Checkpoint 3: Policy Process artifacts

Abstract/Executive Summary

The Patient Protection and Affordable Care Act, sometimes call (ACA) made it through congress and Obama signed the law in 2010. The immediate goals of the Patient Protection and Affordable Care Act were to make health insurance available to more people while making healthcare affordable and expanding the Medicaid program. “Before the Patient Protection Affordable Care Act was passed in 2010, according to Dirigo review, there were nearly 49 million uninsured Americans; this is a large number when you consider other countries insurance rates.” (Dirigo, 2010) High rates of uninsured are a problem, and medical bills can be huge. You can go bankrupt in paying rates even if you have the financial support of an insurance company. The bad advantage is the number one reason people appear not to be buying plans is still the cost. Some can’t afford plans, and no Medicaid is available. Others fall into a family glitch, where they can’t get subsidies for family members because they have individual insurance from their jobs. Some can’t afford insurance cause, even with subsidies, they still can’t afford insurance. So, the ACA was successful in expanding healthcare insurance coverage in the United States. The Center Budget and Policy reports, more than 20 million people were getting coverage in the years passed, and the un-insurance dropped in 2018 (Budget and Policy, 2019).

Scope of Problem

The biggest objection to the ACA was cost. American is a very individualist country. People, businesses, and state governments don’t like to be told what to do, especially if they have to pay for it, even if it’s good for public health (McConnell, 2014). The Affordable Care Act is designed to slow rapidly rising healthcare cost and provide quality health and affordable insurance to every legal resident in the United States. “Although the law has never enjoyed widespread support, polls show that most Americans want the law reformed and improved rather than repealed.” (Hamel, et al. (2020) Appealing to America was companies requiring insurance to be sold to all and with pre-existing conditions. Repealing the ACA policy appears to improbable. From a realistic view, reforming the ACA is not significant enough in light of employers' Medicare and Medicaid and health care spending. Change to expand affordable insurance can compromise the ACA to improve the healthcare financial crisis.

“The most controversial and received the most push back out of anything is the ACA requiring states to expand their Medicaid program, a government-run health insurance program for low-income Americans administered thru a state and federal partnership.” (NCSL, 2020) Though Medicaid was an original requirement, the ACA was struck down by the supreme court, and states can now opt-in to decide whether they want to extend Medicaid, which they are no longer required to do.

It is expensive for states to cover; therefore, the federal government agrees to cover the cost of Medicaid expansion for the 1st three years and slowly phase out federal funding after that. “As of 2020, the state government is only paying 10% of the cost of extending in their state.” (Healthcare.gov, 2018) In addition to expanding Medicaid, ACA established penalties for large employers that don't provide health insurance. This has affected business that were over the limit of employees. More employers were cutting health insurance from their list of benefits.

The disputed part of the law was the ACA individual mandate, requiring the individuals who don't have coverage from other sources to buy insurance for themselves or face a penalty. The law established individual markets for people to shop and purchase insurance plans and buy one for themselves. This provision existed to encourage young and healthy people who wouldn't otherwise buy health insurance to sign up to keep the premium payment low. “As of January 2019, the individual mandate is at zero dollars; it no longer exists.” (Paychex, 2020)

Before the ACA, insurance companies could refuse to cover people with pre-existing conditions or charge much more than the average healthy person. People with pre-existing conditions or are chronically ill use healthcare the most. So, they're the most expensive to the health insurance company. To offset adding more sick people, you would also add more healthy people to the pool to make sure premiums weren't incredibly high for everyone.

Policy Alternatives

Before the ACA, could we choose free-market in health care? Employees can only take insurance plans offered by their employers. Low-income people and the elderly are forced into government insurance programs without free-market choices. Meaningful reform and achieving lower costs require patients to be in charge of their health care. This effort can be obtained through provider's transparency, changes in the tax code and less dependence on the employer or sponsored coverage, insurance reform, eliminating mandates, reform of Medicare, and use of subsidized high-risk pools to deal with a pre-existing condition.

Although the law has never had full support, I support the law reformed to improve its approach rather than repealed. If you repeal the ACA, subsidies will allow people to buy insurance in the exchange. It will disrupt the insurance in the insurance market place. Without the exchange, the individuals would lose their coverage. The insurance companies will also pull out of the total individual market where people buy insurance without subsidies. Many people will be without insurance. If you repeal the ACA and get rid of the funding mechanisms, the federal deficit would increase. Many people who lose their insurance will still need healthcare but can’t pay for their healthcare. Hospitals do provide healthcare without payment from individuals, yet hospitals will have to recover the care cost. They will bill the people who have insurance to provide free care who don’t have insurance. It’s like the common phrase, robbing Peter to pay Paul. Premiums will increase because of the repeal of the ACA.

Policy Recommendation

Ultimately, reforms are more about stopping the existing conditions, offering stability and security to Americans who need it. “Some states are repealing the reform, going back to discriminating against children with pre-existing conditions.” (HHS.gov, 2014) Dropping coverage to the sick or reinstate lifetime limits on benefits is the reason the Patient Protection and Affordable Care Act exist. Americans who work hard and do the right thing are expecting to get a fair share. These efforts are still alive and moving forward, even if it looks like it’s lost. Every time this country moves forward, it’s because America seeks healthcare quality and fairness.

Will healthcare cost ever be predictable? No one knows; however, America recognizes the uncertainties the country faces with healthcare. A primary concern should be, who should make critical healthcare decisions that affect your life? Should the government officials determine what plan, benefits, or treatments available to you? You would have more authority if you controlled your healthcare decisions and the dollar amount that enforced decisions.

Before the ACA, healthcare stability was weak. The ACA promoted a more stable environment that lessens the threat of losing healthcare coverage. If you get are sick, you could be dropped from your healthcare insurance, now you have access to shop for suitable healthcare plans. Another provision is adult dependency, giving children coverage under the adult healthcare plan until the age of twenty-six. More people, young and old, are getting more healthcare coverage. People with low income can benefit from expanding Medicaid, providing funds from the government that is free or low insurance cost based on income or household status.

To strengthen the ACA, my recommendation is to focus on the flow of funding. Do we have the capitalism to soar? To help with the deficiency would be to fiancé the growth of money thru taxation. No one loves taxes, but it is a mechanism that can be used to finance healthcare. Taxes are mandatory and progressive, and as we know, the rich pay more than the poor, thus using that money to fund healthcare.

Secondly, I recommend supporting healthcare financing thru premiums. The cost of health insurance depends on who buys health insurance. The health insurance pools people together. For example, two people at the beginning of the year purchase insurance and maybe have the same risk but at the end of the year, the healthy person thru their premium has virtually subsided the sick person. It was fair at the beginning of the year because everyone was pitching in pooling their risk. So, you’re paying for your own risk and people at a higher risk with benefits, called cross-subsidy, forcing everyone to be in the pool. The sicker people have premiums they can’t afford. The Affordable Care Act pushes those groups together, bringing the healthy people in with a premium slightly higher than the fair compensation to fiancé the sicker people.

Lastly, I recommend a person get rewarded monetarily for good health at the end of the year. For example, taxes we pay throughout the year, and at the end of the year, we get a refund if we didn’t have to pay back taxes.

Despite progress, the Affordable Care Act did struggle to keep premiums affordable for working families, prevent insurance companies from dropping out of health exchanges and extend coverage to everyone. So, I strongly recommend to reform to strength the ACA and not to repeal. Repealing would prevent millions from receiving care.

Center Budget and Policy Priorities Chart Book. (2019). Accomplishments of Affordable Care Act. Retrieved November 24, 2020, from https://www.cbpp.org/research/health/chart-book-accomplishments-of-affordable-care-act.

Dirigo. (2010). DHA Connecting You to Health Coverage & Health Quality. Retrieved November 22, 2020, from https://dirigohealth.maine.gov/Documents/DI10112eNewsletter

_dec2010F2.pdf.

Healthcare.gov. (2018). How the Affordable Care Act Affects Small Business. Retrieved November 22, 2020, from https://www.healthcare.gov/small-businesses/learn-more/how-aca-affects-businesses.

McConnells. (2014). ACA / Obamacare Lies by the Numbers. Retrieved November 22, 2020, from http://acasignups.net/14/10/14/mitch-mcconnells-kynect-aca-obamacare-lies-numbers.

National Conference of State Legislatives (NCSL). (2020). Affordable Care Act Medicaid Expansion. Retrieved November 22, 2020, from https://www.ncsl.org/research/

health/affordable-care-act-expansion.aspx.

Paychex Worx. (2020). ACA Individual Mandate Penalty Reduced. Retrieved November 22, 2020, from https://www.paychex.com/articles/compliance/aca-individual-mandate-penalty-reduced-2019.

Hamel, L., Kirzinger., A., Munana, C., Lopes., Kearney, A., & Brodie, M. (2020). Kaiser Family Foundation-KFF. Public Opinion on the Affordable Care Act. Retrieved November 22, 2020, from https://www.kff.org/health-reform/poll-finding/5-charts-about-public-opinion-on-the-affordable-care-act-and-the-supreme-court/.

HHS. Gov. (2014). U.S Department of Health and Human Services: Pre-Existing Conditions. Retrieved November 22, 2020, from https://www.hhs.gov/healthcare/about-the-aca/pre-existing-conditions/index.html.