The Policy and Implementation of the Affordable Care Act

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Policy

Medicaid was created in 1965, during that time Medicaid was the largest grant program serving over sixty -five million people with health insurance, in particular, low -income citizens ( Govodarajain & Ramaurti,2018). While the rest of the world was able to maintain health insurance the poverty-stricken was not able to do the same. (Govodarajain & Ramaurti ,2018). The underprivileged were not afforded the benefits of annual check-ups or able to seek professional care when one became ill due to the absence of affordable medical care ( Govodarajain & Ramaurti,2018). The youth during this time made up a greater percentage of individuals without health insurance. ( Thompson & Gusmano, 2014 ). The Affordable Care Act originally stated that the able-bodied citizens with income of at least 138 percent up the poverty line were considered candidates for Medicaid ( Thompson & Gusmano, 2014 ).

Following the Affordable Care Act Congress developed a policy called the Patient Protection and Affordable Care Act to heighten the number of citizens protected by medical insurance while lowering the cost of health care ( Thompson & Gusmano, 2014 ). This command from the government made it imperative the majority of American’s were to obtain minimum medical insurance coverage ( Thompson & Gusmano, 2014 ). If any citizens were not cleared because of specific conditions they were able to satisfy the requirement by obtaining insurance from a private sector ( Thompson & Gusmano, 2014 ). By 2014, people that did not cooperate with the new policy would have to pay a penalty to the Internal revenue Services while filing their taxes (Feldman, 2013). In addition, the Medicaid program was also giving federal funding to different states to aid the disadvantaged in receiving health care ( Feldman, 2013). As time went on and the ACA became larger due to the increased number of enrolled citizens the ACA expanded the Medicaid program as well ( Feldman, 2013). Now the policy made it essential that all state programs provide health insurance to adults with an income of 133 percent on the poverty line ( Feldman, 2013). With this enactment put in place, a majority of states currently cover all adults who have children with lower incomes, while not covering adults without children at all (Feldman, 2013).

Target Population and Social needs Policy Addresses

The government wanted to change ethnic disparities in health care by the enactment of policies like the Patient Protection and Affordable Care Act (ACA) the goal was to be inclusive while improving the health care for all ethnicities and poverty-stricken individuals and communities ( Talmage et al, 2017). The vision and execution of the ACA work have recently focused on improving the incentive of young people being able to stay on their parents' health insurance until they are 26 years old ( Talmage et al, 2017). Newer research analyzed improvements to accessibility and navigation of More research explored improvements in access and navigation of social determinants for other disenfranchised communities (Talmage et.al, 2017). The ACA zeroed in on improving areas to have access to care, access to preventative services, and equality by reducing racial and ethnic disparities in the health care system( Talmage et al, 2017). The ACA has continually provided a great number of opportunities for the expandability of health care enrollment and services to many marginalized people and communities within the past 7 to 8 years ( Talmage et al., 2017 ). However, despite the improvements and expansion of the ACA distinct communities, including LGBTQ and disabled individuals, remain marginalized ( Vangarde et al., 2018).

This creates space for more inclusivity of the LGBTQ and the disabled community to afforded improved health care and quality of life. After the adoption of the ACA health care rates on average among the youth increased by 6.12 percent ( Vangarde et al., 2018). The increase was great news for all ethnicities however, the impact was largest for non- Hispanic whites. ( Vangarde et al., 2018). Young adults represented a 2.61 percent decrease in experiencing challenges to health insurance due to health care being more cost-efficient ( Vangarde et al., 2018). So far we’ve examined how much of a positive impact the ACA has had on young adults who were in desperate need of health insurance but was unable to obtain it due to cost-related factors. And we also observed how the racial/ ethnic disparities in coverage and access remain ( Vangarde et al., 2018).

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Public Health Implications recommended Individuals who are not dependent on their parents' insurance would continue to increase access to health care and reduce disparities for all people ( Vangarde et al., 2018). Because the ACA allowed young people from the ages of 19-25 to stay on their parents' health plan until they are 26, the coverage reduces young people stress levels of worrying about their health and allowing them to put money in other areas of significance in their lives( Vangarde et al.,). When this extension of the ACA came into effect in September of 2010 3 million young people were insured( Vangarde et al.,). Expanding coverage in the public eye by creating more opportunities through Medicaid eligibility and private sectors through exchanges, that provided lower premium insurance to participants that qualify ( Vangarde et al.,). While the ACA covered various important health care concerns one of the most important coverages opportunities was for individuals struggling with substance abuse disorders. ( McCabe & Whaler, 2016 ). Many Individuals with Substance abuse disorders found it quite challenging to obtain and maintain employment that would provide sufficient health coverage ( Waitzkin & Hellander, 2016). By adding substance abuse to the Medicaid expansion, the category qualification that historically would have left many people with SUDs with no coverage had been waived and would now have access to coverage through the healthcare system ( McCabe & Whaler, 2016 ). Medicaid specifically was mandated to acknowledge mental health and SUD’s services, in the same manner, it insured other health issues ( Weeden, 2013).

Proponents and Opponents

Although the ACA was able to bridge some disparities between socioeconomic classes and making health insurance affordable among everyone. Minorities are still at a d higher rate of being uninsured and research has yet to find the correlation between ethnicity and the disproportionality of this policy ( McCabe & Whaler, 2016 ). Opponents expressed the negative impact the revised and modern-day policy of the ACA ( Obamacare ) would have on nearly 27 million people still uninsured as they were previously and more than twice that number underinsured according to congress (Waitzkin & Hellander,2016). Another downside to Obamacare were arguments about co-payments and deductibles increasing almost becoming too much of a burden for families to pay, this includes employer-sponsored coverage as well (Waitzkin & Hellander,2016). This argument appears to be biased and based on families and businesses who are well above the poverty line, there are advantages and disadvantages to every policy that has ever been enacted. Our focus is on what would have a significantly positive impact on most of the people. A vast majority of the United States is living paycheck to paycheck (Zimmerman et al., 2017). The proponents argue every individual has the right to have their basic needs met and health care is one of them ( Plaxe & Nagle,2017). While there are many great arguments for the necessity and effectiveness of the ACA many studies focused on three. 1). The thousands of young people who were able to benefit from being able to stay on their parents' insurance until 26 years of age (Plaxe & Nagle, 2017). The individuals who were provided affordable health care through the market despite not being able to afford coverage through their jobs or their parents ( Plaxe & Nagle, 2017) .3). And Individuals who suffered from substance use and mental health problems being able to seek help due to these ailments and being covered through the expansion of the ACA ( Waitzkin & Hellander 2016).

Policy Enactment

The expansion of the Patient Protection and Affordable Care Act (ACA) of 2010 (Obamacare ) was an incredible feature ( Plaxe & Nagle 2017). The Obama administration and Congress were able to defeat a long haul battle of disappointments and failures in revising health care(Oberlander, 2016). The ACA’s enactment has shown us that feasible health reform was surely possible to implement in the United States, within the past six years all have witnessed the challenges the president was faced with to pass such a policy (Oberlander, 2016). The Obama administration and its allies have endured many objections trying to make provision for Obamacare: creating new institutions and administering several regulations, developing a difficult insurance enrollment system, traveling the world, educating millions of at the time potential enrollees about the law’s benefits, and sharing a lot of experiments in payment and delivery system reform ( Oberlander, 2016). Furthermore, implementation also has (or in some cases, should have) detailed attempts to build a political system for the ACA, reassuring a confused and anxious public about Obamacare’s impact, and persuade reluctant and sometimes opposed state policymakers to partake in the reform project ( Oberlander, 2016).

The revision of ACA implementation ( Obamacare) has shown us the importance of consistency, focus, and the necessity of positive change when needed. The new law aimed to do many things— expand access to health coverage, control health care spending, and transform medical care payment and delivery options( Oberlander, 2016). Congress struggled with the idea of having to cover all domains in one policy without taxpayers being required to pay more taxes( Oberlander, 2016). It was done once before in the earlier years of the Medicaid reform act and it failed ( Oberlander, 2016). This was a great concern for congress or were there other factors that contributed to the resistance of the enactment and process of this policy ( Oberlander, 2016). The implication for further study has shown us underserved communities like minorities, LGBTQ, and the disabled are still disproportionately treated differently in the health care system and are still uninsured correlations are still under study ( Weedan, 2013 ). The Obama administration was faced with a lot of backlashes when first exploring the concept of the ACA and how to improve it, the many hurdles and they would be faced with heightened their certainty this health care reformed program would work and increase the quality of life for millions of people ( Oberlander, 2016).

Summary of Implementation

The implementation of the ACA so far has been very impactful, evidence by the reported numbers of the underserved population routine doctor visits, fewer ailments, and citizens with mental and substance abuse problems searching for help at abnormal rates because of the ACA ( Talmage, 2017). While the execution of the ACA has been very impactful for many Americans thus far there are still a few concerns for the underinsured, like being taxed at the end of the year for not sustaining insurance coverage or struggling to find affordable health care through the marketplace with their increasing rates although it was created to be affordable ( Talmage, 2017).

Lastly, like many polices minorities have shared their experiences with the ACA and expressing their concerns about structural and systematic barriers ( Ritchie, 2013). An American Indian shared Arizona's health system as a barrier to receiving federal benefits, while an African American shared she was instructed to find a primary doctor before she could see her specialist ( Talmage, 2017). Another U.S. citizen shared she started to take notice that her friends were losing their chose primary care physician due to specific physicians no longer taking Medicaid clients ( Talmage, 2017). More research into the structural and systematic barriers must be conducted in the Post ACA era to develop more culturally sensitive policies that serve all ethnicities ( Talmage, 2017). And breaking through barriers to gain access to these policy programs and all the benefits they have to offer ( Talmage, 2017). In addition, cost remains a barrier for health insurance and receiving the health care post-ACA era.

References

  1. Plaxe, S., & Nagle, V. L. J. (2014). Patient Protection and Affordable Care Act (“Obama Care”). Journal of Gynecologic Oncology Nursing, 24(1), 25–26.
  2. Govindarajan, V., & Ramamurti, R. (2018). How One Nonprofit Is Expanding Health Care for the Uninsured. Harvard Business Review Digital Articles, 6–10.
  3. Feldman, S. M. (2013). Chief Justice Roberts’s Marbury Moment: The Affordable Care Act Case (Nfib V. Sebelius). Wyoming Law Review, 13(1), 335–348.
  4. LEONG, D., & ELIZABETH ROBERTS, L. G. (2013). Social Determinants of Health and the Affordable Care Act. Rhode Island Medical Journal, 96(7), 20–22.
  5. Weeden, L. D. (2013). The Commerce Clause Implications of the Individual Mandate Under the Patient Protection and Affordable Care Act. Journal of Law & Health, 26(1), 29–50. R
  6. RITCHIE, D. (2013). Our Zip Code May Be More Important Than Our Genetic Code: Social Determinants of Health, Law, and Policy. Rhode Island Medical Journal, 96(7), 14
  7. Schembri, S., & Ghaddar, S. (2018). The Affordable Care Act, the Medicaid Coverage Gap, and Hispanic Consumers: A Phenomenology of Obamacare. Journal of Consumer Affairs, 52(1), 138–165.
  8. Zimmerman, M., LaPierre, T., Jones, E., Gurley-Calvez, T., & McCandless, B. (2017). Awareness and experience with Affordable Care Act insurance exchanges: Perspectives from low-income adults in two non-expansion states. Journal of Poverty, 21(3), 193–207.
  9. WAITZKIN, H., & HELLANDER, I. (2016). Obamacare, the Neoliberal Model, and the Social Movement for a Just and Accessible Health System. Conference Papers -- American Sociological Association, 1–35.
  10. Thompson, F. J., & Gusmano, M. K. (2014). The Administrative Presidency and Fractious Federalism: The Case of Obamacare. Publius: The Journal of Federalism, 44(3), 426–450.
  11. Oberlander, J. (2016). Implementing the Affordable Care Act The Promise and Limits of Health Care Reform. Journal of Health Politics, Policy & Law, 41(4), 803–826.
  12. McCabe, H. A., & Wahler, E. A. (2016). The Affordable Care Act, substance use disorders, and low-income clients: Implications for social work. Social Work, 61(3), 227–233.
  13. VanGarde, A., Yoon, J., Luck, J., & Mendez-Luck, C. A. (2018). Racial/Ethnic Variation in the Impact of the Affordable Care Act on Insurance Coverage and Access Among Young Adults. American Journal of Public Health, 108(4), 544–549.
  14. TALMAGE, C. A., FIGUEROA, H. L., & WOLFERSTEIG, W. L. (2017). Cultivating a Culture of Health in the Southwest: Linking Access and Social Determinants to Quality of Life Amongst Diverse Communities. Journal of Health & Human Services Administration, 40(4), 397–432.
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