HEALTH POLICY ISSUE 7
KeyFeatures of the ACA
TheObamacare as the Affordable Care Act (ACA) is sometimes referred toas a federal bill/policy in the United States that is considered tobring the most changes to the health sector in the US in over 45years. Now with the ACA under implementation, all American s have achance of accessing quality, affordable health care. The policymandates the government to make necessary changes to accommodate thenew changes and allow Americans to move into the new system withlittle struggle. According to the Congressional Budget Office (CBO),the ACA is fully paid for to ensure that more than 94% of Americanshave health insurance. This bends the health care curve and helps toreduce the national deficit by 118 billion US Dollars in a period often years from the time the policy was implemented. The deficit isexpected to be reduced even more in the following years. Before theAmerican health care system was reformed, it was approximated thatover 18.5% of non-elderly individuals lacked health insurance.Additionally, insurance firms charged high premiums and copaymentsfor insured individuals while employer-sponsored insurance continuedto decline (senate.gov, n.d). While these effects sound less hurtingon paper, they had some really bad outcomes on individuals andfamilies that had low income. Lucky enough for Americans, with theACA being signed into law by President Obama on the 23rd day of 2010,there was a real chance for eliminating all the hardships (Blumberg,2012). The policy ensures that all Americans have unlimited access tohealth insurance, brings subsidies to the insured, increasesemployer-sponsored insurance, creates possibilities for tax relief,revises terms of insurance, and reduces federal budget deficit amongothers.
Eventhough the enactment of the ACA in 2010 brought hope to Americans,the policy has not been embraced by everyone. Its implementation hasalso not been without hurdles and obstacles, which have political,financial, demographic, economical, and social dimensions. Some ofthe aforementioned obstacles include making significant changes tothe Medicaid program, reforming the insurance market regulations,developing new systems to help with delivering subsidies and havingindividuals enrolled into coverage, and creating greater transparencywhile promoting efficiency (Blumberg, 2012). According to Mahar(n.d), the policy is capable of paying for itself and do even more.Besides the hardship, the policy also has several weaknesses of itsown that need to be revised for it to be implemented and achievedwith ease (Blumberg, 2012). This essay seeks to discuss some of themajor changes that need to be done to the policy to make it betterand easier to achieve.
PossibleRevisions to the ACA
Asstated in the section above, the ACA solves most of the problems thatAmericans had before the reforms in the health system, but notwithout hurdles. According to Lahm (2013), the Obamacare has sinceits implementation been plagued with technical problems, criticisms,and controversy. These indicate that the law is not as perfect as itwas initially thought to be. The disappointment in people andgovernment officials is indicated by the reduced percentage ofAmericans who support the law. In recent years, some democrats haveshown disapproval for the law while republicans continue to oppose itas a political strategy to win the public. The implementation of thepolicy is centered on health care insurance exchanges as directed bythe Department of Health and Human Services (HHS). The policyrequires people to participate in purchasing insurance throughexchanges that take place on HHS’s website HealthCare.gov. Failureto purchase an insurance policy by a given date attracts a penalty.All these sounds good and reasonable, but the problems sets in whereHHS’s website, HealthCare.gov has been experiencing frequentfreezing and crashing problems among other technical problems even asthe deadlines approach (Lahm, 2013). In my opinion, the Obamaadministration should extend the period more and have the websitetested thoroughly before directing the public to it and enforcing thepenalties. Lahm (2013) states that security problems have also beenexperienced on the website. The administration should take more timeto set all systems and ensure that they are functional before tryingto implement the policy. The way the policy is being implementedcurrently is like systems are being designed concurrently as theimplementation of the policy.
TheObamacare further offers health insurance subsidies to all Americanswho have an income that falls below the range of 133% and 400% of thepoverty line. Going with the current statistics in the US, citizenswhose income falls within this income range total to 110 millionpeople. The implication here is that the government pays severalbillions of taxpayer’s money to individuals in this income bracketin form of health insurance subsidies (Sorrell, 2012). The billionsof dollars that are paid to citizens in the form of subsidies can bereduced significantly by making minor changes to the policy. One ofthe ways would be to cut the percentage to 300% instead of 400%.Reducing that percentage would save billions of dollars that could beused in the implementation of the policy. As a matter of fact, theObama administration could use some funds given that the policy isalready facings difficulties financing itself. As the policycontinues to be implemented through stages, its full financial andsocial implications start to be revealed. The Congressional BudgetOffice has already extrapolated that the policy will not be able tofund itself in the next few years. According to C u t l e r et al.,(2010), although the ACA has lowered overall health spending for thetime it has been in implementation so far, the effects are notexpected to last long. There is a looming danger that the expenditureon health is likely to continue rising with the implementation of thepolicy. CBO’s extrapolation of the expenditure reveals that at somepoint, the expenditure on health will consume the entire federalbudget if it continues to rise at the current rate.
Theindividual mandate was ruled as a constitutional tax by the chiefjustice making it be protected by the constitution. The individualmandate requires citizens to buy government-issued health insurancecover or to be liable to paying a penalty. This penalty is called thenoncompliance penalty and is meant to make government-issuedinsurance more attractive to people. According to Sheils and Haught(2011), many analysts have predicted that eliminating the individualmandate would cause “premium spiral” where premiums would riseand people would drop coverage leading to the total number of peopleinsured plummeting. On the contrary, that is not true at all. Infact, it would be best to drop the individual mandate entirelyprovided some provisions within the law are enforced. Any increasesin premiums would be curbed by subsidies provided to individualshence preventing a premium spiral (Sheils and Haught, 2011). Sheilsand Haught (2011) estimate that dropping the penalty would lead to a12.6% increase in premiums in individual markets. Although somepeople would lose coverage, the number would be much lower comparedto the 23 million people who would have been uninsured if the law didnot exist. The CBO has also estimated that repealing the law wouldlead to a reduction in the budget deficits by nearly $300 billionwithin a period of ten years. This reduction in the federal budgetdeficits would result because elimination of the penalty would reducethe number of people participating in the Obamacare entitlementexpansion. Sheils and Haught (2011) state that the individual mandateis important to certain aspects of the coverage and its premiums, butit is not helpful to the successful implementation of ACA.
TheACA also introduces another tax on medical device industry. This taxhas had negative implications from the time it was enforced. First,there is an observed reduction in innovation and research and the jobcreation and employment sector. Companies that are taxed prefer tolet employees go in order to raise funds to cover the tax (Lathrop, &Hodnicki, 2014).
Anotheraspect of the policy in which the federal government has failed iswhere it takes all the power. The government moves millions ofcitizens into a federally-sponsored system of insurance in the formof exchanges. The private sector is not allowed any role in the wholeprocess, which is very wrong. Breaking the exchange monopoly wouldmake things easier as the policy is implemented. Americans should beallowed more options in the issues to do with exchanges (Lathrop, &Hodnicki, 2014).
Inconclusion, the Obamacare is a great law that has the potential oftransforming the health system in the US. It is the single onlypolicy in many years that has introduced such vast changes in theAmerican health care system. It addresses several issues thatpreviously rendered the health system inefficient, unaffordable, andwasteful. Although the initial blueprint was clear and seemedachievable, the actual implementation has proved to be flawed and inneed of major changes to make it capable of successfulimplementation.
Blumberg,L. J. (2012). The Affordable Care Act: What does it do for low-incomefamilies? Madison,WI: Institute for Research on Poverty, University of Wisconsin.
Cutler,D. M., Davis, K., & Stremikis, K. (2010). The impact of healthreform on health system spending. IssueBrief (Commonw Fund),88,1-14.
LahmJr, R. J. (2013). Obamacare and small business: Delays and “glitches”exacerbate uncertainty and economic consequences. Journalof Management and Marketing Research,16,1-16.
Lathrop,B., & Hodnicki, D. (2014). The Affordable Care Act: Primary Careand the Doctor of Nursing Practice Nurse. OJIN:The Online Journal of Issues in Nursing,19(2).
Mahar,M. (n.d). Better Care for Less. Accessed 15/6/15 fromhttp://www.tcf.org/assets/downloads/tcf-bettercare.pdf
Sheils,J. F., & Haught, R. (2011). Without the individual mandate, theAffordable Care Act would still cover 23 million premiums would riseless than predicted. HealthAffairs,30(11),2177-2185.
Sorrell,J. (2012). Ethics: the Patient Protection and Affordable Care Act:ethical perspectives in 21st century health care. OJIN:The Online Journal of Issues in Nursing,18(1).
TheSenate.gov. (n.d) ThePatient Protection and Affordable Care Act. Accessed 15/6/15 fromhttp://www.dpc.senate.gov/healthreformbill/healthbill52.pdf