How the Affordable Care Act Has Changed Since Implementation

The Patients protection Affordable Care Act, also known as the 'Obamacare,' was signed into law by President Obama on 23 rd March 2010 (The Future of U.S. Health Care, 2010). The main objective of the implementation of this Act was to enable American citizens to have access to health insurance coverage. This act was also meant to improve the accessibility of healthcare and to protect the citizens from exploitation by regulating the health insurance industry (The Future of U.S. Health Care, 2010). Thus, this law changed the health landscape of the US. That said, for this law to be effective, Medicaid eligibility had to be redefined to expand the marketplaces that would enable unemployed citizens to secure insurance coverage directly from insurance firms. Therefore, this law made it compulsory for all adults living in America to get health insurance or else face the punishment of fines. 

As a result, ACA has enabled millions to have access to subsidized or entirely free medical care. However, the change of administration, to the Trump administration in 2016 has shaken the ACA. Several changes have been made regarding the act while others are being proposed; thus, continuing to raise controversies surrounding this act. Some of these changes include; changes to mandate penalties imposed for failure to secure health insurance coverage. Firstly, the implementation of ACA into law was strongly opposed to most people due to the individual mandate penalty. 

Every adult living in the US was required to have a health insurance plan that could be secured either through the employers, ACA exchange, or ACA-compliant plans. Most people were opposed to this idea and deemed it unethical for the government to force them to have insurance coverage they did not wish for. Despite these protests, the supreme court of the US upheld this complaint. However, due to the low rate of penalties set, some individuals prefer to pay the penalties for non-compliance rather than securing health insurance, which is a bit expensive. 

As a result, President Trump signed the Tax Cuts and Jobs Act (TCJA) into law on 22 nd December 2017 and became functional as of January 2018 ( Glied, 2018) . In 2019, this law also affected ACA in many ways. Firstly, people no longer have to pay for penalties for non-compliance. This has led to the unbalanced pool as the younger generations, which are healthier, refuse to secure health insurance plans. This has left the older individuals, especially those aged sixty-five years and above and who have a higher likelihood of falling sick, shoulder the insurance costs alone 2018 ( Glied, 2018) . 

consequently, this is likely to raise the costs of insurance premiums irrespectively. Likewise, as the citizens continue to celebrate the eradication of the ACA penalty, the state officials are enacting state-wide health care individual mandates that require citizens in certain states, such as New Jersey and District of Columbia, to have health insurance covers. Thus, while these states continue to gain more revenues from individual mandate non-compliance, other states continue to lose such revenues. 

Another change that has impacted the ACA act is the expansion of Medicaid to cover more individuals; that is, Medicaid was expanded to cover not only families but also “adults with incomes below 138 percent of the federal poverty level (FPL)” ( MACPAC , 2012 n.p.). However, the ruling by the Supreme Court in June 2012 made it optional for states to expand Medicaid. This enabled the US federal government to reach many people, whereby Medicaid increased by over 34.4% in the states. However, under the Trump administration, following the amendment of the Social Security Act, states are required to add work requirements; that is, individuals have to prove that they work or go to school so that they can benefit from Medicaid programs. The approval of a waiver of previous practice has seen requirements being imposed on the Medicaid program, which has resulted in over eighteen thousand beneficiaries in Arkansas state getting disenrolled. 

The states of Arkansas and Kentucky to file a lawsuit challenging the imposition of such waivers given that the Medicaid programs are open to all individuals eligible by law. This has resulted in a lot of paperwork as beneficiaries “must now go online monthly to report at least 80 work hours or equal time spent on the job training, community service, or caring for a dependent child” ( Commonwealth Fund, 2019 n.p.). Any beneficiary who does not comply with this regulation for at least three months cannot access the Medicaid program for a year. Thus, this has impacted US citizens negatively as the number of people getting disenrolled continues to rise, leaving them without health insurance for a year. Critics also believe that this is a tactical strategy employed by the administration to reduce the number of beneficiaries in the program by kicking them out. On the other hand, the federal government benefits as it can cut on funding the Medicaid program. 

Another change that has occurred to the ACA under the Trump administration is the emerging of short-term plans meant to compete with ACA. The main advantage of such plans is that there are no deadlines for enrollments; that is, individuals can enroll at any time they wish throughout the year. Likewise, these plans are also cheaper as opposed to other plans such as ACA. Under the Trump administration, these plans last for twelve months (364 days) and can be renewed for three years. These programs have lower premiums; thus, “ these policies offer fewer covered benefits and consumer protections compared to plans that meet all Affordable Care Act (ACA) standards” (ACA Open Enrollment, 2019 n.p.). 

Short-term plans attract many people, especially given that the ACA individual mandate penalties were eradicated. However, consumers of such plans are advised to be extremely careful during enrollment as they stand to be offered with low premiums as opposed to those offered by ACA. Likewise, people with pre-existing conditions cannot be enrolled in such programs. Also, not all states allow the practice of short-term plans. Likewise, short-term plans have other limitations, including; most of these plans limit the number of visits to see a doctor only three times. Also, these plans impose dollar limits in that any amount that exceeds the one indicated is not covered; thus, patients are required to pay for themselves. These plans also have limitations covering the prescription of drugs. 

Therefore, despite these short-term plans making health affordable, they can be expensive in the long-term, especially given the limitations imposed. Likewise, the states pass their laws limiting or expanding access to such plans. Hence, patients are advised not to get enticed by the cheap premiums, which might put one in a financial crisis in events of emergencies that can only be financed by ACA or other expensive plans. 

References 

ACA Open Enrollment: For Consumers Considering Short-Term Policies . (2019). The Henry J. Kaiser Family Foundation. https://www.kff.org/health-reform/fact-sheet/aca-open-enrollment-for-consumers-considering-short-term-policies/ 

Glied, S. (2018). Implications of the 2017 Tax Cuts and Jobs Act for Public Health.  American Journal of Public Health ,  108 (6), 734–736. https://doi.org/10.2105/ajph.2018.304388 ‌ 

Medicaid enrollment changes following the ACA: MACPAC . (2012). Macpac.Gov. https://www.macpac.gov/subtopic/medicaid-enrollment-changes-following-the-aca/ 

Medicaid Work Requirements Increase Coverage Gaps | Commonwealth Fund. (2019).  Commonwealthfund.Org . https://doi.org/https://doi.org/10.26099/tsw9-1w66 

The Future of U.S. Health Care . (2010). Rand.Org. https://www.rand.org/health-care/key-topics/health-policy/in-depth.html