This paper argues that state participation in health insurance exchanges established by the Affordable Care Act (ACA) is essential to providing affordable health coverage to millions of uninsured and underinsured Americans. The paper examines how health insurance companies have exploited customers through denied coverage, excessive premiums, and inflated out-of-pocket costs, leaving over 47 million Americans without insurance as of 2007. It contends that ACA exchanges offer a flexible, federally supported mechanism for states to address these inequities, highlights available grant funding, and calls on all states to be ready to open exchanges by 2014.
In the United States, citizens hold basic rights to life and liberty. Yet many major health care companies are infringing on those rights by exploiting health insurance rates, leaving millions of Americans either underinsured or uninsured altogether. This puts their lives directly at risk through limited access to essential care. In order to best provide for their uninsured or underinsured citizens, states need to work within the regulations of the Affordable Care Act and open up exchanges to provide affordable health insurance to the millions of Americans who are currently in need under the ineffective system operating today.
In the current landscape, there is a severe lack of affordable health insurance options. Health insurance companies have been permitted to abuse their power over customers. Many deny coverage to those in need because of a pre-existing condition, or they force such individuals to pay extreme premiums (The White House, 2012).
Additionally, those who are eligible for coverage under the current system are often manipulated into paying extremely high out-of-pocket costs (Health Care for America Now, 2009). There have even been reports of health insurance companies encouraging physicians to perform unnecessary procedures and tests in order to drive up the average co-pay for patients. This is a clear breach of trust and illustrates how many health insurance companies are taking advantage of vulnerable patient populations for profit.
These abuses have left millions of Americans uninsured or underinsured, exposing them to massive medical debt and limited access to appropriate care. In 2007, there were over 47 million Americans without health insurance, and millions more who were underinsured (Paddock, 2007). This number was steadily increasing until very recently. Without state intervention, there was simply no way for all Americans to obtain the insurance they need at such high prices.
States need to begin building affordable insurance exchanges, as provided for in the Affordable Care Act, in order to better deliver appropriate levels of healthcare to the majority of Americans who need it at more affordable premiums. The Affordable Care Act establishes measures that enable states to offer these exchanges. This is one of the most practical and beneficial provisions within the act because it allows for flexibility between states and the unique needs of each state's population. As a result, the President's health plan gives "hard working, middle class families the security they deserve" (The White House, 2012, p. 1).
States need to ensure that by 2014, when these exchanges open to the public, they are fully prepared. They must participate within the exchange system to best serve their citizens, many of whom are uninsured or underinsured. Forcing citizens to continue overpaying — or to go without coverage because of current high costs — is a disservice to the people of every state.
However, many oppose several elements of the ACA's plans. Several states have shown clear disapproval and the possibility of not participating, with many believing that providing such exchanges would impose a significant financial burden. Yet the federal government is providing financial benefit packages to participating states. Due to the positive benefits these exchanges provide, "thirty-three states, including the District of Columbia, are on their way, having received a total of nearly $670 million in Exchange Establishment Grants" (The White House, 2012, p. 6).
Many states, such as California, are also developing programs that will provide affordable health insurance options for small businesses, known as the Small Business Health Options Program (SHOP) (State of California, 2012). Funding is available, making it crucial for states to participate in these exchanges in order to best serve their citizens.
Overall, it is clear that action must be taken to stop health insurance companies from abusing patients and to better address the health needs of all Americans. No meaningful reform is possible without government support. States must therefore work with the federal government's plan in order to help improve the overall situation and ensure that every American has access to the affordable, quality health coverage they deserve.
"Rebutting cost objections with federal funding evidence"
The White House. (2012). Affordable Care Act: The new health care law at two years. Retrieved November 26, 2012, from
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