Free The Affordable Care Act Essay Example
In 2000 The World Health Organization published a ranking of health systems by country. The US came in at 37th, even though it spends more in absolute terms and as a proportion of its GDP on health than any other country (World Health Organization 155). The Affordable Health Care Act (ACA) is an attempt to remedy this situation.
According to the U.S. Department of Health and Human Services, the ACA extends health coverage to uninsured Americans, lowers costs, and improves the quality of health care for Americans, including insurance for preventive care for many Americans (United States. Dept. of Health and Human Services). The prime mechanism by which the ACA attempts to improve health care is the market. With the exception of Medicare for the elderly and Medicaid for the very poor, most Americans get their health coverage with the aid of their employer through private health care insurance companies. The ACA leaves this situation intact, but puts restrictions on health insurance companies, including the ability to refuse coverage because of pre-existing conditions. Title 1, Part I, Section 1503 of the act requires individuals who do not have health care either directly or indirectly from a health care insurer to be mandated by law to buy health care from such an insurer. The Act expands Medicaid to plug gaps for those who cannot afford to purchase their own health coverage (United States. Dept. of Health and Human Services).
The ACA operationalizes the health market through means of government administered health insurance “exchanges”, online health market places run by states or in some cases the federal government, or jointly run by states and the federal government (United States. Dept. of Health and Human Services). Health consumers go to the state’s website and choose between a variety of health coverage options provided by health insurance companies. If their state does not have its own exchange, then consumers can go to the federal government website healthcare.gov. Exchanges are a form of public and private partnership. They are created and administered by government, but citizens’ actual health insurance is still provided by the privately run companies; citizens are still health “consumers” in a market place The basic structure of the American health system thus remains unchanged, but new regulations placing both restrictions and obligations on health insurance companies are designed to give consumers more health coverage security. A prime example is the new obligation not to deny coverage based on pre-existing conditions.
Thus, in principle, most Americans should benefit from the ACA. But some groups benefit more than others. One group that greatly benefit are those who have had no health insurance at all. The Center on Budget and Policy Priorities cited census data and other studies which showed that in 2013 45.2 million Americans had no health coverage (Broaddus and Park). This is the last pre-Affordable Care Act figure, as the main provisions of the act did not come into effect until January 2014. The center cites several studies indicating that number of uninsured have decreased significantly in 2014. For example, the number of uninsured fell by 3.8 million in the first quarter of 2014 (Broaddus and Park). Who, typically, have been the uninsured groups? According to the 2013 Census, those uninsured were disproportionally poor, black, hispanic, and live in rural areas (Smith and Medalia 11-13), and it is these groups that have benefitted most from the act. The New York Times cited a studies by Enroll (the agency helping to sign people up) and data firm Civis Analytics, showing that the groups benefiting from the law include people between the ages of 18 and 34; blacks; Hispanics; people who live in rural areas, and people with the lowest incomes (Quealy and Sanger-Katz).
The “pros” of the ACA are the obvious benefits to health consumers: increased coverage to more Americans, so that the overwhelming majority all Americans have affordable health care; more patients rights, such as the right to coverage even with pre-existing conditions. In addition, health insurance companies are mandated to provide essential health services including ambulatory (outpatient) hospital services, hospitalization, including surgery, pregnancy, maternity and newborn care, mental health services, and prescription drugs, rehabilitation, laboratory services, preventive services, and pediatric services (United States. Dept. of Health and Human Services, “What Marketplace Health plans Cover”). Assuming these goals are met, the big “pro” of the ACA is a healthier America. The aforementioned data collected by Enroll and Civis Analytics suggests that one of the goals is already being met; more Americans are insured than ever before. During 2014 around 10 million previously uninsured Americans became insured through the ACA, reducing the rate of uninsured by 25% (Sanger-Katz). By this single measure, the ACA has been a massive success.
The ACA, however, faces major obstacles. The website roll out for healthcare.gov was a disaster, with consumers needing a long time to access the website, or not being able to access the site at all, and giving up. The technical problems were fixed, but there are deeper obstacles. Both legislative houses are now controlled by Republicans who have vowed to repeal it. Some Republican controlled states have refused to accept federal assistance to expand Medicaid, the expansion being a key ACA instrument to extend coverage to the uninsured poor. Polls have shown that the population has been and continues to be divided over the act, with a small majority against it. The act is highly politicized, with a majority of Democrats in favor of it, a majority of Republicans against it, and significantly, a majority of Independents against it. (Newport).The failure to garner support for the act from Independents means that it has not had and continues not to have majority voter approval. Thus, a big “con” of the ACA is that a majority of Americans simply do not support it.
Another “con” of the ACA is that although it extends health coverage to millions more Americans, it still does not guarantee health care to all Americans. Some Americans fall through the ACA net (“Affordable Care Act, A Perfect Fit for Some, but Not Others”). Even if all parts of the ACA are fully implemented, the United States, unlike all other advanced industrial economies, would still not guarantee all of its citizens affordable health care.
The biggest “con” in the ACA is that it leaves the bulk of health care provision in private hands and the market place, and there is not an example in the world of such a system providing universal health coverage. The documentary film maker Michael Moore and the PBS documentary series Frontline compared the US health system with those of other countries, and the US system was found wanting. The documentary film makers found that other advanced industrialized countries guarantee all their citizens affordable health care. They do this in different ways, but all involve extensive government intervention in the market place.
The Affordable Care Act is a step in the right direction for the US; the “pros” outweigh the “cons”, so the act is a net gain for American health. But the US will not be able to provide the best care in the world for all its citizens unless Americans can accept extensive government intervention into the system, for example through a “Single Payer” system, in which a single payer such as the government pays for health services. Medicare is an example of a single payer system and in principle could be extended to the whole population. The biggest hurdle bringing the American health care system up to the standard of other advanced industrialized is that extensive government intervention in the health system is anathema to vast swaths of the American public.
“Affordable Care Act, A Perfect Fit for Some, but Not Others.”New York Times 27 Oct. 2014.
Web. 3 March 2015.
Broaddus, Matt and Park, Edwin. “Census Data Show Uninsured Rate Fell Slightly in 2013:
Other Survey Data Indicate Significant Coverage Gains in 2014.” Center for Budget and
Policy Priorities, 2015. Web. 2 Mar. 2015.
Newport, Frank. “American Public Attitudes Toward the Affordable Care Act”. Gallup, 10 Oct.
2014. Web. 3 Mar. 2015.
Sanger-Katz, Margot. “Is the Affordable Health Care Act Working?” New York Times 27 Oct.
2014. Web. 3 March 2015.
Quealy, Kevin, and Sanger-Katz, Margot. “Obamacare: Who was helped Most?” New York
Times 27 Oct. 2014. Web. 3 March 2015.
“Sick Around the World”. Frontline. Public Broadcasting Corporation. WGBH, Boston. April 15,
Sicko. dir. Michael Moore. Dog Eat Dog Films, 2000. Film.
Smith, Jessica and Medalia, Carla. “Health Insurance Coverage in the United States: 2013”.
Current Population Reports. Washington: U.S. Census Bureau, Sept. 2014. PDF file.
United States. Dept. of Health and Human Services, The Affordable Care Act, Section by
Section. Washington: Dept. of Health and Human Services, Mar. 2015. Web. 2
United States. Dept. of Health and Human Services. Healthcare.gov. What Market Plans Cover.
Washington: Dept. of Health and Human Services, March 2015. Web. 2
World Health Organization. World Health Report 2000: Improving Performance. World Health
Organization, 2000. PDF file.