Program Description
The Affordable Care Act is a significant law that revolutionized the United States' health care system. The program ensured that about 95% of the legal population gained access to health insurance ( Sen & DeLeire, 2018) . In other words, between 32 million to 50 million more Americans gained health care insurance ( Sen & DeLeire, 2018) . The ACA is also known as Obamacare and it became law on March 2010 ( Sen & DeLeire, 2018) . The program was phased in about four years. The insurance program targeted every citizen. Moreover, each citizen was supposed to have health care insurance by March 31, 2014, or face penalties through income tax surcharge ( Sen & DeLeire, 2018) . Every citizen could choose how they would be covered by the insurance program. If the citizen already had a plan privately, or through Medicare, their employers, or Medicaid, they were allowed to keep it. Furthermore, Americans who were unable to acquire health insurance had various options such as accessing it through health insurance exchange where they could get subsidies. The research paper will evaluate the Affordable Care Act program.
The ACA has three main objectives:
Support innovative and unique healthcare delivery techniques that would reduce the overall healthcare costs.
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Expansion of the Medicaid program to insure all American adults including those who earn below 138% of the federal poverty level.
Moreover, ensure that the health insurance program was accessible to more people
Some people qualified for exemptions. However, the healthcare costs are dependent on an individual's location, age, income, family size, and type of plan. One of the ACA's main objective was lowering health care costs. By 2009, Medicaid and Medicare cost 10.4% of the country's budget or 676 billion ( Herrmann et al., 2015) . According to the projections, the health care costs would double by 2020 and would increase their budgetary allocations to about 20% ( Herrmann et al., 2015) . Medicaid and Medicare were part of the country’s mandatory spending that could not be reduced in absence of a literal Act of Congress.
The only way the country would reduce spending on health care was lower healthcare costs in the nation. Furthermore, the Act sought to reduce health care costs by cutting the number of hospital visits. By 2011, about 20% of all American adults used the emergency room ( Sen & DeLeire, 2018) . Moreover, ER visits are the most expensive treatments in the country and account for about 33% of federal health care costs ( Sen & DeLeire, 2018). If the number of ER visits could be reduced, the healthcare cost would automatically lower. Moreover, the rising health care costs had caused over one million Americans to become bankrupt. The program sought to minimize ER visit by prevention. Most people believed that preventive care would reduce Medicaid costs because people could seek treatment before the illness or condition became a crisis. Additionally, the program reimbursed hospitals for all ER treatments that were unpaid ( Sen & DeLeire, 2018) . The main objective of the program was to lower healthcare cost through preventive care because it would be easier and cheaper to treat an illness in its early stages instead of treating late stage or full-blown illness.
According to the program's projection, the ACA would add to the federal budget by about $940 billion by 2020. Also, a research conducted by the Congressional Budget Office estimated that the ACA would reduce the budget deficit by about $143 billion by 2020 Herrmann et al., 2015) . The program would lower costs by evaluating taxes on different health care costs, lowering hospital payments, and reducing overhead cost in higher education loan program through consolidation with the Pell Grant program. Additionally, it would increase Medicare taxes on all high income earning households. Also, it would analyze penalties on people who do not apply and employers who do not provide for health insurance coverage. The ACA revolutionized the US healthcare system. Small enterprises could receive tax credits that would cover about 35% of the entire employee premium payments ( Herrmann et al., 2015) . By 2014, it had increased to about 50% ( Herrmann et al., 2015) .
Evaluation Methodology
The research paper will use secondary sources of information especially journals to evaluate the ACA. It will also use quantitative and qualitative techniques to acquire essential information regarding the program. Qualitative methods will assist the researchers to gain more insight regarding the underlying motivations, reasons, and opinions regarding the ACA. It would also provide additional insight into the challenges facing the ACA. Also, it would assist in developing hypotheses and ideas for future research regarding the topic. It would also uncover emerging trends in opinions and though while diving deeper into the issue ( Sen & DeLeire, 2018) . Some of the essential data collection techniques would involve observations, focus groups, and individual interviews conducted in the secondary sources.
On the other hand, quantitative research will allow the researchers to quantify and evaluate the objectives of the programs through usable statistics. The numerical data will evaluate whether the ACA achieved its objectives of reducing healthcare costs. Furthermore, quantitative research is essential in generating results, attitudes, defined variables, opinions, and behavior from a large population. Also, it would assist the researchers to measure data that will uncover patterns and formulate facts according to the topic study. Some of the quantitative data collection methods include systematic observations, online surveys, website interceptors, paper surveys, online polls, mobile surveys, longitudinal studies, telephone interviews, and face to face interviews contained in the secondary sources ( Herrmann et al., 2015) . All in all, the research will utilize both quantitative and qualitative techniques that will ensure the research is accurate. Moreover, different sources of information will be critical in comparing data and formulating accurate data. However, secondary sources of data may have various limitations such as outdated data or biases. Therefore, the research will depend on up to date information while comparing information from different authors to authenticate information.
Findings
Positive Impact
The main benefit of the ACA is that it slowed down the rising healthcare costs. By making preventive care free and offering insurance to many Americans, it slowed down the rising healthcare costs. Furthermore, it ensured that people could receive preventive care before the illnesses or diseases were fatal and required costly ER services. By 2016, the healthcare costs increased by about 1.2% in comparison to 2004 where the health care costs increased by 4% ( Parente et al., 2017) . Moreover, it required basic insurance plans to cater for 10 essential health benefits such as treatment for chronic diseases, mental health, and addiction ( Parente et al., 2017) . Without the essential services, many people would end up in the ER and the costs would be ultimately passed on to Medicaid and taxpayers. Also, insurance companies cannot deny insurance coverage for any individual because of pre-existing conditions.
Also, the ACA eliminated annual and lifetime coverage limits. Also, children could be part of the parent’s health insurance coverage until age 26 ( Parente et al., 2017) . By 2012, over 3 million people who were uninsured were added to health insurance coverage ( Parente et al., 2017) . The move allowed insurance companies to achieve increased profits because they received more premiums from healthy individuals. The ACA was expected to either utilize the federal government's exchange or set up their own insurance exchanges. The decision made it easier for citizens to shop for insurance plans. Individuals who earn about 400% above the federal poverty level or the middle class can receive tax credits on their monthly premiums under the ACA ( Parente et al., 2017) . Additionally, it expanded Medicaid to all individuals who earn about 138% of the poverty level ( Parente et al., 2017) .
Moreover, the coverage extended to adults without children and eliminated the ‘doughnut hole’ gap in basic insurance coverage by 2020 ( Parente et al., 2017) . The doughnut hole coverage gap describes the Medicare prescription drugs plans where individuals have limited coverage and people are forced to pay out of their pockets to achieve the limit in the gap ( Parente et al., 2017) . After the insurance plan spends $3700 on the covered drugs, or the total of the amount paid by the plan and deductibles, an individual fall into the coverage gap or doughnut hole gap. Also, the ACA ensured that businesses or corporates with more than 50 employees to offer health insurance. Additionally, the government provided tax credits to the businesses to assist with the health insurance costs. According to the Congressional Budget Office, the ACA would lower the budget deficit by about $143 billion by 2020 ( Parente et al., 2017) . It reduced budget deficits by shifting the burden of health care costs to pharmaceutical companies and healthcare providers. It also reduced government spending on Healthcare costs while raising more taxes from high income earning families and businesses.
Negative Impact
In as much as the program had many benefits to the country, it has many cons. About five million individuals lost their employment-based insurance coverage. Furthermore, some businesses realized that it was more cost-effective if they pad the monetary penalties while allowing their workers to buy insurance coverage from the exchanges. On the other hand, many small businesses found it more effective to get better insurance coverage in the state-run exchanges. Furthermore, about thirty million people did not have employment-based insurance coverage and were dependent on private health insurance. Due to the ACA, insurance companies cancelled most of the insurance plans because the health insurance policies did not address the ACA's 10 essential health benefits ( Parente et al., 2017) . The costs of replacing the basic insurance coverage were quite high according to the ACA and it requires services that not all citizens needed such as maternity care.
Notably, the ACA increased healthcare costs. Because many people received testing and preventive care for the first time, the overall health care costs increased significantly. Also, it was quite costly to treat conditions or diseases that were initially ignored for decades ( Sen & DeLeire, 2018). Although the ACA imposed penalties on people who did not purchase insurance, many people avoided the monetary penalties through the ever-growing list of exemptions. The Congressional Budget Office estimated that over four million preferred paying the monetary penalties that paying for basic insurance coverage. The four million people paid about $54 billion ( Sen & DeLeire, 2018) . In 2013, the program raised taxes for over one million individuals who were earning over $200000 annually and over four million couples filing joint returns and earned over $250000 annually ( Sen & DeLeire, 2018) . The rate increased to 2.35% from 1.45% ( Sen & DeLeire, 2018) . additional, they were required to pay 3.8% Medicare tax. From 2013, importers and medical device manufacturers were required to pay a 2.3% excise tax while indoor tanning services got a 10% excise tax ( Sen & DeLeire, 2018) . However, the 2.3% tax was suspended from 2016 because it discouraged companies from hiring new workers ( Sen & DeLeire, 2018) .
Between 2013 and 2023, pharmaceutical companies would pay an additional $84.8 billion to close the coverage gap r the ‘doughnut hole’ in part D Medicare costs. The cost of drugs will eventually increase because the pharmaceutical companies would pass the additional costs to consumers. By 2020, insurance companies would implement a 40% excise tax on special health plans especially the ‘Cadillac' health care plan ( Sen & DeLeire, 2018) . Cadillac health care plans refer to health care plans that exceed $10200 annually for individual and about $27500 for families ( Sen & DeLeire, 2018) . Most of the plans focused on individuals in high-risk pools such as employees in dangerous jobs and the elderly. Most of the increased taxes would be passed to employees and companies thus raising deductibles and premiums.
Interpretation and Reflections
According to the qualitative and quantitative data highlighted in the findings, Obamacare failed to achieve its objectives. According to the CDC, the number of uninsured people has not changed since 2015. Also, the penalties for the uncovered were too low in comparison to the increasing premium cost. For instance, the penalty for being uninsured is $695 for each adult, which is far much lower in comparison for basic insurance coverage ( Sen & DeLeire, 2018) . Also, since insurance companies are for profit and all their activities focus on reaping the greatest benefits from the American population rather than focusing on improving health care benefits. An insurance scheme is based on risk pools where the healthy people take care of the unlucky. However, Obamacare allowed people to only sign up after they got sick and required financial assistance. Ultimately, the insurance scheme has a large influx of sick and older patients who require costly and extensive care. Ultimately, it is highly likely that the insurance scheme will fail.
The main objective of Obamacare was to tame the increasing health care costs and prevent the healthcare spending from reaching 20% of the GDP by 2020. ( Sen & DeLeire, 2018) Currently, the US spending on healthcare stands at 17.4% ( Sen & DeLeire, 2018) . according to the current projections, it may exceed 20% by 2020 ( Dickstein et al., 2015) . Therefore, instead of controlling the rising healthcare costs, citizens have had to pay higher premiums. Moreover, an average healthcare cost in developed countries is 12% ( Dickstein et al., 2015) . The US has the highest healthcare costs in comparison to other developed countries. Americans have had to pay higher premiums by about 45% ( Dickstein et al., 2015) . Instead of reducing the health care costs as promised, the ACA has led to higher healthcare costs. Moreover, the program does not cover all Americans. On the contrary, Switzerland spends $6300 per capita while the US spends about $9000 per capita ( Dickstein et al., 2015) . Also, about 98% of Switzerland’s population has basic insurance coverage ( Dickstein et al., 2015) .
Recommendations
Since insurance companies have a big role in determining the cost of basic medical procedures and they are for profit, the federal government should focus on having competitive insurance companies that are not for profit. In Switzerland, all the profit accumulated by insurance companies in reinvested in the nation’s healthcare system ( Miller et al., 2016) . The government should focus on making health care affordable to most Americans by controlling the costs of basic medical procedures. Ultimately, it will reduce the out of pocket costs and the excessive deductibles. Also, the US has a higher rate of lifestyle diseases in comparison to other developed countries. The Congress needs to find better policies that will improve preventive care among citizens. Due to the high costs of basic insurance coverage, it is highly likely that some healthy individuals would prefer paying penalties than getting basic insurance coverage ( Miller et al., 2016) . The healthcare system should ensure that the basic insurance coverage is affordable so that healthier people can enroll in the insurance coverage so that they can balance the increasing healthcare costs.
Also, the insurance companies should assist consumers when selecting coverages. The insurance marketplace should offer improved personal assistance and tools to Americans when selecting their plans to ensure they access basic coverage that is best suited to their resources and needs. Furthermore, the ACA should enhance formulator and network transparency. State regulators and marketplaces should demand improved formulatory and network transparency from all insurers while deploying assistance and tools that will allow consumers to better evaluate and understand the formularies and networks available ( Dickstein et al., 2015) . The government should consider standardizing products provided by insurance companies so that it can enhance insurer competition while improving and facilitating consumer choice.
Also, the Congress should revise the ACA to improve Medicaid for all low income earning Americans and families. The federal government may take over the entire role and costs associated with expanding the Medicaid population. The move will encourage states to increase Medicaid coverage while assisting and protecting the expansion population from future impacts of budget based cutbacks. The American Healthcare Associations (AHA) also made various recommendations. If the lawmakers decide to repeal the ACA, they must have alternative laws that will ensure that citizens do not lose basic coverage under the ACA. Also, they should ensure that they restore payment reductions from health systems and hospitals covered by the ACA so that the health care providers may have adequate resources to offer medical services to the uninsured ( Miller et al., 2016) . Also, the lawmakers should not reduce or lower payments to health systems and hospitals because it may affect the quality of service delivery. Also, the regulatory reforms must address the challenges facing health systems and hospitals.
Conclusion
The research paper has evaluated the Affordable Care Act program. About eight years after the ACA was passed, the program achieved remarkable accomplishments but also failed to meet its main objective. There has been uncompromising political opposition, numerous lawsuits, widespread public misunderstanding, and technological failures. All in all, the rising healthcare costs have been a major failure of the ACA. Due to the current realities, the ‘replace or repeal’ mantra may appear increasingly irrelevant if there are no improvements to the ACA ( Dickstein et al., 2015) . It is a good time to consider how new laws can improve the service delivery while reducing the overall healthcare costs. In as much as it has helped millions of Americans, the program has significant glitches and shortcoming that should be addressed. The research paper had offered a variety of recommendation that will improve the ACA. The Congress should evaluate the success of healthcare programs in other developed countries and makes healthcare policies that will help every American.
References
Dickstein, M. J., Duggan, M., Orsini, J., & Tebaldi, P. (2015). The Impact of Market Size and Composition on Health Insurance Premiums: Evidence from the First Year of the Affordable Care Act: American Economic Review , 105 (5), 120-25.
Herrmann, T., Peters, P., Williamson, C., & Rhodes, E. (2015). Educational outcomes in the era of the Affordable Care Act: impact of personalized education about non-small cell lung cancer: Journal of Continuing Education in the Health Professions , 35 , S5-S12.
Miller, S. C., Frogner, B. K., Saganic, L. M., Cole, A. M., & Rosenblatt, R. (2016). Affordable Care Act Impact on Community Health Center Staffing and Enrollment: Journal of Ambulatory Care Management , 39 (4), 299-307.
Parente, S. T., Feldman, R., Spetz, J., Dowd, B., & Baggett, E. E. (2017). Wage growth for the health care workforce: Projecting the affordable care act impact. Health services research , 52 (2), 741-762.
Sen, A. P., & DeLeire, T. (2018). How does expansion of public health insurance affect risk pools and premiums in the market for private health insurance? Evidence from Medicaid and the Affordable Care Act Marketplaces: Health economics .
