The Patient Protection and Affordable Care Act: Legislation Analysis

Background on the legislation

The Patient Protection and Affordable Care Act (PPACA) was passed into law in March 2010, following a public outcry on the need for reforms in the healthcare system. Previously, the provision of health care in the United States has been in the spotlight over the accessibility and affordability of healthcare services and medical insurance cover. The evolution of American health care providers to its citizens has been hinged on the U.S. legal system.

Even though health care had been allocated the highest percentage of funds worldwide there was no well-designed efficient national health care system and it is bizarre that most Americans had not been insured and the cost of healthcare services had been on the incline at a rate of 6.7% annually as of 2009 (Jacobs & Skocpol 2010). Health provision in the United States had been handled mainly by the private sector, which was charging exorbitant prices. This had brought a lot of imbalance, also considering that only about six out of ten Americans could afford and enjoy insurance covers by their employers (Bodenheimer 2005). It is these issues that necessitated the enactment of the Patient Protection and Affordable Care Act (PPACA).

In several defining moments, important implications of the legal changes were not recognized by the observant public, industry insiders, or even decision-makers themselves. Yet each of these events set in motion powerful economic and political forces that dramatically altered the face of the industry. The PPACA came about as a result of consultations between Senators Max Baucus of Montana Chuck Grassley of Iowa, Kent Conrad of North Dakota, Olympia Snowe of Maine, Jeff Bingaman of New Mexico, and Mike Enzi of Wyoming, after many hours of consulting leading to the health care reform bill.

Despite the great achievements in clinical medicine in the American health sector, the health care system in place has failed over and over again to provide reasonable and equal access to health care to all. The use of resources is also not efficiently done and major impediments are always in the way of any form of reforms that try to streamline the sector (Jacobs & Skocpol 2010). Several problems and situations warranted a major look into the sector and recommendations of policies that will reform it.

This includes existing obstacles to the health care system; health insurance; people with pre-existing conditions; health care providers-hospitals; chronic diseases; lobbying from corporations and private players for their own interests; future challenges for the American health care system; and health policy and thoughts on reform; criticism of any reform process. The PPACA is meant to address several issues that will streamline the health sector. These issues include: improvement of public health care, costs control, quality improvement, accessibility and insurance coverage, and promoting healthy behavior (Boyle, Deaton & Maddigan 2010).

Improvement of public health care: many a time people often take their good health for granted and anything they come into contact with that is related to their bodies and health. Consequently realizing the importance and impact of a public health care system is fundamental to the effectiveness of preventive health, health education and environmental health. The United States has in past decades not put much focus on this and thus the need for a reform in the health sector that looks into effectively utilizing and enhancing public health. This is an ongoing challenge that the government has undertaken by introducing the reform law to be able to make a case for better public health, and provide sufficient funding (Bodenheimer 2005).

Costs control: health care costs have been increasing over the last decades, thus a need to streamline the cost of accessing health care in America. This rise in costs can be attributed to the sudden increase in technology, an aging populace, inflation of salaries and a rising occurrence of chronic conditions. A major challenge to all stakeholders involved in deciding on the most affordable technology and coming up with measures that check on rising costs. Kovner & Knickman (2008) argue that harnessing health care price increases still is one of the major challenges of the next decade. The health sector is very important that all sectors within the American economy have to take it into consideration and think of the impact of mounting health care costs.

Quality improvement: studies now more than ever Americans are dying from medical-related errors, putting the number at about 98,000 a year. The new legislation seeks to improve the quality of health and service delivery. The PPACA has come up with managed health programs where it is a process in which techniques are employed to reduce the health care cost together with improving the quality of these health care services. The law also looks into the lack of synchronization between providers which results in Americans being offered duplicative and even counterproductive services.

Accessibility and insurance coverage: most American citizens do not enjoy insurance cover due to the high costs involved in securing it. Employers are also afraid of getting complete insurance coverage for their employees as it is very expensive. The high cost of insurance makes health care practically unaffordable, especially where cases of chronic cases are involved. There are a number of reasons that hinder people from getting insurance covers. The United States has not had a functional system of health provision and health insurance as compared to the rest of the world. The law makes it hard for private insurance cover providers to make money out of poor Americans thus making health care more affordable for Americans.

Promotion of healthy behavior: Americans are constantly being encouraged to embrace healthy living and not only rely on the government to make health care more accessible. Embracing healthy lifestyles is a sure way of reducing health care costs, consequently avoiding illnesses and injuries. Some measures Americans are being encouraged to take up include the use of seatbelts, balanced diets and proper eating, avoiding drugs, and much more.

An Analysis of the Specific Proposals in the Legislation and their Potential Effects

The PPACA law brings to light several proposals as it seeks to answer the myriad of problems facing the health sector and consequently streamline the provision of health care to American citizens. One major problem is that of health insurance cover especially in cases of pre-existing medical conditions among American citizens.

This paper, analyses the proposals brought out and what their implications are to the public. The paper strives to find out:

1. whether the new legislation serves the public interests;
2. whose interests are being addressed by the new reform- is it the public, private sectors or politicians?;
3. Is the PPACA a long term reform process or is it just meant to look into and answer a few situations for now and become redundant?

This paper looks into all the aspects and dynamics involved in the health sector and comes up with an assessment of the above factors pointed out.

Does the new legislation serve the public’s interests?

This is a very fundamental question to ask which requires logical and tangible answers. This is because it is the public that is served by the health sector and if their interests are not being met then there is no point in the health care system being in operation. The constantly increasing health care expenses have turned out to be a widespread problem for American citizens over the years to a degree where people have to prioritize health care expenses before they even think of undertaking major financial decisions. The PPACA seeks to lower health care costs and especially insurance costs so that health care is more affordable to American citizens.

The PPACA proposal seeks to do away with the constant turning away and segregation of persons suffering from pre-existing conditions, from obtaining health insurance covers. It is a radical move that will get in the way of private insurance providers’ market but is worth a risk to be undertaken by all players within the health sector. The PPACA states that the state shall consult with the health secretary and shall establish mechanisms, as well as an Internet website, by which a person residing in any state may be able to access reasonably priced health insurance covers within their state of residence.

Seltzer (2009) suggests that America is divided into three different classes of people within the healthcare context. People enjoy health insurance cover provided by their employers, people with personal health cover purchased individually (wealthy), and the uninsured due to its high cost. Each of these categories is a force that affects the marketplace dynamically and has an influence on the outcome of health care provision. A common denomination that touches on all is cost but each has its own vital factors that affect them individually. Exclusions and rescissions are some of the factors that affect individual purchasers of insurance.

All Americans should have the right to health insurance coverage and people should not be discriminated against for being sick, the Patient Protection and Affordable Care Act (PPACA) protects uninsured people with pre-existing medical conditions from being discriminated against by insurance companies. The insurance sector is mainly controlled by big multinationals that are privately owned and are in the business of making money.

This puts check on this so as to ensure that affordable health care is accessible to everyone and not the wealthy alone. One way it has tried to put the escalating high costs being charged for insurance is by introducing managed health care plans. The government through managed health care programs wants to be able to control health care providers by offering them product bundles and incentives for various services offered at collectively, discounted and affordable costs. Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and managed-care fee-for-service plans make up the managed health care sector (Forrester & Griffiths 2005).

Whose interests are being addressed by the PPACA – is it the public, private sectors, health providers or politicians?

The PPACA legislation addresses the interests of two groups in particular. That is the public and health providers. As mentioned previously, the government through the new legislation on health care wants to be able to control the provision of health care through managed health care programs (Harold 2008).

The exclusions and rescissions mentioned above are correlated to cases of pre-existing conditions. This locks out many people from accessing insurance covers as their conditions relate to a pre-existing condition. This is mostly encountered for the elder segment of the population, younger Americans rarely experience this as a setback as the rate of falling sick is rare. One faces a situation where they are not able to gain insurance cover for the existing conditions unless they are employed and their employers have taken out insurance on them. These kinds of schemes do not have exclusions in them but getting that kind of employment is not easy.

The Pennsylvania Office of the Governor (2010) argues that “…many adults with certain medical conditions are denied health insurance in the individual market or offered coverage at an unaffordable price – at a time when they need it most.” The Governor, Rendell, adds, “This is an absurd practice – almost like only being allowed to go to a restaurant when you are not hungry. Thanks to federal health care reform, health insurers will be prohibited from denying coverage or charging sick people more for insurance in 2014. In the meantime, we are doing everything we can for Pennsylvanians to have access to affordable, quality health care, including offering coverage through a high-risk pool.”

This clearly shows that the PPACA is addressing the core issues of the problems facing the American health sector, which are insurance covers especially among the elderly and people with pre-existing conditions. This is a positive gain to both the public since costs are reduced and the health providers as they can produce positive returns and able to cover their expenditures.

The law requires all states to liaise with the health secretary and have in place regulations that seek to ensure development of service systems that are designed to provide services by allocating adequate resources so that they sufficiently address the needs of Americans. American citizens can now be able to afford to pay for heart diseases, cancer, trauma, mental disorders, and lung conditions which are the five most expensive medical conditions in the united states with cancer topping the list at $4,462. Individual expenses mounting quickly cultivate frustration with existing insurance cover providers among large numbers of Americans.

Is the PPACA a long-term reform process or is it just meant to look into and answer a few situations for now and become redundant?

Is the PPACA a long-term reform process or is it just meant to hoodwink the public? This is a question everyone has to ask themselves. The PPACA can be seen as a long-term measure. However, only nine months after its adoption, people are already complaining that the PPACA has failed. Effective implementation should be carried out so that its goals can be realized and adequate time given to the legislation to see it fully fruitful.

The spirit of the PPACA is to address the troubles Americans go through in obtaining healthcare, which cannot be escalated overnight. However, for the nine months it has been in existence we have seen many persons suffering from pre-existing conditions being able to buy health cover premiums from insurance companies. Insurance executives have argued that it has to be level and affect all those insured equally.

Americans have for decades cried out to the government to look into the health sector as just a select few (the wealthy) can obtain quality and hassle-free health care plus health insurance cover. Nevertheless, most Americans living below the middle-income level are not able to afford insurance covers and employers to are afraid of taking out covers for their employees due to its insanely high cost.

The previous law and how the sector was run, has only been profitable to private health insurance cover providers and big corporations. Several health providers and hospitals have been forced out of business due to them not being able to cover their expenditures thus are not able to realize any profits. Whether this new law addresses all the issues about the health sector or not; is a long term reform process or a mere ploy by the government to get the American citizens of their back is left in the hands of the lawmakers to carry out the implementation of the health care reform law of march 2010.

Comparison of this legislation to similar legislation or policy in one or more other countries

How does the PPACA reform law compare to previous laws or other legislation in other countries? Understanding the importance of the PPACA and its implications on the American health sector is very fundamental to answering the above question. To fully appreciate the impact and why the PPACA was introduced one has to understand that the American health sector was and has been a mess.

For instance, in Britain cases of pre-existing conditions are fully covered but under strict guidelines therefore everyone can obtain health insurance, regardless of the condition. The covers include consultations by specialists, tests and therapies. “Most of the insurance companies offer full covers for pre-existing conditions but the only issue is that one cannot claim hospital cash benefits, recuperation and home help during the first two years the policy has been taken” (Twaddle 2002). Unlike the united states where it takes about 12 months for claims to be settled, the claims here are more often settled direct and do not give you the headache of paying on your own and claiming the money from your insurer. (Andersen, et al 2007).

Ethical dimensions of the legislation’s proposals

Uninsured people relate to pre-existing medical conditions in an ethical dimension. These pre-existing conditions refer to medical cases where an individual has defects that were obtained before health insurance covers were taken out on a person. Sick people have the right to have health care insurance coverage options no matter whether they are covered or not. This is a major issue in the United States in terms of accessing healthcare as it may hinder those needing urgent attention from obtaining healthcare services and health insurance cover. In some cases, if they are obtainable they are usually very costly. The legislation tries to address healthcare from an ethical point of view by introducing things such as Non-maleficence, Beneficence, and Autonomy. (Haley, 1997).

According to the PPACA, beneficence is simply doing something without an intention of benefiting but having other people in mind when doing it. It is essentially doing a beneficial act to another person other than you. In a health care provision context, doctors are obliged to provide good services and help to their patients and avoid doing them harm. Beneficence can consist of caring for and protecting the liberties of people, rescuing the vulnerable ones, and assisting those incapacitated (Morrison 2009). The difference between an obligation and ideal beneficence is told apart and founded on an ethical background. Doctors are not wholly expected to be ideally beneficial but they are required to practice it to some extent and the nature of their interaction with patients leaves them with no choice but to

1. avert and do away with problems, and
2. evaluate and create a sense of balance between probable benefits against likely risks of action.

Acts of beneficence could include: “Resuscitating a drowning victim, vaccine provision for, encouraging a patient to quit smoking and start an exercise program, talking to the community about STD prevention” (Morrison 2009).

Non-maleficence on the other hand simply means “do no harm”. It is originated from an ancient maxim primum non-nocere. This ethical standing dictates that doctors and medical practitioners should avoid doing something or hold themselves back from doing something, or from making decisions and taking actions that are detrimental to a patient’s health and acting with cruelty to patients. There is however very little direction to go by and it leaves behind a big question on whether benefits outweigh problems. The principle of Non-maleficence is much accommodating when it is balanced to that of beneficence. Some acts of non-maleficent include: “discontinuing perceived harmful medication, refusing to provide a treatment that has not been shown to be effective” (Morrison 2009).

The above two principles are more or less to be an advantage to the common American as doctors and health providers have been given a stipulated mode of operation to go by. However, the argument is on who is eligible for healthcare insurance and access to health care continues to rage on with some people stating that sick people are going to misuse the ethical principles that come with health care.

The issue with pre-existing medical conditions is that people are put on large waiting lists by health insurers who are not in a hurry to take up persons who are already suffering. Payments of medical bills of people with pre-existing medical conditions also take unnecessarily long to be settled by insurance providers. The PPACA stipulates certain safeguards to people suffering from pre-existing conditions so that they can get healthcare and insurance covers as long as they meet the set down requirements.

Conclusion

The PPACA has not significantly impacted the American healthcare system for the nine months it has been in existence. This has raised a lot of criticism on the legislation, however, Americans should understand that the PPACA is more of a long-term plan and is aimed to benefit them in the long run. So far the legislation had been successful in some of its short-term goals. We have seen many people who had been uninsured previously can now access healthcare services and insurance cover affordably, also people suffering from pre-existing conditions and the elderly benefiting somehow. Given time, the PPACA can be the answer to the healthcare needs of every American.

Reference List

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Pennsylvania Office of the Governor. (2010) Uninsured Pennsylvanians with Pre-existing Conditions Will Benefit From Health Care. Web.

Seltzer, M. (2009). Pre-Existing Conditions and Health Care Reform: Necessary reforms or free-market intrusions? Politics unlocked. Web.

Twaddle, A., C. (2002). Health care reform around the world. Westport, CT: Greenwood Publishing Group.