The Affordable Care Act: An Examination of Health Care Policy
Adeleye AladeCalifornia Miramar University
HCM 6001HEALTH CARE POLICY ANALYSIS AND DECISION MAKING
Dr. Arcadia. L. Cruz
This paper is on the Affordable Care Act which is also known as the Obamacare. It will look into the reasons why the act came into existence in the first place. Outline
Brief History on American Healthcare System
Why Affordable Care Act
Medicare and Medicaid?
Pros and Cons of ACA
The Patient Protection Affordable Care Act (ACA) also known as Obama Care was passed into law on the 23rd March 2010. It is a type of health insurance covered by the government for the public as a whole. This health insurance was considered to be made affordable to the general public at large. Affordability to doctors, drugs, hospitals and clinics.
To Americans, it still remains the best health care solution after President Lyndon Johnson’s Social Security Amendments Act which created Medicare and Medicaid. The Patient Protection and Affordable Care Act, as of 2014, made it possible for every citizen to achieve health coverage, regardless of any previous medical condition (WebMD).
Brief History on American Healthcare System
In the nineteenth century, the doctor-patient relationship was extremely unique to what is attainable as of today, doctors had little understanding of ailments to really give valuable health care information to the people and that made medical services less costly.
Now and again, mostly in interior areas, doctors were being paid with farm produce and domesticated animals. When the new century rolled over, doctors began learning more about diseases with the advent of medical discoveries such as the presence of different blood types, electrocardiography, and the invention of the stereotactic method for the treatment of Parkinson disease to mention but a few, medicine became relatively sophisticated and with this complexity came costs that the normal low income family could not afford.
The United States healthcare system compared with other countries is perceived to be the most costly and leaving over fifty million American nationals uninsured, with the low-salary rate. The individuals who, actually have insurance are not so secured, in this way most people don’t try squandering their cash and obtaining health insurance. When people need medical services or care, they happen to battle with their previous conditions and experience the ill effects of the illness on the grounds that they can’t bear the cost of the medical bills.
Without being reckless, it can be said that if America with all her prestige and glamour fails to find a lasting solution to her health care surge financially, and on the off chance that it fizzles, she will at last experience an extreme money-related catastrophe.
Why Affordable Care Act
President Barack Obama saw the need to subsidize health care bills so that Americans can afford it and be healthy. The ACA was not just created for low-income earners but for every American citizen.
In 2014, March 31st to be precise marked the deadline given that every American must have health insurance or else they may be punished by having to pay a fee (1% of their household income greater than $10,000 up to a maximum of $2,448 per person or $95/adult and $47.50 per child, up to a family maximum of $285 ) (Consumerreports, 2014) . These cost continued to increase year on year.
The ACA changes the non-group insurance market in the United States, mandates that most residents have health insurance, significantly expands public insurance and subsidizes private insurance coverage, raises revenues from a variety of new taxes, and reduces and reorganizes spending under the nation’s largest health insurance plan, Medicare. Projecting the impacts of such fundamental reform to the health care system is fraught with difficulty. But such projections were required for the legislative process, and were delivered by the Congressional Budget Office (CBO).
With the Affordable Care Act one could keep pre-existing insurance plan and still get coverage. Exemptions were given due to religious beliefs. The condition to have insurance is known as the Mandate health plans which can be bought via a broker, or through work and government health care programs like Medicare or Medicaid.
Medicare & Medicaid
The United States health care system is an analyzed subject matter that touches every strata; the young, old, rich, and poor. The health care system consists of three major units. Meanwhile, in 1973, majority of Americans signed up to having managed-care programs, called HMOs (Health Maintenance Organizations). Secondly, another type of health care was introduced to the Americans which is for the elderly; Medicare. The third is Medicaid, a health care program for the poor.
Medicare is a Federal health insurance program which consists of hospital insurance, medical insurance, customizable plans, and prescription drug coverage. It is categorized into four groups of A: Hospital Insurance , B: Medical Insurance, C: Medicare Advantage Plans and D: “Every other” e.g. dental, eye, foot, hearing. To be eligible for Medicare, the individual must be at least 65 years old, or disabled under the age of 65, and individual who at any age has had End-Stage Renal Disease. End-Stage Renal Disease is a permanent kidney failure needing dialysis or a transplant. Furthermore, being able to benefit from Medicare, an individual must be a U.S. citizen or permanent legal resident for five continuous years. Individuals must also be eligible for Social Security benefits with at least ten years of contribution payments (Crosta, 2013).
Medicaid is a health and medical services program for individuals and families with low incomes and limited assets. Low-income persons, families, children, pregnant women, the elderly, and people with disabilities may be eligible for Medicaid. Each state creates her own eligibility criteria; regulates the type, aggregate, period, and scope of services; sets the rate of payment; and administers its own Medicaid program (Crosta, 2013).
Medicaid plans provide compulsory federal necessities that each state must meet. These necessities are the in-patient and out-patient hospital services, vaccines for children, physician services, rural health clinic services, home health care, and laboratory and x-ray services. Prenatal care, family planning services, nurse-midwife services, and pediatric and family nurse practitioner services are also required and covered by Medicaid (Crosta, 2013).
Pros and Cons of ACA
A question that comes to mind when reviewing the Affordable Care Act is “how does this policy affect her citizens?” The answer that comes to mind is that the great majority of citizens uninsured get access to affordable quality health insurance. However, the money is taxed by the government majorly from high earners and the taxes that directly impacts the individual is the individual mandate and employer mandates. To me, it is an unfair deal because it necessitates Americans to mandatorily buy into comprehensive health-insurance plan designed by the government irrespective of their pre-existing healthcare plan with other health insurance companies.
This just brings objectionable financial limitation on the citizens particularly the low income earners. The ACA was purportedly passed to bring a reduction to the cost of healthcare insurance and access to healthcare benefits so how does the average individual American seemingly maintain two healthcare insurance packages?
The individual and employer mandate should be that Americans in their own right can have a choice of healthcare package/options that suits them. For businesses, when your company has greater than or equal fifty employees it is seen as large under the health care law and are mandated to make available health insurance for full-time employees because penalty will be given if the company fails to do so. With this in mind, some companies would rather reduce the number of staff and /or reduce the working hours of the employees in order not to be burdened with the cost of providing healthcare insurance to the employees. On the contrary, smaller businesses such as twenty-five or less employees will see only the pros of the ACA because they are not mandated to offer health insurance to their employees.
The removal of pay- out- of- pocket for prescription by senior citizens was done when the Obama care bill was passed, Senior citizens could not afford their prescription even under Medicare not until Obama care came. Obama Care increased existing coverage for seniors by including free preventive services and check-ups. This gave them (seniors) free access to wellness visits, cancer screening, flu shots and so on. Even though Obama Care will support many seniors in getting access to better health care and saving money on drugs, this reform on Medicare will also create a huge payment reduction to Medicare providers.
According to the Congressional Budget Office (CBO), Obama Care will reduce Medicare compensation by $716 billion over 10 years. These cut could force the closure or withdrawal from Medicare of hospitals, nursing homes, skilled nursing facilities, along with Medicare advantage plans. This will definitely have a negative impact on Senior as regards access to medical care.
Due to religious beliefs, things like contraception, abortion inducing drugs and sterilization are not acceptable in religious organizations and these are mandated safety checks to be given to employees of such companies. This brought about the individual mandate exemption of members of certain religious sects. The con here is that the law applies to everyone Obama care or not. Another law cannot be created singularly because of a sect. Hopefully, there will be considerations to include exceptions in the American laws to meet the needs of her people.
Every citizen is meant to have a right to quality and affordable healthcare which is the main aim of the ACA. For years citizens lived without health coverage, and only put off going to the hospital until they were gravely sick or taken to the emergency room because they could not afford it. People that had medical conditions before were victimized by insurance companies. What Obama care did was to eradicate the discrimination and qualified every citizen to have equal rights to healthcare.
Nevertheless, instead of the health benefit, Obama care is simply reallocating the financial burden by compelling Americans to pay more, so that those yet to be covered are paid for by the new regulations. This action will trigger laziness of other citizens to get a job and contribute to the economic growth of the nation, as it implies that healthcare will be available for all irrespective of their financial situation.
My recommendations on the Affordable Care Act are as follows:
First and foremost, I suggest that the American government should bring forward the age limit on Medicare to cover people who are 55 years old instead of the 65 years old peg put on it. This will mark the age group (55-65) that can afford private insurance in which they have the choice to get this government insurance at a competitive price. This insurance will provide the same benefits that Medicare regularly offers. The acquired money will go to a pool of funds to provide coverage for the uninsured who fall in this category and to keep funding Medicare for the elders. This will also create a fair competition in the insurance market, prevent monopoly, and improve quality and utilization in this market.
Secondly, government should offer the youthful age groups (insured or uninsured) some incentives to embolden more beneficial way of life, e.g. tax credit, or health care coverage vouchers that will be issued on a yearly basis for persons with low or no hospitalization or ER visits, or for individuals who can present a doctor note proving that they adhere to all medical recommendations and preventive measures. This can also be applied to companies and businesses that promote healthier life style among their employees and provide annual health screening and examination for their employees. The tax credit and the voucher will help this age group to afford paying for health insurance. Hopefully this will bring the total health care cost down and furthermore enhance usage.
Government should liaise with thriving big organizations to employ youths without health care coverage, provide more wellbeing facilities, and enhance health programs. This ought not make it cumbersome on the on tax payers.
There should be some form of punishment for patients who don’t follow preventive standards and doctors’ recommendations. This can be carried out by creating a system where a healthcare provider can report such actions. An example is a patient with severe emphysema who comes to the hospital every week so she can get better just to go back home and smoke again. She refuses nursing home placement because she will be forbidden to smoke there and she doesn’t wear her breathing machine at night.
Offering healthcare providers like physicians and home health agencies a tax break if they agree to accept a certain percentage of uninsured patients who still can’t fall in any of the above categories and can’t afford healthcare services. This may help strengthening preventive medicine and avoid expensive treatments and hospitalizations which usually happens when a medical condition is left unattended for a long time secondary to lack of insurance. These are some ideas that may provide an equal, sustainable and efficacious health care coverage for the uninsured while keeping the current benefits for other Americans and improving the quality of care.
Consumerreports (2014). Consumerreportsorg. Online. 11 June 2018. Available from: https://www.consumerreports.org/cro/news/2014/11/penalty-for-not-having-health-insurance/index.htm
Crosta, Peter. (2013). What Is Medicare/Medicaid? http://www.medicalnewstoday.com/info/medicare-medicaid/
Gruber, J. (2011). The Impacts of the Affordable Care Act: How Reasonable Are the Projections? National Tax Journal, 64, 893 – 908.
Medicaid Reform-Introduction (2003). The Century Foundation: Policy in Perspective.
Zinner, M. J., Loughlin, K.R. (2009). The Evolution of Health Care in America. 36(1) pp.1–10. 7.