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Research Paper Example on State Experiences with Implementing the Affordable Care Act

7 pages
1870 words
Sewanee University of the South
Type of paper: 
Research paper
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The Affordable Care Act (ACA) is a federal statute of the United States that was signed into law by President Barack Obama in 2010 after being enacted by the one hundred and eleventh United States Congress. This act, as well as the Health Care and Education Reconciliation Act of 2010, depict the most significant regulatory changes in healthcare, and they cover the largest number of people since the times of the Medicaid and Medicare in 1965 (, 2018). Different states had different experiences during the process of implementing the act. This paper shows the positive and negative effects of the Affordable Care Act and its overall effect on the countrys economy. Despite the numerous negative feedbacks that this health insurance plan has received, it has proved to be a great medical insurance cover for many Americans. It has aided in reducing preventable deaths as well as reducing the countrys debts.

The Affordable Care Act has different requirements. If one is eligible for the insurance policy but fails to apply for it, they are penalized in accordance with the law. People who are not required to be part of the Affordable Care Act are those who; are incarcerated, part of a religion that is opposed to the act, members of an Indian tribe, undocumented immigrants, people who are eligible for a hardship exemption, and those who have a family income that is below the threshold that is required for one to file tax returns (, 2018).

Additionally, people who are insured on Medicare, Medicaid, or Tricare are not penalized since their requirement to have health insurance has already been satisfied. Moreover, those who already had a grandfathered health care plan in place before the Affordable Care Act was enacted are not penalized. Finally, people who are either on the veterans health program or those whose insurance plan is offered by their employers are not penalized since they have also met the requirement of having an acceptable health insurance plan in place. From the year 2017, the penalty for not having health insurance is six hundred and ninety-seven dollars per adult and three hundred and forty-seven dollars per child. For families, they will be charged two thousand and eighty-five dollars or two and a half percent of their family income whichever is greater (, 2018).

The Affordable Care Act was first adopted for various reasons. The primary reason was due to the extremely high cost of healthcare in the United States. These high costs have been said to cause a bankruptcy in America every thirty seconds. Before the enactment of the Affordable Care Act, statistics show that premiums had risen four times faster than the peoples wages in the past eight years. Additionally, in each of these eight years, it was established that one million Americans lost their health insurance covers. The issue of high health costs was also seen to adversely affect the economy since many small businesses closed down while many corporations began outsourcing majority of their jobs (Rosenbaum, 2011). The Affordable Care Act was also aimed at improving health care services and assisting the less fortunate in society to settle their medical bills. It was identified that very many people who earned low incomes were suffering from preventable diseases and some even succumbed to them due to lack of funds to pay for their health care. Hence, the government found that it was essential to provide health insurance for these people.

The Affordable Care Act has had a significant impact on the United States health sector for different reasons. First, it has expanded the coverage of health insurance. One of the primary reasons why this health reform was put in place was because there was a need to increase access to health care for many Americans. Since the Affordable Care Act commenced in 2013, the number of Americans who are uninsured has dropped to twenty-seven million from forty-one million initially. The Affordable Care Act increased the Medicaid coverage in all the states that were participating in this reform, to all adults who received incomes that were below one hundred and thirty-three percent of the federal level of poverty. Medicaid is a joint-federal state insurance program that was created to aid the disabled and poor people of America (Silvers, 2013). It provided thirty-three thousand, five hundred dollars for families of four members and sixteen thousand dollars for individuals. It also subsidized insurance for individuals and small businesses that did not have access to insurance that was based on employment. The National Bureau of Economic Research reported that the Affordable Care Act has led to a 5.9% increase in insurance coverage in states that strived to expand Medicaid and a three percent increase in non-expansion states (Rosenbaum, 2011).

The Affordable Care Act has also aimed at ensuring that insurance companies become more accountable for their actions. The act has set federal standards for health insurers in the group or individual health insurance markets. This has aided in banning discrimination against certain people in the society from health insurance such as people in poor health conditions, children, the aged, and women. The Affordable Care Act also bans against the majority of the annual dollar cost averaging and lifetime coverage limitations. It also prohibits against excessive periods of waiting such as ninety days or longer and the exclusions based on certain pre-existing conditions. The ACA thus requires that insurance companies make use of modified community rating whereby the prices paid vary due to factors such as tobacco use, family size, and age. It also provides the right to external and internal impartial appeal procedures whenever patients are denied insurance coverage and the insurers are required to take care of the routine medical care procedures for patients who have a life-threatening condition such as cancer (Silvers, 2013).

The Affordable Care Act also requires insurance companies to take up more risk in covering their clients health care. This means that the insurance companies need to find the average risk they will assume by using a cross-section of the population in a bid to find the average risk assumed. The Affordable Care Act requires the majority of its participants to pay very low premiums on a monthly basis (The Commonwealth Fund, 2017). This has brought about competition between them and other private healthcare insurers which has translated into a more efficient job being performed by the private insurers as well as reduced premiums.

Additionally, the affordable care act aimed at lowering health care costs. It was able to achieve this objective partly. Millions of people who were able to gain the Affordable Care Act insurance through the law have benefited from it and are paying low costs. Approximately seven million three hundred thousand people, including many who were shut out of the market because their medical conditions were considered expensive remain in the private insurance sector (Rosenbaum, 2011). The individuals who qualified for subsidies enjoyed a seventy-six percent reduction in their health care costs. Since the Affordable Care Act required that insurance companies provide health insurance coverage for people who had pre-existing conditions, this led to a rise in the premiums for some of the people who had insurance already (The Commonwealth Fund, 2017). Majority of those who were affected were youths who were in good health and not eligible for subsidies.

Today, the law has caused competition in the health sector to increase as many new firms have entered the market. McKinsey conducted an analysis where they discovered that there has been a twenty-two percent increase in the number of health insurers in forty-three states. It also stated that there are indications of premiums increasing in the coming year by four percent in twenty-one states for silver plans (Silvers, 2013). Hence, it is clear that the Affordable Care Act has increased health insurance costs for some people and reduced them for others with Medicaid.

Finally, it aimed at enhancing the quality of healthcare provided to all American citizens as well as to guarantee them more choice in relation to their health care. The Affordable Care Act has improved health care quality. Incidentally, statistics show that between 2010 and 2013, the number of people who died from preventable infections and errors reduced by fifty thousand (Silvers, 2013). For the people who had been unable to get subsidized health care, they have benefited from low costs as well as improved quality of health care.

Many people are against the Affordable Care Act. Some of them disapprove of the act because they do not feel that it is right for the government to force people into buying health insurance and then penalizing those who do not buy it. Others view the subsidies provided by the government and the Medicaid expansion as an entitlement program that helps moderate and low-income earners who have enrolled into the program to benefit using the taxpayers money of the hardworking people in the country. Many people have said that this is a welfare program that is disguised as a health care program that robs half of the population and uses this money to help the other half. Other people are of the opinion that contrary to the programs name, it is not affordable. They feel that it is charging them high premiums that increase year to year. Others are not happy about it since they feel that they cannot keep both the doctors and the insurance plans they had earlier (Rosenbaum, 2011).

Conversely, other people have highly benefited from the Affordable Care Act. The primary beneficiaries are the low-income earners who have been able to enjoy subsidized health care. The Affordable Care Act also emphasizes on preventive care, and this has helped many people to take care of different diseases before they become too serious. Statistics show that since the enactment of the act, the number of preventable deaths has reduced considerably (Reisman, 2015). This is mainly attributed to the fact that the act required preventive health care to be provided at no costs.

The healthcare delivery has also improved considerably. People with terminal illnesses have also enjoyed the act since they are now charged lower premiums than they used to pay before the act was enacted. Employees also enjoy having their health insurance premiums paid by their employers. The Affordable Care Act requires that businesses with more than fifty employees have to pay health insurance for their employees (Reisman, 2015).

Different states embraced the Affordable Care Act with open arms. These include Vermont, Oregon, Minnesota, Massachusetts, Maryland, Hawaii, and Connecticut. They implemented the market reforms, expanded their Medicaid programs, and established a marketplace that was state-based. Other states such as New York, Colorado, and California which actively implemented the affordable care act almost met all the standards. However, five states namely Missouri, Alabama, Wyoming, Texas, and Oklahoma entirely declined to participate in implementing the different components that were required of the act (The Commonwealth Fund, 2017).

The different states have flexibility in implementing the Affordable Care Act which they are taking advantage of. Out of the thirty-four states that have marketplaces that are federally regulated, eighteen took regulatory or legislative actions on the market reforms. Eleven states are conducting an expansion on their Medicaid programs while an extra four states are still considering whether they should expand. In instances where states have been unwilling to carry out an implementation of the act, t...

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