Health Care Reform in the United States has been a central subject owing to the high costs involved and the relative lack of access to health care. Health care reform has been a campaign issue and a number of initiatives in addressing the issues. Most Americans grapple with the high costs of health care and lack of access especially to the poor who may not afford health insurance cover. In relation to the White House Health Care Reform government website, I find the Affordable Care Act (ACA), also known as Obamacare, as the most intriguing health care reform for a number of reasons. The Act which was assented to as law in the year 2010 proposes a number of reforms aimed at extending coverage to persons who were initially not covered by health insurance. It sets out the minimum standards that need be adhered to, besides offering a number of federal subsidies to low income earners. The interesting issue about the Affordable Care Act lies in its controversial effects. Statistics reveal that support for the law is divided on party lines and age brackets. Most of persons aged above forty years are not in support of the law while those who are younger are in favor of the Act. Similarly, most of those who support the law have Democratic leaning while the Republicans and the Independents strongly oppose the same. This paper reviews the Affordable Care Act and its characteristics with a view to highlighting its benefits and demerits.
The Affordable Care Act (ACA)
The ACA, also known as The Patient Protection and Affordable Care Act (PPACA), is a federal statute signed into law on the 23rd of March 2010 and stands out as one of the most important regulatory overhaul of the United States health care system. Ever since the enactment of the Medicaid and Medicare in the year 1965, there has been no other law with significant reforms and changes in health care system, as has the ACA. It must equally be set out that the major provisions of the Act are set to take effect by January 2014 and thus the full impact of the law is yet to be realized. Simply put, the Affordable Care Act (ACA) targets the expansion or increase of quality and affordability of health insurance to United States citizens. It achieves this by decreasing the uninsured rate through the expansion of public and private coverage and reducing the costs of health care for both individuals and government. The Act avails a string of mechanisms through which it seeks to achieve the noble task such as mandates, offering of subsidies and insurance coverage in a bid to enable affordability and increase health insurance coverage. The ACA demands that insurance firms do cover all applicants within the new minimum standards set and in addition, offer the same rates to the applicants irrespective of their prior health conditions or gender. This will and indeed has, cured the lack of access to health insurance for a number of earlier marginalized groups. More so, the law aims at reducing costs besides improving on health care by tilting from quantity towards quality health care through the institution of increased competition and regulation. This will also be achieved through the provision of incentives with the overall effect of streamlining health care delivery. As envisaged by the Congressional Budget Office, the Act is expected to lower future deficits and Medicare spending once full implementation of the law takes effect.
Owing to the above mentioned controversies and differences of opinion on the Act, its constitutionality was tested in the year 2012 in the United States Supreme Court. On the 28th June 2012, the Supreme Court in the case of National Federation of Independent Business v Sebelius upheld the validity and constitutionality of the law. Nonetheless, the Court was emphatic that individual states could not be forced to take part in the expansion sought by the ACA’S Medicaid under the penalty of losing their Medicaid funding. Even after this ruling, the ACA has continued to be surmounted by numerous challenges to its implementation in the Congress, some of the state governments as well as the federal courts. Most of the concerted efforts in opposition to the Act have emanated from prominent conservative advocacy groups, Republicans and small business organizations. It is now crucial to examine the major provisions of the Act so as to identify the major changes and reforms that the law seeks to achieve. It need be noted that most of the provisions were meant to take full effect from the time of its enactment in the year 2010 progressively until the year 2020. Also, insurance policies that were issued before the year 2010 are exempt from the effects of this law though these policies are affected by some other provisions. One of the health care reforms sought by this Act is the establishment of minimum standards for health insurance policies. This provision is essential in the sense that it provides a solution for the continued issue of poor quality of health care and the low standards occasionally offered by some health insurance firms. A significant reform also made possible by the Affordable Care Act is a guaranteed issue that mandates and proscribes health insurance firms from denying insurance coverage to persons based on their preexisting conditions or age. In addition, the partial community rating provided under the Act obliges insurers to offer applicants of the same age and geographical location the same premium prices without having regard to their gender or preexisting conditions. The effect of this provision is the elimination of preexisting discrimination on health coverage by insurers on the basis of gender or prior health conditions.
Further, the ACA demands that individuals who are not covered by an insurance plan of the employer, Medicaid, Medicare or any public insurance program secure a private health insurance policy cover, in default of which they shall be forced to pay a penalty. This obligation is only waived where the particular individual is able to demonstrate that he has a financial hardship which makes it difficult to secure such a policy or is a member of a religious sect which is usually exempted by the Internal Revenue Service. This law also comes to the aid of the low income earners who are unable to comply with these obligations by offering subsidies. Another major reform necessitated by the Act is the institution of health insurance exchanges which are basically online market places offering a platform to individuals and businesses to compare policies and buy them. The Act stipulates that the first operation of the health insurance exchange will commence from the 1st of October 2013 and run till the end of March 2014. In the ensuing years, open enrollment on the health insurance exchanges will be commencing on the 15th October and ending on the 7th December of the same year. More so, the ACA provides for subsidies to low income earners. In particular, low income individuals and families whose incomes are classified as falling between the 100% and 400% of the federal poverty levels will be able to obtain subsidies in a sliding scale in the event that they buy insurance through the health insurance exchange. In the year 2013, the subsidies will apply for incomes below $45,960 for individuals and those who are below an income of $94,200 where it is a family of four. It is also incumbent upon businesses that employ 50 or more persons and do not offer health insurance to their employees who work on a full time basis, to pay tax penalties where the government has subsidized the employee’s health care by way of tax deductions or by other ways.
The ACA has also expanded the eligibility to Medicaid to encompass individuals and families that have incomes falling below 133% of the federal poverty level. This includes adults that suffer from no disability and that have no children as dependents. It is, however, noteworthy that states have the option of opting out of the Medicaid expansion as held in the cited case of Federation of Independent Business v Sebelius discussed in this paper. Indeed, a number of states have pulled out of the Medicaid expansion. The other reform that has been brought by the ACA has been the new payment system. This system is meant to improve health care delivery through the restructuring of the Medicare reimbursements from fee-for-service system to bundled payments system. A single payment will be made to the hospital and a group of physicians for a particular episode of health care instead of an individual payment to an individual service provider.
On my part and based on the learning and the professional experience attained in the course of my study, I do support the reforms brought by the Affordable Care Act. The obligation that the law places on all Americans to buy health insurance is laudable as it ensures all individuals are protected and can afford health care. Further, the low income earners are availed subsidies to enable them purchase health insurance policies. This will alleviate or reduce the numerous instances of medical bankruptcies, which have been the leading causes of bankruptcies in the United States. Without doubt, the learning in this course has opened my eyes and shaped my opinions in health care reform. In particular, it has exposed me to the challenges that confront the health care system in the United States. I have been able to learn that health care costs are the leading cause of bankruptcies in America besides learning that a good number of people have no access to quality health care. More so, it made me realize the pressing need for health care reforms, which has to a great extent been achieved by the ACA.
The reforms notwithstanding, it is important to note that around 23 million residents of the United States will still remain uninsured even with the full implementation of the ACA as they do not fall within the groups envisaged by the Act. The health care reforms and policies pursued by the state should thus aim at subsuming these persons into the health insurance bracket.
References
Barr, D. A. (2011). Introduction to U.S. Health Policy: The Organization, Financing, and Delivery of Health Care in America. New York: JHS Press.
CCH. (2010). Law, Explanation and Analysis of the Patient Protection and Affordable Care Act: Including Reconciliation Act Impact. New York: CCH Incorporated.
Chaikind, H., Copeland, C. W., Redhead C, S., & Staman, J. (2011). PPACA: A Brief Overview of the Law, Implementation, and Legal Challenge. Washington DC: Congressional Research Service.
Feldman, A. M. (2011). Understanding Health Care Reform: Bridging the Gap Between Myth and Reality. New York: CRC Press.
Gruber, J. (2011). Health Care Reform: What It Is, Why It's Necessary, How It Works. United States. New York: Hill and Wang.
McNamara, K. (2010, 3 5). What Health Overhaul Means for Small Businesses. Wall Street Journal, p. 4.
Pear, R. (2012, 7 7). Health Law Critics Prepare to Battle Over Insurance Exchange Subsidies. New York Times, pp. 1-2.
Trumbull, M. (2010, 3 23). Obama signs health care bill: Who won't be covered? The Christian Science Monitor, pp. 1-2.
