The Patient Protection and Affordable Care Act (ACA) was enacted by President Barack Obama in 2010, but most of the ACA provisions took effect in 2014 (French, Homer, Gumus, & Hickling, 2016). Since the moment of its formulation, the public health reform remains a target for criticism. The act transformed the basic components of the U.S. healthcare system in which over 20% of adult citizens do not have medical insurance (Key facts about the uninsured population, 2016).
Since the very moment of its implementation, the Act provoked many disputes and encountered opposition on the part of the Republican party and other conservative groups who claim that the ACA enabled the government to take total control over the public health and consider that it may lead to cost increase and primary care provider shortage (Top 10 pros & cons, 2015).
The main strategic targets of the ACA are the coverage of diverse social-economic groups and the increase of the overall insurance coverage in the country (French et al., 2016). A high percentage of uninsured citizens due to high rates of insurance fee represents a big issue as it leads to significant disparities in the access to healthcare service and results in a large number of deaths associated with the lack of medical insurance and bankruptcy provoked by the necessity to pay healthcare bills out of the pocket (Buchmueller, Levinson, Levy, & Wolfe, 2016). In this way, the ACA aims to provide compulsory insurance for all individuals regardless of their health conditions, regulated insurance fees and scope of coverage, control over the insurance market, and the prices for medical service and the quality of healthcare.
The American citizens are primarily concerned with federal acts considering any legislative initiative as an attempt to limit their personal freedom. It is considered that the introduction of the universal governmental regulation of service costs, adoption of mandatory insurance, and other forms of federal intervention in the state of the free enterprise may lead to the nationalization of healthcare and socialism (Is Obamacare a socialist law? 2015).
Moreover, consistently with the ACA provisions, the economically secured individuals will have to cover the costs of medical insurance for uninsured people out of their pockets. However, despite these objections, the Supreme Court adopted a positive decision on one of the most important provisions of the ACA – mandatory health insurance – in June 2012 (French et al., 2016). This provision became active since 2013.
The ACA strategies allow young people at the age of 19-26 to stay on parents’ coverage plans. It also requires large employers to provide affordable insurance for all full-time staff members and obligates citizens without ESI to purchase insurance by themselves, otherwise, they are imposed with a penalty (French et al., 2016).
Moreover, the act assists lower-income social groups by expanding Medicaid eligibility to all nonelderly people whose annual income is less than 133% of the poverty level. Nevertheless, the Supreme Court allowed some states not to expand the existing coverage eligibility. In many states, it has led to the formation of groups of citizens who are insufficiently poor to obtain health care and not wealthy enough to get subsidies for insurance. Therefore, the ACA implementation is not well-coordinated across the country.
Despite the lack of cooperation among the states, the reform has passed the approbation in some states, including Massachusetts. It proved to have a positive impact on the U.S. healthcare system resulting in the decreased number of non-insured individuals (67% reduction per year was registered in Massachusetts) and reduced insurance fees at the market of individual insurance (Mangan, 2014). Due to the expansion of funding for the Medicaid program, the volume of free medical care has increased. However, better access to Medicaid programs is not necessarily related to better patient outcomes because it is observed that Medicaid patients are “25% likelier to have an in-hospital death” (Top 10 pros & cons, 2015, par. 4).
In my opinion, the ACA supports the redistribution of resources for the majority and, in this way, supports the elimination of health care disparities and the inclusion of populations with serious chronic diseases in insurance programs. The main disadvantage of the act is the drastic increase in taxes for a limited group of citizens with a high-income level in order to provide subsidized insurance policies to a larger number of individuals with lower incomes.
Moreover, in the states where the expansion of Medicaid eligibility was refused, young and healthy people who previously had cheap insurances now have to pay greater amounts for noncomprehensive health insurance, and, in case they earn good money, they also are deprived of a chance to get subsidiaries. Thus, a portion of injustice is still associated with the reform.
I tend to believe that the universal implementation of the ACA principles across the states is a more rational solution as it will facilitate the partnership between the federal government and the local governments. Additionally, the mandatory nature of the insurance seems to be a controversial issue because, on the one hand, it stimulates healthcare service accessibility but, on the other hand, it creates financial burdens on the budgets of the families who are not in 133% FPL.
Overall, it is possible to say that the realization of the ACA and the achievement of a sustainable positive result will take a long time and will require significant investments. However, in the long run, it still has potential for the elimination of disparities in healthcare insurance coverage which remains a big problem in the current health care system.
Buchmueller, T. C., Levinson, Z. M., Levy, H. G., & Wolfe, B. L. (2016). Effect of the Affordable Care Act on racial and ethnic disparities in health insurance coverage. American Journal Of Public Health, 106(8), 1416-1421. doi:10.2105/AJPH.2016.303155
French, M. T., Homer, J., Gumus, G., & Hickling, L. (2016). Key provisions of the Patient Protection and Affordable Care Act (ACA): A systematic review and presentation of early research findings. Health Services Research, 51(5), 1735-1771. doi:10.1111/1475-6773.12511
Is Obamacare a socialist law?. (2015)
Mangan, D. (2014, June 24). Top states: Big differences in health ‘uninsured’ rate. CNBC.
Top 10 pros & cons. (2015).