Business Finance - Management Week 10 Assignment - Interest Group Presentation

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The Affordable Care Act (ACA)

Gabrielle McNeely

Professor Timothy Smith

Strayer University

PAD 510

2/12/2024

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Summary of the Policy

The Affordable Care Act (ACA), passed into law in 2010 by President Obama, aimed to solve

critical challenges within the United States' healthcare system. Primarily, the ACA strove to

increase healthcare coverage, improve healthcare quality, and diminish costs. Among its main

facets was the creation of insurance markets where individuals and small businesses could

routinely select and purchase their health plans through subsidies assessed according to income.

The ACA also covered broader low-income individuals to achieve Medicaid eligibility but

reduced coverage denial based on previous conditions. Moreover, it required that everyone be

covered by health insurance coverage or face an 'individual mandate' penalty. However, this fine

was later eliminated. Some of the aspects included in ACA are also aimed at developing

preventative care and reducing spending on health. However, the policy addresses a healthcare

system with millions of uninsured citizens, high costs incurred to receive treatment, and rampant

differences across services. The ACA addressed these issues by improving access to affordable

healthcare coverage, quality of care, and cost-containment measures. The recommendations to

make this policy more effective include the creation of health insurance marketplaces, the

promotion of preventive care programs, and the implementation of reforms in healthcare to

protect consumers. Consumers should have access to platforms to compare and purchase health

insurance plans. The reforms could incorporate enhanced protection for the consumers against

insurance companies abuses, new information about prices, quality measures, and renewed

governance to prevent fraud and ensure patient safety. Investing in preventive care programs is

as vital as saving public health by contributing to better end-results and the eventual decrease of

the overall health bills. These programs may include screenings, vaccination, counseling, and

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other interventions designed to detect and prevent illnesses before they become more severe and

costly for treatment.

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The Affordable Care Act (ACA)

The ACA policy was signed into law on March 23, 2010, during President Obama's

tenure. The primary objective of this policy was to enhance healthcare coverage by making car

services affordable to all Americans. The policy affirms that every U.S. citizen should have

equal access to healthcare as primary security. The policy offers insurance to at least 30 million

uninsured Americans. This insurance is attained through the expansion of Medicaid and the

extension of federal financial assistance to the lower and middle-income populations to ease

purchasing private coverage. Although most Americans perceive the policy positively or

negatively, it impacts every aspect of the American healthcare system differently.

Parties Involved In The ACA Policy

Health Insurance Companies

Insurers' contributions to ACA are of significant importance. Insurers provide

opportunities via health insurance exchanges and Medicaid managed-care plans that offer the

best insurance choices. The ACA brought about new regulations regarding insurance practices in

the form of denial of coverage because of pre-existing conditions, among other essentials such as

necessary health benefits (Brodie et al. 2020). The role and function of health insurance

companies is to influence the awareness about the policy. They must lobby, campaign, and

participate in healthcare industry associations on healthcare coverage and accessibility. The

primary intentions should be preserving their market share and making health insurance coverage

favorable to all Americans.

Government Entities

The federal government, through Congress, enacts healthcare policies. These policies are

then carried out and enforced by the Executive arm of the government, including federal

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agencies like the Department of Health and Human Services. The role and function of

government entities should be to implement some aspects of the policy. For instance, State

governments implement the policy provisions, such as increasing Medicaid coverage and

establishing health insurance exchanges.

Employers

The ACA has business stakeholders, mainly small and medium-sized enterprises, due to

their employer role that directs some employers to offer health insurance for workers or pay

penalties. The ACA additionally brought in rules on employer-backed protection that led, for

instance, to the coverage of reliant until they are 26 years old. In aiding the effectiveness of the

policy, Lester et al. (2021) show that employers should promote the employer's "shared

responsibility" by offering adequate and affordable health coverage to certain workers.

Patients and Advocacy Groups

Patients and families searching for healthcare services coverage also need more of the policy.

However, the implementation of the policy implies patients have access to broader coverage and

consumer protection and preventive care services as stipulated by the policy. The role and

function of patients is to use marketplaces to find and apply for health coverage that matches

their budgets and specific healthcare needs. Organizations like the American Cancer Society and

the American Heart Association should aid the policy by supporting patient rights, healthcare

accessibility, and affordability.

Healthcare Providers

This stakeholder includes hospitals, physician group practices, clinics, pharmacies, and

other providers that deliver patient care. The parties are interested in the effects of patients,

reimbursement rates, quality metrics, and volume on ACA. The role and function of healthcare

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providers in the policy is lobbying for campaign contributions, and professional organizations

provide them with significant political power (Oberlander, 2020). However, the intentions should

focus on securing adequate reimbursement rates, decreasing workloads resulting from

administered appearance, and medical authority. Therefore, the care providers can push for the

policy to facilitate increased reimbursement scales to attain more comprehensive healthcare

coverage. The healthcare provider's effect on ACA is spearheaded through quality metrics,

payment reforms, and electronic HSR implementation.

Political Influence Analysis

Health Insurance Companies

The motives of insurance companies regarding the ACA are multi-faceted. On the other

hand, they are advantaged by the growing coverage, which means they have more clients.

However, they are subject to such constraints as compulsion to cover preexisting conditions and

profitability restrictions. Instances may arise whereby insurers will desire to make as much profit

from people as possible while policymakers want insurance practice regulated for the interest of

consumers (Keisler-Starkey & Bunch, 2020). Conflicts usually occur between insurance firms

and other stakeholders on premium pricing, coverage mandates, and network adequacy issues.

Insurance firms constantly lobby Congress and partner with other stakeholders to mold rules and

policies in their favor. Their political power has led to revisions of some ACA sections—for

instance, the modifications of the risk corridors and the cost-sharing reduction payments.

Patient Advocacy Organizations

The main driving force of patient advocacy groups is to guarantee affordable and quality

healthcare access to their followers. They advocate for coverage enhancement, patient rights

protection, and healthcare outcomes improving policies. Although their interest tends to coincide

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with those of patients, there are conflicts with other stakeholders like insurance companies or

policymakers concerning the specifics of coverage requirements, reimbursement rates, or the

extent of government involvement in health care (Warner et al. 2020). These associations

typically work with legislators, governmental bodies, and other advocacy groups to effect

healthcare policy through lobbying, grassroots activities, and public education initiatives. Their

political power has been critical in forming some ACA provisions, notably essential health

benefits and preventive care services without cost-sharing requirements. Furthermore, they

support the retention and growth of Medicaid, a necessary part of the ACA’s coverage expansion

initiatives.

In conclusion, ACA has affected United States healthcare, making it greatly obligated not

only to develop a fuller measure of inclusion but also to enhance quality and control

expenditures. From the myriad of stakeholders, involving governmental institutions, health care

establishments, insurer entities related to the Health insurance sector, and lastly, patients people

or, in other words, the employer has some determinant control of politics at accounting policy

making. Knowledge of why these groups want what they do is essential to understanding the

politics surrounding U.S. healthcare policy because in that context, especially whenever non-

medical issues may be contemplated, a group's motivations are where conflicts and

interrelationships among stakeholders can best be understood by those who create policies for all

Americans which comport with federal constitutional law on no matter whatever might.

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References

Brodie, M., Hamel, E. C., Kirzinger, A., & Altman, D. E. (2020). The Past, Present, And

Possible Future Of Public Opinion On The ACA: A review of 102 nationally

representative public opinion polls about the Affordable Care Act, 2010 through 2019.

Health Affairs, 39(3), 462-470.

Keisler-Starkey, K., & Bunch, L. N. (2020). Health insurance coverage in the United States:

2019. Washington, DC: US Census Bureau.

Lester, G. V., Brock Baskin, M. E., & Clinton, M. S. (2021). Employer-sponsored benefits in the

United States: The past, present, and future. Compensation & Benefits Review, 53(1), 24-

42.

Oberlander, J. (2020). The Ten Years’ War: Politics, Partisanship, And The ACA: An

exploration of why the Affordable Care Act has been so divisive despite the law’s

considerable accomplishments. Health Affairs, 39(3), 471-478.

Warner, J. J., Benjamin, I. J., Churchwell, K., Firestone, G., Gardner, T. J., Johnson, J. C., ... &

American Heart Association Advocacy Coordinating Committee. (2020). Advancing

healthcare reform: the American Heart Association’s 2020 statement of principles for

adequate, accessible, and affordable health care: a presidential advisory from the

American Heart Association. Circulation, 141(10), e601-e614.