The Affordable Care Act (ACA) is the best legislation in the American history of Medicare and Medicaid due to its provisions for accessibility, affordability, and quality of health care services. This paper depicts the ACA health care reforms as regards the advantages and disadvantages of those modifications, and the most affected population based on ethical considerations. Therefore, some of the modifications analyzed here include Medicaid expansion, the premium tax credits, revision of market regulations, and reforming the health care delivery system to provide more efficient and topnotch services.
The P.L 115-123: Bipartisan Budget Act of 2018 modified the ACA to expand the Medicaid program in the US (Mach & Kinzer, 2018). The amendment was made to ensure affordability and increase access to health insurance options available in the country. Therefore, the expansion will facilitate the coverage of more low-income citizens and ultimately reduce the number of uninsured individuals (Kominski, Nonzee & Sorensen, 2017). The advantage of this reform is that the state governments will be able to cover many of their residents on Medicaid through the allocated federal matching funds. For instance, approximately 14 million citizens have been newly captured under the expansion program. This has compelled the federal government to maintain funding for the same between 50% and 75% of the entire Medicaid costs for enrollees who were eligible prior to the introduction of the ACA in 2010 (Kominski, Nonzee & Sorensen, 2017). Further, the expansion enabled citizens to access health care services at home and within their communities based on their Community First Choice Options, especially for the disabled. Still, the reform necessitated the central government to introduce new funding to states to enable the latter to cover preventive services at either subsidized or no cost. This helped in improving the general preventive health coverage. Conversely, despite the advantages of the Medicaid expansion, the reform has enormous challenges that have negatively impacted the low-income Americans and minority groups. Ideally, the Medicaid expansion is associated with higher costs in the long run; hence there is dire need to further modify how to finance the program. For instance, a rise in health care cost will be directly indexed to the country’s inflation and the taxpayer will eventually feel the burden. Again, the Medicaid Expansion Act will adversely strain state budgets since all states that undertake the expansion program must contribute to the same even though it is currently 100% funded by the central government. The expansion even reduced the amounts of benefits that employees formerly received from their employers and this is primarily due to noncompliant ACA policies (Manchikanti, Helm, Benyamin & Hirsch, 2017). Finally, the Medicaid expansion generally had more positive impacts on the low-income families because of the significant reduction in their out-of-pocket expenditures as compared to non-expansion states.
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Additionally, the ACA was amended to provide premium tax credits in order to deliver quality health care services to their citizens at lower costs. As a result, about 4 million small businesses are now eligible for tax credits and they can easily insure their employees. Actually, the initial phase of this amendment ensured that employers remitted a credit of 35% of the employees’ premiums to the insurance company. However, this provision was subject to change since only up to 25% was allocated to small non-profit organizations. Note that in this context, the tax credits are intended to enable the middle class to afford insurance, especially those who are eligible for other options. Such individuals may not be eligible because their incomes do not fall within the 100%-400% range of the poverty line. The tax credit reform is advantageous since it is advanceable and reduces an individual’s monthly premiums instead of only targeting the tax time. Additionally, it is refundable and this benefits even the average-income families who can also reap the fruits of the credit in addition to eligibility relating to reduced cost sharing like copayments, co-insurance, and deductibles. Therefore, this reform ensured that health care services are more affordable since in any case, the benchmark plan shall exceed their maximum payable premium, then the government will pay the difference as a tax credit.
Furthermore, modification of market regulations was made to the ACA to ensure that health insurers adhere to minimum set standards of the central government. The minimum requirements enabled the US citizens to purchase and renew beneficial coverage that protects them and are of lower costs. Again, it introduced competition between the public and private health insurance providers to empower the insured to be able to compare costs and enroll in the best options available in the marketplaces. This is good for the citizens who enroll in exchange plans because the federal government may provide them with financial aid upon meeting the minimum income requirements. Additionally, the reform modified rating regulations, which charged older Americans five times as compared to younger individuals. The P.L. 111-383 Jan. 7, 2011 H.R. 6523 (Skelton) relieved dependent adult children aged 26 and below of the tax premium burden through the TRICARE coverage (Mach & Kinzer, 2018). Still, the new consumer protection under the market regulations (S.222) criminalizes discrimination based on pre-existing conditions or gender considerations (Williams, 2017). This reform will cushion low-income citizens from insurance firms that hinder them from renewing their policies or sometimes denying them the same coverage due to preexisting conditions. Therefore, the firms cannot charge them higher than recommended rates on allegations based on either gender or health conditions.
Also, improving health care quality and efficiency was a reform intended to improve the entire delivery system. It is a crucial modification that eliminated the fee-for-service payment systems and improved the overall quality of care. For example, this reform introduced the Medicare Advantage Plans to ensure that service delivery match their respective costs. Therefore, the reforms in Medicare payment regulations are advantageous to the common man in that they reduce costs of services within the private health care sector. Therefore, this measure prevents possible health care fraud by thoroughly scrutinizing potential clients prior to their enrolment and imposes harsh penalties for offenders. Therefore, the government allocates extra amounts of money to cater for antifraud initiatives and to strengthen value-based payment systems. Reforming the health care delivery system has improved the quality of care since its implementation as reflected in the reduced hospital-acquired conditions relating to infection and pressure ulcers. As a result, the improvement has reduced mortality rates in the US because statistical analysis reveals that nearly 87,000 deaths were prevented in the first four years of the ACA (Obama, 2016). Unfortunately, prescription drug costs still remain higher and unaffordable to many because of poor policies regarding Medicaid rebates and approval of biosimilar drugs. Generally, Americans will benefit from this reform since a new center for both Medicare and Medicaid programs will be established to oversee how care is delivered to patients to lessen the increasing costs.
Finally, the health care reform debate is a major controversial issue in the US health care system and it will not end any time soon. Not until the federal policymakers will comprehend the benefits associated with the ACA coverage, the low-income citizens and public sector workers will still experience increased health care costs. Therefore, the lawmakers should conduct comprehensive research to locate where the problem really originates from to be able to counteract the adverse impacts of health care costs.
References
Kominski, G. F., Nonzee, N. J. & Sorensen, A. (2017). The Affordable Care Act’s Impacts on Access to Insurance and Health Care for Low-Income Populations. Annu. Rev. Public Health , 38:489–505. Retrieved January 31, 2019, from https://www.annualreviews.org/doi/pdf/10.1146/annurev-publhealth-031816-044555
Mach, A. L. & Kinzer, J. (2018). Congressional Research Service: Legislative Actions to Modify the Affordable Care Act in the 111th-115th Congresses. CRS Report Prepared for Members and Committee of Congress , 1-26. Retrieved January 31, 2019, from https://fas.org/sgp/crs/misc/R45244.pdf
Manchikanti, L., Helm, S., Benyamin, R. M. & Hirsch, J. A. (2017). Health Policy Review: A Critical Analysis of Obamacare: Affordable Care or Insurance for Many and Coverage for Few? Pain Physician , 20:111-138. ISSN 1533-3159. Retrieved January 31, 2019, from https://www.painphysicianjournal.com/current/pdf?article=NDMwMg%3D%3D&journal=104
Obama, B. (2016). JAMA: United States Health Care Reform Progress to Date and Next Steps. JAMA , 316(5): 525–532. [Updated: 2016 Aug 2]. Retrieved January 31, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5069435/
Williams, K. (2017). Federal Focus: The Uncertainty of Health-Care Reform and the Affordable Care Act. Government Finance Review , 51-54. Retrieved January 31, 2019, from https://www.gfoa.org/sites/default/files/GFR041751.pdf
