Unintended Consequences of Health Care Reform Consequences of Health Care Reform

My discussion is related to the individual mandate of the Patient Protection and Affordable Care Act (PPACA) of 2010.

The policy problems addressed by the Patient Protection and Affordable Care Act (PPACA) of 2010 are the high cost of health insurance that is untenable for low and middle income earners and the discretionary criteria for enrollment and coverage exercised by medical and health insurance carriers. The PPACA is an excellent policy solution to these issues in the United States and, absent socialized medicine, is a robust response to what has been an intractable and escalating problem in the U.S. Many people who have unable to obtain medical insurance are now able to do so.

The Patient Protection and Affordable Care Act was designed to significantly reduce the number of people who are uninsured through the provision of a continuum of affordable coverage options, that include Medicaid and the new Health Insurance Exchanges ("Kaiser," 2013). The PPACA expanded the Medicaid coverage available to most low-income adults whose household income is at 138% of the federal poverty level (FPL). The major stumbling block to full implementation of the PPACA is that there states are able to independently decide whether they will participate in Medicaid expansion component of the law (Pear, 2013). Many states, particularly in the South, are unwilling to provide coverage under this federal program primarily because they are unhappy that the present Administration in Washington D.C. is liberal and Democratic ("Kaiser," 2013). People who do not make enough money...

As of October 2013, 25 states and the District of Columbia had opted to participate in the expanded Medicaid program that is part of PPACA. Over half of the uninsured U.S. citizens live in the states that are currently not participating in the expanded Medicaid program ("Kaiser," 2013). Yet, according to the Congressional Budget Office, "Through those changes and numerous others, the 2010 legislation significantly decreased Medicare outlays relative to what they would have been under prior law" (Elmendorf, 2011, p.44).
The fundamental consideration regarding unintended consequences of the Patient Protection and Affordable Care Act is the size of the program that will be implemented in response to the policy mandate. The sheer number of people who will be enrolled coupled with the scope of healthcare systems and medical institutions that will implement the program is staggering. On the one hand, these numbers are a clear indication that the policy problem addressed by the bill is a substantive one and that enacted law is a good fit to the policy problem. As with any policy implementation on this scale, a tiered approach is not only desirable, but likely to be the only feasible path to efficacious provision of services. The nature of the services requires the immediate granting of health insurance coverage -- which is a tremendous implementation task in and of itself -- but the saving grace is primarily that everyone enrolled will not require immediate care beyond annual check-ups. Indeed, as the Patient Protection and Affordable Care Act was just being enacted, confirmation of enrollment was made by email and through telephone calls. The purpose of the phone calls was twofold: notify and reassure enrollees about their coverage, and conduct brief surveys about patient healthcare history and medical needs. This second goal enabled policy implementers to gain a more detailed perspective of the needs, habits, and potential impact that these new enrollees would have on the existing healthcare systems. For instance, one of the questions and associated probes asked of new enrollees by the interviewing staff focused on their use of emergency rooms for medical needs. Use of emergency rooms for routine medical care -- in lieu of receiving care from a medical practitioner with which a patient has established a longer-term doctor-patient relationship -- has been one of the drivers of the policy enactment and one of the primary concerns of those engaged in evaluating the rising costs…