Table of Contents
Abstract
Many health concerns are coming up suddenly in today’s lifestyle. With many Americans suffering from chronic illness, many do not have adequate health insurance to get their symptoms diagnosed. With the Affordable Care Act also known as Obamacare, many of those individuals were given the opportunity to receive health care insurance without the financial burden of insurances for pre-existing conditions. The Affordable Care Act is a rare change in the United States health system after many years of private insurance. With the healthcare change, it promises access to health care, creates new incentives to change clinical practice, gives physicians and other healthcare professionals more information available, and changes the payment system to reward value. The Affordable Care Act took out many barriers that were unnecessary to health care systems, but instead of repealing the act there needs to be fixed. Keywords: Affordable Care Act, Health Policy, Implementation, Fixing, Repealing
Fixing the Affordable Care Act
The Affordable Care Act (ACA) or also known as Obamacare was intended to guarantee that all Americans regardless of health status have access to affordable health insurance. The Affordable Care Act was signed on March 23, 2010, by President Barack Obama and upheld by the Supreme Court on June 28, 2012. The central concept of this act was “healthcare is a right, not a privilege” (Rak, 2013, para 2).
When looking at the primary goal for this act, it was to reduce barriers for obtaining health care coverage and allow everyday individuals to access much-needed health care services such as preventive care and yearly screenings. Gaining an understanding of the reasoning of why the Affordable Care Act was created is essential. The purpose was to “focus on reforming the private health insurance market, extending insurance coverage to the uninsured, providing better coverage for those with pre-existing conditions, improving prescription drug coverage in Medicare, and extending the life of the Medicare trust fund accounts.” (Shi, 2014, p. 31).
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With the goals to better healthcare, the Affordable Care Act has many setbacks and needs to be fixed from fixing healthcare regulations, improving patient quality and lower costs and have states lead the way with Medicaid innovation. The three changes that need to be made that will have both parties in-house be happy is that more states need to start reinsurance programs that will reimburse or pay the highest medical cost (Oregon Reinsurance Program, n.d.). Secondly, states need to open up government contracted programs such as Medicaid, and lastly, the current administration under President Trump needs to fulfill some responsibility toward Obamacare.
Policy Implementation
After controversy within the policy cycle, the Affordable Care Act was fully implemented in 2014. Looking into the policy cycle the formation and implementation of health policies are comprised of five components; those five components for policy cycle change start with, “(1) issue raising, (2) policy design, (3) public support building, (4) legislative decision making and policy support building, and (5) legislative decision making and policy implementation” (Shi, 2014, p. 522). With changes to the Affordable Care Act, there will need to be another policy implementation by having the healthcare policy go through three phases, the formulation phase, modification phase, and implementation phase. “Policymakers in all three branches of government make policy in the form of position-appropriate, or authoritative, decisions,” (Longest & Crossley, 2016, p. 86).
The healthcare system in the United States, include public and private segments as well as politics playing a factor in how the system is influenced. With change starting at any start point from local, state or federal legislation, regulations manage the terms of the Affordable Care Act and healthcare services. Looking at the private segment business related to healthcare such as hospitals and managed care organizations, policies are regulated by these entities. There are phases when it comes to policy processes such as formulation phase, modification phase, and implementation phase. In the formulation phase legislation comes up with agenda-setting looking at the problems, solutions, and circumstances, implementation phase looking at the designing, evaluating, rulemaking, and operating and the last phase being modification due to specific policies needing modification such as the Affordable Care Act. With any fix or change made to the Affordable Care Act, it would not be made up for discussion due to the Republican-controlled Senate, and the current President wants to get rid of Obamacare altogether.
Challenges in Today’s Health Care
The Affordable Care Act has been implemented for a few years now, but there are many challenges still. We have surpassed technical meltdowns, presidential elections, Supreme Court challenges and a vast number of repeal efforts in Congress but we still do not know the long-term future for the Affordable Care Act. The most significant hurdles that are impacting the Affordable Care Act today are Medicaid expansion, anemic enrollment, market stability, affordability, and political resistance.
The three changes that need to be made that will have both parties in-house be happy is that more states need to start reinsurance programs that will reimburse or pay the highest medical cost (Oregon Reinsurance Program, n.d.). Looking into this although individuals are covered with pre-existing conditions, the high cost of premiums and deductibles have also skyrocketed. Here need to program such as the one currently in Fresno, California called the 5.5 Adventist Health Program for individuals who are not able to pay for radiology expenses such as mammograms and x-rays.
Secondly, states need to open up government contracted programs such as Medicaid only to individuals that will take part in the exchange. Medicaid is much larger than the market for individuals, so there need to be some steps for getting rid of the exchanges.
Lastly, the current administration under President Trump needs to fulfill some responsibility toward Obamacare. Although everyone has mix thoughts on the Affordable Care Act, it is a policy that was implemented and needs to be enforced and not demeaned. The currently Republican party that controls the Senate and the president himself have a responsibility to make it work instead of getting rid of the policy entirely.
As an individual who is working in healthcare administration, the everyday struggles of the ACA are seen, but like many policies, there are pros and cons to everything. Tax breaks are also given to individuals who are below the socioeconomic threshold, and many middle-class families see the rough side of the ACA with a gap of coverage. Roughly looking into Medicaid expansion, more than 4 million Americans would gain insurance coverage if all states were to expand the state and federal programs to cover everyone with earnings that are at or above the poverty line (Holahan, 2012).
Implementation of the ACA
The ACA required all Americans to have health insurance through their employer, a public program such as Medicaid or Medicare, or to purchase insurance through the insurance marketplace exchange such as private insurance. After the signing of the Affordable Care Act into law, many provisions came into effect. “… including 26 provisions in 2010, 18 in 2011, and 10 in 2010 … as of August 2012, an additional 11 provisions have gone into effect…” (Shi, 2012, p. 525). The ACA had a rocky start at the beginning due to many issues such as technology with the website crashing, lack of experience and leadership as well as schedule pressure. The launch of the Affordable Care Act had so much pressure that not enough testing and troubleshooting was done to help fix any issues that individuals might encounter.
Conclusion
All in all, the Affordable Care Act has many components that provide faulty positive feedback to health care. Although there is an increase in the accountability of insurance entities, lower cost and overall affordability for many, there are setbacks as well. Setbacks such as consequences and gaps in coverage but the ACA has worked to help merge those gaps. All policies have pros and cons, and the ACA is one of them. There are pros to the ACA because of the privilege of insurance many have received such as gaining health coverage, extending coverage for those with pre-existing conditions and not feeling the financial denial of health care. The cons being that fixing regulations, improving patient quality and having stated lead the way with Medicaid innovation programs, all while implementing reinsurance programs, a government contracted programs for Medicaid, and the Republic party acknowledging that there is an Obamacare policy but there is a more significant meaning to healthcare other than the name itself. Through the years ahead there will be many more changes to the ACA, but with government playing a considerable role, changes will not be seen for many years.
References
- (N.A) (2015). Improving Our Healthcare and Increasing Health Security. http://www.whitehouse.gov/about_us/
- Holahan, J. (2012). The cost and coverage implications of the ACA Medicaid expansion: National and state-by-state analysis.
- Longest, B., & Crossley, M. (2016). Health PolicyMaking in the United States (6th ed).
- Oregon Reinsurance Program (n.d.). http://dfr.orgeon.gov/business/reg/health/Pages/oregon-reinsurance-programs.aspx
- Rak, S., & Janis Coffin DO, F. A. A. F. P. (2013). Affordable care act. The Journal of medical practice management: MPM, 28(5), 317.
- Shi, L., & Singh, D. A. (2014). Delivering health care in America. Jones & Bartlett Learning.
