The Patient Protection and Affordable Care Act Comprehensive Review
Introduction
The Patient Protection and Affordable Care Act (PPACA) is the current healthcare policy enacted by the government of the United States amended by the Health and Education Reconciliation Act and became law on March 23, 2010 (Rosenbaum, 2011). The primary provisions of the bill include establishing new founded rules for the insurance industry, strengthens existing forms of health insurance coverage while building a new affordable health insurance market, increasing the availability of health insurance and care for individuals and families with incomes that are below average or less than 133% of the federal poverty level.
The policy has been a subject of debate since the election of Donald J. Trump as the President of the United States but attempts to repeal it have not gained widespread support, the reason being that the mildest repeal adjustment could undo the Affordable Care Act entirely and place American back in the predicament of health coverage before the ACA. Nevertheless, the PPACA shows significant weaknesses despite its improvements to the national healthcare system, and recommendations for the elimination of these issues should be investigated.
Policy Summary
The Act is founded on the existing Medicaid and Medicare systems introduced by the federal government and seeks to reframe a financial relationship as it expands its scope and reduce the numbers of uninsured Americans. However, it also proposes measures that aim to ensure that all citizens are covered by insurance by introducing changes to the individual market. To assist the process, the law simplifies the process of choosing an insurance provider by creating an open exchange and provides subsidies for less financially established families.
Furthermore, the bill promotes a variety of smaller changes, such as calorie listings in menus, to improve the overall health awareness and address relevant concerns. Lastly, the tax provisions that are necessary for the provision of the funds needed to implement the Act are also listed in the document.
One particular group of people who benefit significantly from the law is young adults, who often cannot afford or do not want to purchase insurance. Under the PPACA, people can stay on their parents’ health insurance plans up until the age of 26 (Jhamb, Dave, and Colman, 2015). It also has a ban on the exclusion of children younger than 19 years of age with preexisting conditions (Health and Human Services 2010). This law provides exemptions for people for whom enrollment could be a conflict to religious belief or remains unaffordable or a hardship (Rosenbaun, 2011).
Also, it incorporates expansions to Medicaid that make it available to more people and quality standard improvements for Medicare. According to Rosenbaum, Rothenberg, Schmucker, Gunsalus, and Beckerman (2017), 30% more people became eligible for the former program as the law was implemented, and now Medicaid covers over 20% of the U.S. population. As such, the Act has contributed significantly to the availability of insurance to less wealthy categories of citizens.
The PPACA has also introduced changes for people who have sufficient incomes to be able to afford private insurance. The legislation contains incentives for employers to provide employees with coverage, whether directly or not, but introduces tax penalties for the people who were not covered by employer insurance and refused to purchase their own. However, this provision was repealed in 2017 by Donald J. Trump’s government (Mukherjee, 2017). The original goal of the so-called “individual mandate” was to prevent people from only purchasing insurance when already ill through economic disincentives, a notion the Republican government opposed. As such, the administration motioned for the concept to be removed from the PPACA as part of an initiative to reduce the tax burden on the population.
Opposition to the law claimed that its provisions would require a significant budget, contributing to the overall deficit. The PPACA put ambitious goals forward, functionally paying for the coverage of millions of people, and the initiative likely required extensive funding. However, according to ”National Health” (n.d.), the law was able to fund itself through the tax clauses within the text, and the nation’s budget remained mostly unaffected. Currently, the PPACA is an integral part of the U.S. healthcare budget, and as the Act’s provisions have all been implemented, there are no significant changes that would affect the spending remaining. As such, and due to the increased insurance coverage of the U.S. citizens, the legislation can be considered a success, both practically and economically.
Advantages and Disadvantages of the PPACA
The Act is popular with the citizens of the United States, as the failure of the attempts to fully repeal it has shown. This trend is in part due to its success at expanding coverage and making it available to more people. However, the PPACA has not eliminated the ongoing healthcare crisis that characterizes the U.S., and some of its changes may have introduced new problems, particularly in the field of private providers and the costs of their services.
Individuals without employer coverage and the owners of small to medium businesses, which were significantly affected economically, also did not meet the law favorably. However, the former has since had their concerns resolved due to changes in the legislation, and the latter has adapted to the new conditions.
The expansion of Medicaid allowed more people to benefit from inexpensive health care. It created high-risk health insurance pools, thus allowing individuals with preexisting conditions to have affordable health plans, which should be considered an advantage. The overall influence of the law on the health of the population is difficult to discern due to the relatively short length of time that has passed, but the higher availability of care to the community should result in better health outcomes. However, it should be noted that an increase in the number of patients could lead to a decrease in the quality of care if the medical providers were not prepared for the increase in traffic.
One of the concerns associated with PPACA is its economic influence on small businesses. As the employer mandate only affects businesses with 50 or more employees, owners may feel pressured to maintain a lower number unless the company in question is large enough to be able to afford the costs without experiencing significant economic disadvantages. The situation is exacerbated by both employers and individuals by the lack of cost-control measures in the law, which promote monopolistic, high-cost insurance networks (Brown, 2015).
While the bill improves the situation for the disadvantaged segments of the population, it puts pressure on the middle class. This idea is a part of a broader economic critique of the law, which claims that people with average wealth are the ones paying for the underprivileged sections of the population instead of their affluent counterparts.
Challenges and Opportunities
The PPACA helped expand coverage for more citizens of the United States, but it has not resolved the overall concerns associated with the high costs of care in the country. At the same time, the law has become deeply rooted in the healthcare system of the U.S., and full repeal of its provisions would lead to significant adverse outcomes. According to Glied and Jackson (2017), “many replacement proposal components, including flat tax credits and maintaining cost savings provisions, could jeopardize the ability of many of the ACA’s primary beneficiaries” (p. 538).
In turn, leading to a deterioration of the safety net which could also harm population health activities. Nevertheless, the positive effects of the legislation can be expanded upon, and as the issues are mostly not caused directly by the PPACA, further modifications to the Act could help mitigate or eliminate the concerns while maintaining or improving the benefits.
The United States spends significantly more on health care than any other country, but the quality and private costs of medical assistance do not reflect the tendency. According to Sawyer and Cox (2018), while the portion of GDP that goes to healthcare is similar to that of other countries, the figure is much higher than in the average high-income nation when expressed in dollars, and the private sector healthcare spending in the U.S. is triple that of comparable countries.
However, many of the trends have existed since the 1970s and are likely not associated with the introduction of the PPACA. Nevertheless, the law does not ensure that the resources devoted to healthcare are used efficiently, requiring further tax contributions to the already massive budget instead.
The Act does not significantly influence the trend, as the statistics do not display significant outliers throughout its existence. There was a spike in spending between 2008 and 2009 when the law was taking effect, but the other countries in the analysis displayed the same behavior (Sawyer and Cox, 2018). Nevertheless, a repeal would likely lead to the loss of coverage for many citizens, create budget issues for some states, and reset the progress that has been made since the introduction of the PPACA (Rosenbaum et al., 2017).
As the law has become a central part of American healthcare, numerous initiatives now depend on some of its provisions and would have to be redesigned or canceled if it were to cease existing. However, the existence of that progress and the positive influence of the legislation on the coverage situation indicates the presence of opportunities to improve efficiency while eliminating the downsides present in the current system.
On the other hand, if the United States manages to construct a cost-efficient healthcare system successfully, the significant budget available to it will enable high quality and low private costs of care. A further expansion of the Medicaid system will become possible, potentially encompassing all citizens of the country. Alternatively, the resources that are previously allocated to healthcare and would become free could be released, reducing the tax burden on people and companies.
In either situation, both the government and the people would benefit from the changes after the initial period, where drastic changes would be enacted, likely causing disorganization and opposition in the meantime. However, as displayed by the initial resistance to the PPACA, which was later replaced by acceptance and approval as the law took effect, legislation changes should sometimes be completed despite the possible interference.
Recommendations
The PPACA should not be repealed, as the legislation has introduced significant benefits for many parts of the population that have had limited access to healthcare without creating a budget deficit, also in providing those who never had health coverage before due to cost. Furthermore, some of the more controversial aspects of the law, such as the individual mandate, have been terminated already.
The country’s healthcare has adapted to the new regulations, and a repeal would lead to both reduced availability of coverage and services and potential deficits in state budgets. Furthermore, the benefits of the law, such as the improved availability of care, particularly to low-income families, cannot be denied. Any new legislation should use the PPACA as a foundation and expand on the benefits that were enabled by the law while eliminating the weaknesses that it introduced or failed to address.
The federal, as well as state, a policy should address the arising issues with private coverage. As Brown (2015) indicates, the changes should be enacted below the level of the PPACA, as different states may have varied circumstances that lead to uncontrolled price growth, and as such, there may not exist a uniform solution that would be effective across the country. The situation demands an analysis of the prices in-state markets and the underlying factors with the subsequent application of the appropriate policies.
Examples of measures include rate regulation, price transparency, and antitrust enforcement, and some are more appropriate for non-competitive markets while others can encourage healthy behaviors in an environment where numerous offerings are available. The federal government should oversee the process and collect statistics, identifying problem states, and providing assistance through information and suggestions.
At the same time, the issues with the high price of care are a national concern that has existed in the United States for decades. There is no definite policy recommendation that would identify the cause and eliminate it. As such, the federal government should continue gathering data on the prices and trends and continue analyzing them. It may also inspect the healthcare systems of other developed countries for inspiration.
While medical environments can vary broadly depending on historical, economic, and cultural circumstances, it may be possible to adapt some of the principles practiced in other locations to the situation in the United States. The elimination of the current issues will likely be a long and complicated process that would require a complete overhaul of the system, and data gathering will be essential to the planning and coordination of the effort.
Conclusion
In its current form, the PPACA is a successful law that has enabled coverage for numerous people who could not afford it before and provided those with health conditions the chance to be covered with some form of affordable care, also allowed those 26 years of age to be still covered under their parent’s insurance. These measures were not in other passed laws. The PPACA does not have significant weaknesses because it provided so many the ability the chance to receive affordable care, but it also fails to address the concerns overspending, particularly in the private sector, that has existed for a long time.
According to the Center for Medicaid and Medicare Services website, “the U.S. health care spending increased 3.9 percent to reach $3.5 trillion, or $10,739 per person in 2017. Health care spending growth in 2017 was similar to average growth from 2008 to 2013, which preceded the faster growth experienced during the 2014-15 period that was marked by insurance coverage expansion and high rates of growth in retail prescription drug spending” (“National Health,” n.d.).
The overall share of gross domestic product (GDP) related to health care spending was 17.9 percent in 2017, similar to that in 2016 (18.0 percent). The Act should not be repealed, but price control measures should be enacted at the state level, and the federal government should gather data to formulate a proposal for an overhaul of the healthcare system.
References
Brown, E. C. F. (2015). The blind spot in the Patient Protection and Affordable Care Act’s cost-control policies. Annals of Internal Medicine, 163(11), 871-872.
Department of Health and Human Services (US). (2010). Understanding the Affordable Care Act timeline: what’s changing and when. Web.
Glied, S., & Jackson, A. (2017). The Future of the Affordable Care Act and Insurance Coverage. American Journal of Public Health, 107(4), 538-540.
Jhamb, J., Dave, D., & Colman, G. (2015). The Patient Protection and Affordable Care Act and the utilization of health care services among young adults. International Journal of Health and Economic Development, 1(1), 8-25.
Mukherjee, S. (2017). The GOP tax bill repeals Obamacare’s individual mandate. Here’s what that means for you. Fortune. Web.
National Health Expenditures 2017 Highlights. (n.d.). Web.
Rosenbaum S. (2011). The Patient Protection and Affordable Care Act: implications for public health policy and practice. Public health reports (Washington, D.C.: 1974), 126(1), 130-135.
Rosenbaum, S., Rothenberg, S., Schmucker, S., Gunsalus, R., & Beckerman, J. Z. (2017). How will repealing the ACA affect Medicaid? Impact on health care coverage, delivery, and payment. Web.
Sawyer, B., and Cox, C. (2018). How does health spending in the U.S. compare to other countries?. Web.