n.d.).
The opponents of the ACA point at a number of issues about the consequences of the new legislation on the Medicare program. First, they argue that the law will reduce the autonomy of physicians, and hence reduce job satisfaction (Williams, 2013). The consequence of which they believe will be passed on to the patients.
They foresee patients being restricted from accessing, or having to wait for long for appointments, and receiving rationed health care services (Williams, 2013). They regard the Act as having negative impacts on jobs and the overall economy. They argue that the price controls imposed by the legislation on Medicare will be a disincentive to in the medical sector, thereby reducing investment in health care (Williams, 2013).
On the other hand, the proponents argue that this framework increases access to affordable Medicare for millions of low-income Americans and increases the provision of quality Medicare in a more pragmatic and efficient way (Family USA, n.d.). In particular, the proponents of the ACA point out that it gives people the liberty to take charge of their own health matters.
This gives autonomy to the beneficiaries to plan for their health issues instead of leaving it at the discretion of the insurers and health providers (Family USA, n.d.). Additionally, the proponents also point out that the ACA introduces the culture of prevention by encouraging beneficiaries to work together with physicians and caregivers in order to reduce health costs through adequate preventive measures (Family USA, n.d.).
The ACA will strengthen the Medicare program in the country. First, the Act’s top priority is fighting fraud in the Medicare program that has inhibited the delivery of quality health care to many Americans. Secondly, the legislation guarantees many benefits to many Americans who have been denied access to Medicare for a long time through discriminatory tactics.
Finally, the Act reforms the Medicare program by offering medical providers with new incentives to improve the quality, as well as eliminate costs and abuse to preserve the benefits for all Americans.
Conclusion
The ACA was enacted with a primary purpose of increasing access to Medicare for millions of Americans. The law has received a lot of attention from the media due to the arguments leveled for or against it.
Proponents argue that the Act is a landmark reform in the Medicare program that guarantees access to affordable and quality medical care to all in the United States hence benefiting many low-income Americans. On the other hand, opponents argue that the reduction of the autonomy of health providers and physicians, works negatively against the economy. These arguments can be proved early next year when the Act will be enforced.
References
Family USA. A Summary of the, Health Reform Law. Web.
Rosenbaum, S. (2011). The Patient Protection and Affordable Care Act: implications for public health policy and practice. Public Health Reports, 126(1), 130-135.
The patient Protection and affordable Care Act was appended into law by president Barrack Obama in March 2010. This gave birth to the Affordable Care Act after some amendments were made to the original Act a few weeks later (Morse 208). The Act injected significant changes on healthcare delivery in the United States. However, there are myriads of business and human resource implications that this healthcare Act brought into focus.
According to the arguments presented in the article, there are several uncertainties that bedevil individual entrepreneurs and employers in regards to the Affordable Care Act (Morse 212). There are quite a number of business challenges presented by section 36B of the Act. As a matter of fact, exchanges are instrumental on several aspects of this piece of legislation and also for credits described in section 36B (Morse 238).
For instance, this section clearly describes the details of the employer penalty tax. It is interesting to note that each employer is expected by the Act to have at least one worker who is employed on fulltime basis who is covered by the provisions of the Act.
However, the application of this Act requires an employee who resides in a region where Exchange has been put in place. The most challenging aspect of this Act is the dispute resolution part for individuals who live in states not covered by credit exchanges.
At this point, it is evident that unfamiliar problems may be presented by multi-state operations bearing in mind that businesses can grossly suffer the impact of resolving disputes that arise from employees hired from other states. Worse still, subsidized coverage may be pursued by some employees especially if the employer decides to drop some coverage.
Even if the latter is possible, the remaining states may not be in a position to do the same. Gauging from the aforementioned factors, it implies that locating business operations and the level of accessing such businesses especially in the presence of jurisdictions that are competing against each other.
Furthermore, the process of hiring employees located in states where Exchanges have not been created will be a gross hindrance. This has definitely interfered with the selection of employees when hiring human resource within business organizations. To some extent, it implies that some business entities may completely fail to enjoy the benefits of hiring certain professionals merely because they are not favored by the provisions of the Affordable Care Act.
It would have been possible for the Congress to seek alternative funding for the welfare benefits by imposing new taxes. For example, services such as sterilization and contraception could be subsidized by the government instead of negatively impacting businesses with the new tax regimes under the Affordable Care Act. Even if such alternative measures could be taken, the American public and pressure groups could still be on the forefront in fighting such proposals on the basis of moral concerns.
As it stands now, the Affordable Care Act has negatively affected the operations of several businesses due to additional taxation to cover the benefits described in the piece of legislation. Moreover, there are several underlying uncertainties that businesses still face in regards to this law.
If the Patient Protection and Affordable Care Act adopted in March 2010 would have been left intact as it was without any additional amendments, both small and large businesses would be safeguarded from the negative effects being experienced today.
Works Cited
Morse, Edward. Lifting The Fog: Navigating Penalties In The Affordable Care Act. Creighton Law Review 46.2 (2013): 207-257. Print.
The Patient Protection and Affordable Care Act (hereafter referred to as the ACA), which was signed into law on March 23, 2010, by President Barrack Obama, presents a new paradigm shift in terms of how employers in the United States proceed in the management of employee benefits (Deloitte, 2013).
Indeed, as suggested in the accruing literature, the ACA generates novel requirements and options for employers’ future benefits decisions particularly in providing affordable insurance coverage to employees and intensifying their access to health insurance either through personal mandate or through already evolving Medicaid expansion programs (Deloitte, 2013; Henry J. Kaiser Family Foundation, 2013; Schuman et al., 2013).
This paper brings the real issues surrounding the ACA and benefits management into the fore by presenting the findings of an interview with the benefits manager of a service-oriented company employing more than 250 full-time workers in the United States.
From the onset, the interviewee agreed that the ACA has the capacity to substantially shift the American workplace and workforce, in large part due to the important obligations that employers are expected to assume to expand employees’ insurance coverage.
The manager acknowledged that health insurance coverage forms a critical component of employee benefits management and that his organization has invested heavily in the development of a comprehensive health insurance plan for all employees.
As acknowledged in the literature, the ACA “requires employers with more than 200 employees to automatically enroll employees into health insurance plans offered by the employer” (Henry J. Kaiser Family Foundation, 2013, p. 1).
As a matter of fact, the interviewee suggested that the company was investing heavily on a policy that will enable the organization to gain access to new avenues to purchase employee health benefits with the view to providing a wider choice of plans and enhanced affordability through more transparent and competitive means.
When asked if the company would be able to adequately cover its employees as demanded in the ACA, the interviewee acknowledged that the Act was shifting healthcare costs to employers rather than encouraging cost-sharing and plan design.
To deal with this scenario, the interviewee hinted that the organization was considering reducing other benefits accruable to employees and also shifting other expenses to employees so that it can have the capacity to provide employer-funded health insurance coverage.
This view is supported in the literature, with the report by Deloitte (2013) acknowledging that a similar employer-sponsored insurance coverage in Massachusetts caused employers to recalibrate “their coverage by scaling back benefits and increasing employee cost-sharing and financial responsibility” (p. 13).
According to the interviewee, reducing other employee benefits to fund the new Act is the only reasonable thing to do for middle-level organizations that neither benefit from the economies of scale open to large organizations nor utilize the various tax credits open to small companies.
Lastly, when asked to state the viability of the ACA in enhancing employee benefits, the interviewee acknowledged that the Act was not justified owing to its adverse effects on overall employee benefits as organizations use available financial resources to purchase health insurance for employees with the view to expanding coverage.
Indeed, the interviewee was of the opinion that some of the provisions of the ACA were making organizations to reduce the monetary allocations earmarked for other benefits to expand health insurance coverage for employees, though this did not translate to improvements in health care delivery or reductions in health care costs.
As indicated in the literature, the Act continues to receive widespread criticism for its incapacity to control health care costs or enhance health care delivery system (Deloitte, 2013; Henry J. Kaiser Family Foundation, 2013), and also for its predisposition to redirect substantial benefits into health insurance coverage at the expense of other equally important issues dealing with employee benefits such as paid leaves, pensions and bonuses (Rosenbaum, Teitelbaum, & Hayes, 2011; Schuman et al., 2013).
Overall, the interview with the benefits manager of the service organization reveals that the ACA has substantially changed the company’s approach to benefits management, particularly in terms of passing on cost increases to employees to minimize or manage overall costs involved in implementing the Act to avoid the stated penalties.
The company is undoubtedly faced with increasing health care costs as it attempts to expand coverage by purchasing insurance and enrolling its employees into available health care plans.
While expanding coverage seems to be a noble objective for the company, it is only fair to suggest that the increase in health care costs is ultimately passed on to employees through benefit restructuring and cost-sharing mechanisms (Deloitte, 2013), implying that other components of benefits management (e.g., pension programs, bonuses, paid leaves) will be adversely affected as employers try to offset increasing health care costs.
The cumulative effect of this scenario is that most employers may be unable to attract and retain qualified and skilled employees due to failure to provide a variety of benefit packages. Consequently, the government needs to come up with ways and avenues to absorb some of these costs and ensure that the capacity of organizations to continue providing a whole range of employee benefit packages is not compromised.
References
Deloitte. (2013). Health care costs, benefits, and reform: What’s the next move for employers? Results of Deloitte’s 2013 survey of U.S. employers. Web.
Henry J. Kaiser Family Foundation. (2013). Summary of the affordable care act. Web.
Rosenbaum, S., Teitelbaum, J., & Hayes, K. (2011). The essential health benefits provisions of the affordable care act: Implications for people with disabilities. Web.
Maggie Fox writing for NBC News wrote that, if health care was banking it would take days to withdraw money from an ATM because records would be misplaced and if it were airline pilots would have to depend on their own intuitions to dictate which safety checks to carry out (Fox, 2012).
Well, not too harsh an assessment considering the mess that currently bedevils our health care system. As a matter of fact, the rain has not just started beating us now; the US health care system was declared broken and requiring fixing more than a decade ago.
This underscores the recent spate of actions in terms of policy legislation that we are still yet to all agree on. That aside, there are serious issues with our health care system.
Issues of priority such as access in terms of the uninsured, quality and cost in that order are the three most important things in a health care system (Nyman, 2003). I will highlight and discuss in detail each of the three in this paper.
It is quite unfortunate that in the US the most developed economy in the world today access to health care is right now an issue yet to be addressed fully.
Most recent statistics indicate that close to 40 million Americans in this day and era are uninsured and still have to struggle to meet their health care requirements (Squires, 2012).
A few critics would argue that insurance and access cannot be taken as one since the uninsured could still walk into any health care facility and get medical attention at their own cost. However, this would be the narrowest thinking to look at this issue.
With the ever escalating costs, upsurge of chronic diseases requiring complex and costly medical routines to prevent and cure, one can never go wrong in arguing that health insurance is an essential part of care access.
Any sound and viable plan for the future to fix our health care system therefore must arise to this fact and promise to offer universal coverage that guarantees every American citizen right to basic health plan of their choice.
Secondly, quality is an important aspect of a sound health care system. According to OECD health data database 2011, despite high health care costs and spending as well quality indicators of health in the US reflect variable performance and notably not any superior in comparison with other far less expensive systems of other countries in the study (Squires, 2012).
Even though the US is notably rated among the best countries with the highest survival rates for certain chronic ailments in some other chronic diseases the same trend is not consistent with poor showing and in some instances below average performance.
Given that in some of these chronic conditions that the US records a poor showing make up and indeed constitute an increasing share of the disease burden casts doubts as to the quality of care accorded by our current system.
Thirdly but not least is the cost of health care. With nearly $8,000 average spending on health per capita according to statistics carried out in 2009, the cost of health care in the US is arguably the most expensive in the world (Squires, 2012).
This is in comparison with countries such as Japan and New Zealand spending one-third of that and Switzerland and Norway that spends about two-thirds of same. In fact if the trend is anything to go by, the US average per capita spending on health care continue to grow highest than any other economy (Squires, 2012).
We need a health care system that can address these both in terms of reversing the unsustainable trend of escalating health associated costs and also reduce the current recorded spending on health care.
It is important to note the Affordable Care Act of 2010 cognizant of each of the three major issues highlighted above was designed with specific attention to address them.
Firstly with respect to access, the Act proposes universal health insurance coverage for all that would guarantee every citizen to a basic health plan of their choice effectively doing away with previously income-related payments that uninsured would have received.
In addition, the ACA envisages an electronic medical record to store patients’ records and allows physicians via a tight security protocols this information effectively simplifying the health care system that hitherto preapproval requirement by authorities to gain access to this information.
This measure also addresses the issue of quality of health care as both the physician and the patient can be able to trend the medical history. Effectively patients would be able to demand quality care and physicians afraid to taint their careers offer better services.
Having addressed both access and quality the issue of cost comes in automatically through improved system efficiencies and use of preventive rather than curative measures (Santerre & Neun, 2013).
In conclusion it will be interesting to see how the plan works given it will be difficult to eliminate the unnecessary services currently offered which compounds the cost of health care as well as the huge administrative challenges.
On the downside, the plan as some critics point out are the unintended consequences in terms of tax burden which not until the current costs are brought down is a concern to many.
On the upward side though, is an ambitious plan which if it works could lift up the welfare of all Americans and be a major reprieve of our ailing health care system.
References
Fox, M. (2012). US health care: It’s officially a mess, institute says. Web.
Nyman, J. A. (2003). The Theory of Demand for Health Insurance. Stanford, CA: Stanford University Press.
Santerre, R. E. and Neun, S. P. (2013). Health Economics: Theories, Insights, and Industry Studies, 6th Edition, Mason, OH: South-Western.
Squires, D. A. (2012). Explaining High Health Care Spending in the United States: An International Comparison of Supply, Utilization, Prices, and Quality. Commonwealth Fund pub. 1595, Vol. 10.