The Affordable Care Act (ACA)-also referred in here as Obamacare-introduced a wide range of reforms never witnessed in the health care system since the introduction of Medicaid and Medicare in the 1960s (Obama, 2016). Obamacare, which effectively came into force in 2014, aimed at improving access to care through the removal of financial obstacles preventing medical access among millions of Americans and bridging the gap between practitioners and patients. These reforms were motivated by the view that Medicaid and Medicare had become obsolete thereby creating a lot of hindrances to access of health services. For instance, by mid-2009, 46 million American citizens lacked health insurance coverage, and it was projected that by 2040, the number could have risen to 72 million people (US Council of Economic Advisors, 2009).By enacting the law, the Obama administration envisaged that ACA could lead to the insuring of 32 million Americans by 2016 and further expand coverage up to ninety-five percent by the end of six years (Elmendorf, 2011).This paper assesses the effectiveness of ACA since it came into effect in January 2014.
Evidence suggests that Obamacare has effectively increased insurance coverage since its inception. This is evidenced by the decline in uninsured rates across the country. Recent statistics show that a decline of 43% countrywide-a decline from 16.1% in 2010 compared to 9.1% in 2015(Obama, 2016; Cohen, Martinez, Zammitti, 2016). Notably, more people with an income below 133% of the federal poverty level have been enlisted on Medicaid. Accordingly, there has been a tremendous success in enlisting children from low- income background through Childrens Health Insurance Plan (CHIP) and Medicaid. This has resulted in more than 90%of eligible children being enrolled (Obama, 2016; Avery, Finegold, & Xiao, 2016). These trends show that more Americans are coming into the coverage fold and this can be expected to expand in the coming days.
Another area worth noting is the increased coverage for young adults. A number of studies have shown that since the passage of ACA, an estimated population of about 23 to 28 million Americans of legal age have had access to health services through Medicaid expansions, insurance exchanges, and the mandatory inclusion of young adults on their parents' policies. For instance, 2.3million young adults below the age of 26 years now have access to cover courtesy of their parents insurance policies (Sommers, Long &Baicker, 2014). One of the main benefits is that of dependents insurance coverage. Before the Affordable Care Act, insurance coverage for dependents was provided up to age 25 for dependents who were in college, but the current act provides for all dependents up to age 26. This has been beneficial to young people who are not in college and are jobless (Rak& Coffin, 2013; p. 317; Sommers, Gunja, Finegold, Musco,2015; Obama, 2016;) as evidenced in the upsurge of enrollments among young adults. According to Sommers, Long, and Baicker (2014), the increase in enrollment for insurance has led to reduced mortality. This is concrete evidence the expansion insurance coverage is making Americans healthier.
Similarly, coverage gains increased in those states with Medicaid expansion than those without the expansion plan; but all in all, coverage was more significant for rural than urban areas. It is estimated that 20 million people were reached in these areas for insurance cover in 2016, surpassing the original combined projection by the Congressional Budget Office (CBO) of 16 million people by 2016 ( Cohen et al., 2016; Sommers& Epstein, 2010). Consequently, the CBO has projected that Medicare will spend 20% or, approximately less than 160 billion dollars less by 2019.These effects mean that more savings are expected to be realized. As a result, the economy will be strengthened through the investment of the savings in other priority areas.
Obamacare has been effective in various spheres of healthcare provision. Studies indicate that there have been numerous benefits among diabetic patients. Due to the removal of insurance access barriers (through the elimination of the pre-existing condition barriers) more diabetic individuals are receiving care (Herman &Cefalu, 2015; Sommers, Long, & Baicker, 2014). A study done on diabetic enrollment has found that there was 23% increase in diabetic patients with Medicaid; in states which implemented the Obamacare with Medicaid expansion while a 0.4% in states without Medicaid expansion (Kaufman et al., 2015). Bearing in mind that 25% of diabetic Americans are undiagnosed, early treatment and diagnosis reduce long-term complications and preventable deaths (Herman &Cefalu, 2015). This evidence is central the objective of Obamacare-expanding access to improve healthcare quality and the resultant outcomes.
According to data from Market Place Administrative and Health Insurance, individuals found in rural areas constitute of 1 in 5 for Marketplace plan selections. In 2016 period for open enrollment, 1.17 million rural consumers either signed up or their insurance coverage was automatically renewed. This led to 11% increase for rural consumers over 2015 as compared to 8% for other consumers. Furthermore, the 1.17 million individuals in rural who selected in their third Open Enrollment a Marketplace Plan, 88% qualified for the premium tax credits (Avery, Finegold, &Xiao, 2016).Similarly, according to research done by Gallup Healthways Well-Being Index; between 2010 up to 2015, there was 8.0 % increase among rural and 7.9% in urban areas for those who enrolled in affordable care through Medicaid and Marketplace Health Insurance. Further to that, research has confirmed that healthcare overall share cost for enrollees in coverage pay from their pocket for cover has reduced to none; since their employers cover them (Office of the Assistant Secretary for Planning and Evaluation, 2011; Muhlestein, 2015).
Overall expanded enrolment has improved access to financial security, health, and treatment for the nonelderly newly insured. After the Medicaid expansion in the first quarter of 2015, shares in nonelderly individuals with a personal physician increased by 3.5%; access to care by 2.4% while there was a substantial decrease in the number of those patients unable to access coverage which stood at 5.5%. Poor health rate decreased by 3.4% of the population in need of care compared to the period before Obamacare (Sommer et al., 2015). This shows that there is increased number of people enrolling and it is a simple way of attesting to the fact that Obamacare has been effective.
Various provisions enacted to protect consumers through the Obamacare have achieved the expected results. The Act deployed a system in Medicare dubbed as value-based payment which seeks for efficiency and quality of care by care professionals and healthcare organizations. In line with this, ACA has enhanced Medicaid efforts through fostering market competition by ensuring that there is transparency on consumer prices and quality of care delivered. Also, the creation of alternative payment models, Centre for Medicare and Medicaid Innovation (CMMI) widened payment from individual service providers (Muhlestein, 2015). This development has enhanced service delivery and transparency in the healthcare system since customers make single payments for all the services. This is important because it seals loopholes for overcharge at the same time enlightens consumers of their rights and setting channels a customer can follow in lodging complaints against issues such as violation of privacy or overcharge.
In summation, Obamacare has enrollment significantly in the last few years. More young people have enrolled for cover than before. Accessibility to healthcare services provider has also been successful among people with diabetes and other life-threatening conditions. Besides, more Americans in the rural areas access health services than ever before. Furthermore, the enrolment and consumer protection have been enhanced in every aspect to seal not only for loopholes on service delivery but also on service quality and cost. Marketplace enrolment and premium credit have tremendously increased to a tune of 1.7 million people. The overall picture on the effectiveness of ACA suggests that the health care system is more efficient and effective compared to the pre-2014 period. Arguably, if the current trends continue , more Americans can be expected to access quality health services, meaning that the near future of American public will be healthier than it is today. The challenges notwithstanding, ACA has achieved a number of its objectives so far. Therefore, its repeal efforts must take cognizance of the various benefits that the Act has brought to the American people.
Avery, K., Finegold, K., and Xiao Xiao (10 June, 2016). Impact of the Affourdable Care Act Coverage Expansion on Rural and Urban Populations.Issue Brief. Office of the Assistant Secretary for Planning and Evaluation
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Herman, W. H. &Cefalu, W. T. (2015). Health policy and diabetes care: is time to put politics aside? Diabetes Care, 38(5): 743-745.
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Office of the Assistant Secretary for Planning and Evaluation. (16 December, 2011). US Department of Health and Human Services Essential health benefits: individual market coverage. https://aspe.hhs.gov/basic-report/essential-health-benefits-individual-market-coverage. Accessed November 10, 2017
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