Patient Protection and Affordable Care Act’s Failure


In March 2010, the president of the United States Barack Obama signed the comprehensive healthcare reform. This law became known as the federal Patient Protection and Affordable Care Act (PPACA), also referred to as the Affordable Care Act (ACA), Obamacare, or “federal health reform”. The initiative included numerous policies, aimed at extending health insurance coverage as the United States was “among industrialized countries in terms of the high proportion of citizens without health insurance” (Feldman et al., 2015, p. 208).

This initiative became one of the most significant regulatory laws in the medical system of the United States since the appearance of Medicare and Medicaid in 1965. The Act made numerous provisions to facilitate the purchase of medical insurance. However, despite all the positive changes the Act has raised, in reality, not all the mechanisms are working as they were supposed to, which led to multiple failures, and numerous arguments.

Definition and Goals of the PPACA

Purposes and Mechanisms of the PPACA

The ACA was introduced as a law, aimed at reducing the cost of health insurance coverage for millions of people who match the stated criteria. The initiative had three key goals:

  • Making health insurance affordable to more people;
  • Expanding the Medicaid program and covering all adult population with income below 138% of the federal poverty level;
  • Supporting innovative healthcare methods, aimed at lowering the costs (Affordable Care Act).

There are four principal mechanisms for making the ACA work: mandates, subsidies, insurance exchanges, and reforms targeted at reducing costs and improving healthcare quality. One of the most distinctive features of the ACA is granting tax credits to individuals and families to help them afford insurance. Due to this initiative, Americans with incomes between 100% and 400% of the federal poverty line (FPL) received access to the refundable tax credits (Ogundipe et al., 2015). For the ACA’s main purpose of expanding access to insurance coverage, there were made major provisions. Among them are requiring employers to cover their workers, creating state-based insurance exchanges and temporary high-risk pools for those who cannot purchase insurance due to health problems, and enacting consumer protections.

Benefits and Drawbacks of the PPACA

The Outcomes of the Accepted Policy

The ACA established its major purpose in increasing the number of the United States’ population with medical insurance. In 2013, The Congressional Budget Office estimated that the ACA would result in 37 million Americans, who did not qualify before, obtaining insurance (Ogundipe et al., 2015). According to the estimations, by 2016, the uninsured part of the population had decreased, providing approximately 20 to 34 million additional people with coverage (Speiss, 2020). As the result, the ACA has also “made a provision of $15 billion for a Prevention and Public Health Fund” (Ogundipe et al., 2015, p. 55).

The improvement of the population’s health status led to cost savings for both the local and the federal governments. Moreover, the ACA facilitated access to numerous services such as blood pressure monitoring, annual screenings for cholesterol, diabetes, and cancer, vaccinations, and regular checkups for children. From this perspective, the ACA brought many positive changes to the American healthcare system.

The Failures of the PPACA

Despite all the positive changes caused by the ACA, there are multiple drawbacks, which need to be fixed. One of such issues is the confusion of many people by the representation of insurance as an unnecessary product as it is “paying a private company on a bet that we won’t need its product” (Dixon, 2017, p. 81). However, all people become ill, thus, consumption of medical care is an essential option.

In addition, private companies appeared in the position where they can put any price for their product. Moreover, although the ACA provided free access to preventive health services, it lacks the availability of medicine to ethnic minorities including African Americans. According to the research, these groups “appear to have been left behind in terms of access and utilization of health care, including preventive health services” (Eno et al., 2016). All of these facts demonstrate that the system has many changes to be done in the future.

Quality of Provided Care from the Experts’ Point of View

The quality of healthcare services is another important issue, which is required to be further improved. The ACA suggests the concept of value being principal for the health care system, allowing estimating the quality of the provided services. Patients, physicians, and other involved people have different views on the meaning of value, although, all of them recognize “shared clinical decision-making and patient empowerment” as principle aspects of this notion (Marzorati & Pravettoni, 2017, p. 101).

Other experts, for example, Mark Warren, distinguish several important components, required to value health, they are connection, communication, creativity, cooperation, cost-consciousness, and computerization (2017). Nevertheless, all experts agree that the system of health-care needs to become more value-based, meaning that the patients’ needs should be considered to achieve a higher quality of medical services.


The federal Patient Protection and Affordable Care Act was accepted in 2010. The law was aimed at increasing the medical coverage of the population as the country was among nations with the biggest number of people without insurances. The initiative was manifested through four key mechanisms, including mandates, subsidies, insurance exchanges, and reforms aimed at improving the quality of medical services. After the initiative was accepted, the number of people with insurance significantly increased, and access to many services was facilitated. However, experts continue arguing about the pros and cons of this reform.

Among the drawbacks, professionals highlight the misunderstanding of the concept of value-based medicine, the increase of the cost for insurance, and discrimination toward people of different races. All of these problems require the government’s attention, and new solutions to increase the quality of healthcare services and make medicine available to the entire population.


Affordable Care Act (ACA)”. USAGov. Web.

Dixon, B.J. (2017). Novel healthcare reform starts with owning our mistakes. The Journal of Medical Practice Management, 33(2), 81-83.

Eno, V., Mehalingam, S., & Nathaniel, T.J. (2016). The patient protection and affordable care act and utilization of preventive health care services. Sage, 6(1). Web.

Feldman, H. M., Buysse, C.A., Hubner, L. M., Huffman, L.C., & Loe, I.M. (2015). Patient Protection and Affordable Care Act of 2010 and children and youth with special health care needs. Journal of Developmental & Behavioral Pediatrics, 36(3), 207-217. Web.

Marzorati, C., & Pravettoni, G. (2017). Value as the key concept in the health care system: how it has influenced medical practice and clinical decision-making processes. Journal of Multidisciplinary Healthcare, 10, 101-106. Web.

Ogundipe, B., Alam, F., Gazula, L., Olagbemiro, Y., Osiezagha, K., Bailey, R.K., & Richie W.D. (2015). Remaking the American health care system: A positive reflection on the Affordable Care Act with emphasis on mental health care. Journal of Health Care for the Poor and Underserved, 26(1), 49-61.

Speiss, T. (2020). The Yesterday, today and tomorrow of the PPACA. EisnerAmper. Web.

Warren, M. (2017). Defining health in the era of value-based care: The six Cs of health and healthcare. Cureus 9(2). Web.

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