Public health service: A renewed debate on the role of health Insurance Nine pillars of the Affordable Care Act

The upside of the Affordable Care Act

Health reform for masses

Challenges posed by the ACA

Public health service: A renewed debate on the role of health Insurance

There are few other topics in the public health domain that have stirred more controversy than the Patient Protection and Affordable Care Act (PPACA) effective from March 2010. The law was part of the Obama administration's most significant effort to regulate the U.S. healthcare system. The main goals of the law were to:

a) Increase the quality and affordability of healthcare insurance

b) Lower the rate of uninsured population using a more expanded insurance network through private and public insurance companies

c) Reducing the healthcare cost for the U.S. government and individuals

The bill aimed to alter the healthcare insurance by lowering the minimum standards for obtaining the subsidized insurance under PPACA and universal coverage with same rates of service irrespective of the pre-existing conditions in patients. The Obama administration packaged the act with the catch line "responsible reform for the middle class" (U.S. GPO, 2010). The major advantages of the Affordable Care Act as outlined by the federal government considered the act as a transformation of the U.S. healthcare system. The paper analyzes the hotly debated Affordable Care Act (ACA) promulgated in 2010. Section two of the paper highlights the main aims and objectives around which the ACA has been drafted. Section three highlights some of the advantages that ACA promises to bring forth to the American health healthcare system. Section four analyzes the potential drawbacks and challenges posed by the ACA. Section five of the paper concludes the discussion by restating the main points of being highlighted.

2. Nine pillars of the Affordable Care Act

The Affordable Care Act was based on nine basic tenets addressing one essential area within the healthcare system. The major aim was to make the healthcare system affordable and qualitative for all Americans. The role of public programs was to be reinvigorated through the Affordable Care Act. The program also aimed to provide revenue provisions for healthcare practitioners and encouraged community assistance services and therapies. As part of the immediate improvements sought by the program, the government was to prohibit rescissions of health insurance policies. The act also prohibited the insurance companies from leaving citizens out of the insurance pool due to pre-existing conditions. The age for dependent coverage was increased to 26 and immunizations, and preventive services were to be made part of the insurance plans in the future. An important regulation measure of the act was to cap the administrative and non-service expenses. The information dissemination within the insurance industry also required reformation and transparency under provisions of the act. An internal portal was to be established under the act that would provide Americans with the needed information related to choosing insurance plans.

The plan also aimed to reform the insurance market by ending the practices of medical under-writing and treatment of patients on the basis of health status and family genetics. The American Health Benefit Exchange was also created that would provide new formats of health plans and out of pocket requirements were barred beyond health savings. Each U.S. State was mandated with the development of health benefit exchange. The insurance was made available to people with incomes between 100 and 400% of the federal poverty line. The act also introduced the shared responsibility to encourage minimum essential coverage of healthcare through insurance. Medicaid was extended to children, parents and childless adults not entitled for Medicare and were up to 133% below federal poverty line. Child health insurance programs were also introduced, and the U.S. states under the Affordable Care Act would maintain income eligibility levels for CHIP through 2019 (U.S. GPO, 2010).

3. The upside of the Affordable Care Act

The general provisions in the Affordable Care Act indicate that the act has tried to alter the repressive and long-entrenched practices in health insurance industry. Moonesar (2013) observed that the two most challenging reform issues in healthcare sector are a) the quality of healthcare and b) the insurance coverage (p. 9). It is pertinent to mention that the Affordable Care Act spells out the act's aim as covering 94% of Americans under the $900 billion limit. It seems that the government intends to bend the curve of healthcare cost through the inclusion of more number of people obtaining the healthcare...

The development of the Affordable Care Act is premised on the challenges identified by researchers (Koh, et al., 2012; Emanuel, et al., 2012; Moonesar, 2013). However, it is yet to be seen if the government executes the plan effectively. It is also unknown that whether not the government succeeds to achieve the desired target of including more than 94% of Americans in the net of healthcare insurance coverage.
Johnson and Fitzgerald (2014) argued that the Affordable Care Act can be effectively used to address the issue of preventable chronic illnesses. Authors observed that 75% of the total U.S. healthcare spending is incurred on curing preventable chronic diseases. Statistic indicates that the American economy loses more than $466 billion per year due to women's illness from preventable diseases and potential income loss is not included in this figure. The Affordable Care Act (ACA) mandates the adoption of several measures such as eliminating cost sharing services in 8 key women's health preventive services that are recommended by the Institute of Medicine (Johnson, et al., 2014). The eights preventable illness services are well-woman visit, counseling and screening of HIV, breastfeeding support, counseling for interpersonal domestic violence, counseling for sexually transmitted infections (STIs), DNA testing and screening for gestational diabetes. The inclusion of 17 million low-income people in the Medicaid program will also allow the government to improve the insurance coverage issues. The health insurance coverage issue prevents a large segment of low-income population from obtaining healthcare services due to the increased cost of coverage (Auerbach & Kellermann, 2011). It is observed that several U.S. states maintain medical services program for the uninsured people. Under the provisions of ACA, these states will be able to provide coverage to uninsured people at a marginal increase in cost of coverage. The marginal increment can be compensated by abandoning the standalone services maintained to cater the healthcare service needs of uninsured people (Johnson, et al., 2014). Although economists have reservations that the incentives of participating in the program may alter the behavior of patients in the long-term, it seems that the ACA provisions may improve the health insurance coverage of underserved population segments.

3.1 Health reform for masses

The healthcare reform that the ACA aims to introduce has been projected as the program for masses. President Obama has been consistency using different mediums of communication and methods to convince the general public regarding the effectiveness of the ACA. Jacobs and Skocpol (2012) observed that:

"When the provisions are effectively implemented, seniors, the sick, and average Americans-including many families in the upper middle class will receive wider and easier access to health insurance benefits protected from trickery by the insurance industry" (Jacobs & Skocpol, 2012; p. 122).

There are several statistics that Jacobs, et al. (2012) presents as evidence to their claim that ACA will improve the healthcare coverage and induce better service delivery in the U.S. healthcare system. Authors observed that the number of uninsured working-age Americans and their children will reduce by 32 million. Authors based their statistics from figures sourced from the Congressional Budget Office (CBO), a non-partisan entity. Under the ACA, the healthcare coverage will be obtained by 83% of the legal immigrant residents (Jacobs, et al., 2012; p. 122). It is pertinent to mention that the program is designed in a way that low and middle-income families will obtain the maximum benefit from the ACA whereas economically advantageous population segments will have to bear the additional costs. Through increased participation in the program, the government aims to reduce the overall cost of delivering health service. Table 1 highlights the major implications of the ACA on four demographic groups of the U.S. population.

Table 1- Anticipated implications of the ACA on population segments

Population Segment

Implications of ACA

Medicare dependent Retirees (45 Million)

Cost reduction in pharmaceutical medications

Expansion of primary care

Protection against 100-common abuse of seniors

Young Adults

Ability to remain on family insurance plans up till the age of 26

Qualify for Medicaid if income below $14,444

Middle Class Americans

Mandated to forfeit health insurance with minimal coverage and low premiums

More coverage with high premiums

Population in Upper-income segment

Added Medicare Tax of 0.9% for income earning (above $200,000 for Single, $250,000 for married)

Adapted from: (Jacobs, et al., 2012) and (Steber, 2013)

4. Challenges posed by the ACA

The act became so controversial that lawsuits were filed in several U.S. states including Ohio, District of Columbia, Michigan and Florida (Howell, Williamson & Wyatt, n.d.). Attorneys of these states argued that some provisions of the act violated the Commerce Clause of the U.S. Constitution thereby making it mandatory for individuals to purchase health insurance. The Individual Mandate provision of the PPACA (P.L. 111-148, PPACA) requires all Americans must purchase…