Historically, the United States’ health care sector has been faced with numerous challenges. Some of these challenges include the constraints posed by the traditional healthcare policy which was primarily based on how much one could source to cater for their medical expenses. The traditional healthcare policy presented several limitations in terms of quality healthcare access and service delivery. In the wake of these restraints instigated by the former healthcare policy, the Affordable Care Act was enacted in 2010 during President Obama’s first term in office. The Affordable Care Act encompassed comprehensive health insurance ameliorates as well as tax stipulations that are relevant to individuals, families, insurers, businesses, government entities, and tax-exempt institutions (“Affordable Care Act (ACA) Tax Provisions,” 2018). The tax stipulations of the Affordable Care Act are modifications of the previous tax provisions and indicate how individuals as well as families file their tax returns. Responsibilities of organizations is also another important subject covered in the Affordable Care Act. The Affordable Care Act was implemented to address some of the challenges created by the healthcare policy before it. Developing a close understanding of the Affordable Care Act’s impacts on access, coverage, health outcomes, and utilization is vital to informing the ongoing arguments about the policy’s implementation and effectiveness.
The consequences of the Affordable Care Act of 2010 have been subject to a lot of public debates. The impacts of this healthcare policy have been contested by policymakers, politicians, and other relevant stakeholders. The law was implemented to expedite the procurement of healthcare insurance via health insurance exchanges, subsidies, and tax credits (“Effect of the Affordable Care Act in New York,” 2018). One of the main impacts of the Affordable Care Act was manifested in the decline in tally of the uninsured population in New York between the year 2013 and 2016. The figures dropped from 2.1 million individuals in the year 2013 to nearly half the figure (1.2) million individuals in the year 2016. This is an estimated 42.9% decrease. An expression of the uninsured population in New York as a percentage of the whole population in the city reveals that the figures dropped from 10.7% of the population in 2013 to just 6.1% in 2016 (“Effect of the Affordable Care Act in New York,” 2018). The significance of these figures cannot be underestimated. These figures are indicators of the fact that more people have been able to gain access to quality healthcare services year after year since the implementation of the Affordable Care Act in 2010.
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Additionally, hindrances to affordability and access of healthcare proscribe contact with health service providers as well as the healthcare structure. The Affordable Care Act (ACA) was enacted to address these barriers to affordability and access of healthcare. How much the ACA has been able to solve this problem, especially among the low income earners in New York is subject to discussions. With little data addressing the impacts of the ACA on healthcare utilization, it is therefore important to evaluate the impacts of the healthcare policy prior to the implementation of the ACA (Gaffney & McCormick, 2017). The pre-ACA health insurance expansions are crucial in the prediction of the long term consequences of the ACA. Results from the cities of New York and Massachusetts, and the other states that have implemented Medicaid expansions reveal a quantitative increment in the amount of outpatient utilization. Health services such as prescription drug use, preventive care services, primary care visits, screening tests, and routine check-ups have increased after Medicaid expansion in New York contrary to the years before the implementation of the ACA (Gaffney & McCormick, 2017).
Kominski, Nonzee and Sorensen (2017) explored the impacts of the adoption of the Medicaid expansion on access to healthcare. Increasing coverage eligibility as well as affordability was of course one the aims of the Affordable Care Act of the year 2010. The trio discussed the influences of the Medicaid expansion on access to satisfactory healthcare, paying a lot of attention to various dimensions of the latter. They focused on the impacts of the ACA on access to a doctor, timeliness of service, access to medication, primary, preventive and specialty care, and the source of care. Just like Gaffney and McCormick, Kominski, Nonzee and Sorensen examined pre-ACA coverage expansion, citing the passage of just a few years since the implementation of the ACA; hence, data obtained from within that short duration may not be truly reflective of the true state of the ease of access to healthcare (Kominski, Nonzee & Sorensen, 2017). Relying on the results acquired from the era prior to the implementation of the ACA, the trio alluded that indeed the pre-Medicaid expansion era has witnessed better access to healthcare in all the dimensions prior stated especially to low-income populations. This improvement was evidenced in states that have adopted Medicaid expansion, New York being one of them (Kominski, Nonzee & Sorensen, 2017).
Advancing the arguments above, Kominski, Nonzee and Sorensen (2017) also covered the impacts of the ACA on health outcomes. Medicaid expansion entailed improved coverage as well as success and this was predicted to subsequently lead to health improvement. The trio discussed the different aspects of health including diagnosed chronic conditions, self-reported general and mental health, mortality and clinical indicators. To contextualize the significance of the ACA on health, Kominski, Nonzee and Sorensen this time round again, studied the health outcomes before the implementation Medicaid expansion in states with ACA such as New York and Massachusetts. Their study revealed that there have indeed been improvements in self-reported health especially among the nonelderly following the implementation of ACA’s major stipulations in 2014 (Kominski, Nonzee & Sorensen, 2017). They also affirmed that significant health improvements among low income populations were specifically noted two years after the implementation of Medicaid expansion’s key provisions in 2014. These improvements were noticeable in states with Medicaid expansion, New York being one them (Kominski, Nonzee & Sorensen, 2017).
However, the ACA has also borne some detrimental effects to the residents of New York. The most affected group are the city’s middle class. Majority of the people who still remain uninsured are the city’s (state’s) middle class. According to McCaughey, insurance premiums have been on the rise since the implementation of ACA in 2010. This increment is not expected to end any time soon either. McCaughey the rise in insurance premiums on the fact that Medicaid expansion limited the revenue engendered by insurers (McCaughey, 2017). The middle class segment of New York City’s population have therefore found themselves priced out of the ACA insurance plans. Dorsey (2016), revealed that there are about 3 million individuals in New York who fall under the middle class population in New York alone, and sadly enough, these individuals are not eligible to financial assistance. This population pay much more for health insurance coverage.
Lai and Parlapiano also demonstrated some of the problems facing the average residents of New York, thanks to the Affordable Care Act. They focused on the extent of tax returns for individuals paying ACA forfeit penalties. They demonstrated that individuals earning an annual salary of $25000-50000, the percentage penalty is about 8% nationally. These costs are relevant to New York’s middle class (Lai & Parlapiano, 2017). In addition, for individuals earning less than $25000, the tax returns amounted to up to 2-4% of the earnings. From the facts on the tax penalties, it is clear that percentage penalty for the middle class is significantly higher than for those under the middle class. The middle class were the most fined for failing to pay for their ACA health plans in 2015. A number of Republican senators have mentioned similar figures to enhance their motion to have the mandate retracted (Lai & Parlapiano, 2017). This information by Leo and Parlapiano serves to point out to some of the harmful effects of Medicaid expansion.
Conclusion
It is undeniable that the Affordable Care Act has helped promote health access, utilization as well as improved health outcomes. Nonetheless, this has not happened without leaving behind some negative impacts. Data relevant to the state of New York has manifested that Medicaid expansion has transformed the middle class population into both the underinsured and insured members of the society. Families and individuals alike falling under the New York society’s middle class have been left with no option but pay exorbitant insurance premiums rendering them ineligible to benefitting from health insurance as stipulated by the Affordable Care Act of 2010. Whereas these figures are only relevant to the state of New York, it is easy to assume that this could also actually be the case elsewhere (all the other states with Medicaid expansion).
References
Affordable Care Act (ACA). (n.d). HealthCare.gov. Retrieved November 9, 2018 from https://www.healthcare.gov/glossary/affordable-care-act/
Affordable Care Act (ACA) Tax Provisions. (2018). Internal Revenue Service. Retrieved November 9, 2018 from https://www.irs.gov/affordable-care-act
Dorsey, J. (2016). Who are the remaining uninsured Americans? Healthedeals. Retrieved November 9, 2018 from https://www.healthedeals.com/blog/learn/who-are-the-remaining-uninsured-americans/
Effects of the Affordable Care Act in New York. (2018). Ballotpedia. Retrieved November 9, 2018 from https://ballotpedia.org/Effect_of_the_Affordable_Care_Act_in_New_York
Gaffney, A., & McCormick, D. (2017). The Affordable Care Act: implications for health-care equity. The Lancet, 389 (10077), 1442-1452. doi: doi.org/10.1016/S0140-6736(17)30786-9
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. Annual Review of Public Health, 38 , 489-505. doi: doi.org/10.1146/annurev-publhealth-031816-044555
Lai, R.K., & Parlapiano, A. (2017). Millions pay the Obamacare penalty instead of buying insurance. Who are they? The New York Times. Retrieved November 9, 2018 from https://www.nytimes.com/interactive/2017/11/28/us/politics/obamacare-individual-mandate-penalty-maps.html
McCaughey, B. (2017). Obamacare is making the middle class the new uninsured. New York Post. Retrieved November 9, 2018 from https://nypost.com/2017/09/06/obamacare-is-making-the-middle-class-the-new-uninsured/
