Good Research Proposal On PL 111-148 Section 2100 Policy Change Proposal

The problem is that section 2001 of PL 111-148 does not allow previous Medicaid Advantage coverage to continue for those Americans that have been enrolled and received their prescription and healthcare insurance. The public policy question is should the federal government mandate states to provide Medicaid coverage for these special populations and take the government subsidizing of 100% for 2015 and 2016? The resolution of the public policy problem is the amendment of section 2001 of PL 111-148 to the effect that the government shall pay 100% of the cost of the newly eligible individuals while continuing to subsidize at the same rate the individuals receiving Medicaid healthcare plans prior to the passing of this law (The Staff of the WashingtonPost, 2010).

Legal Issues

The legal issue that would affect the passage of the said amendment is the fact it still faces multiple legal challenges to its constitutionality. Twenty-eight states have filed lawsuits either jointly or individually (26 states in a joint multi-state action) against the Act’s individual mandate provisions. The multi-state lawsuit argues that the individual health insurance mandate is beyond Congress’ constitutional authority under Commerce Clause of Article I to regulate interstate commerce, besides the assertion that the individual mandate is outside Congress’ taxation powers. While the Supreme Court had ruled in 2012 to uphold most of the Act’s provisions, it rejected provisions that penalized states that failed to comply with Medicaid’s expanded eligibility. The Court announced its intention to hear King v. Burwell on March 4, arguing that subsidies to individuals that buy insurance on exchanges were only available to state-run exchanges, which could leave millions of Americans without subsidies. This means that even if the government subsidizes 100% of the cost of the newly eligible individuals while continuing to subsidize at the same rate the individuals receiving Medicaid healthcare, millions more people that purchase insurance from non-state exchanges will still be without subsidies. Other than King v. Burwell, 38 states had passed bills invalidating substantive provisions of the ACA (15 of the 181 bills are already law), with at least 21 states having passed laws to challenge or opt out of the ACA-related mandatory provisions.

Political Issues

The main political issue affecting the passage of the proposed amendment stems from the possibility of Senate and Congress repealing PL 11-148, which would render the proposed amendment a futile/unnecessary. By the close of March 2014, Congress had voted 54 times to change, defund or repeal PL 11-148, with this possibility having increased after the Republican Party (which is bitterly opposed to the law) won the control of the Senate after the midterm elections. On February 3, 2015, for instance, the GOP-led Congress voted for the 67th time to roll back the law, despite President Obama’s insistence that he would veto any such bills. The individual mandate is easily one of the biggest political difficulties for the ACA, with the employer mandate implementation having been delayed by the Obama administration until after 2015. Other than the opposition to PL 111-148’s excessive subsidization of insurers, the law has also been viewed as changing the relationship between state and federal governments, by usurping state and local rights over health and social policy (National Congress of State Legislatures, 2015; Walsh, 2015). With the GOP’s opposition to the law (in part out of principle/politics as against it technical aspects), it would be difficult for the part that falls short of its intention to repeal major provisions of the law (including the entire law).

Economic Issues

The US budget deficit declined to $468 billion in 2015 and expected to remain low in 2016 and by the close of 2018, the federal deficit will rise above its 50-year average of 2.7% of the gross GDP to reach 4% ($1.1 trillion). The expected increases are in part because of the retiring baby boomers and debt repayment costs, increases federal health insurance subsidies, rising health care costs per beneficiary and higher interest rates on the federal government’s debt. It is expected that the spending will expand faster than the social security economy including key healthcare programs such as Medicaid, Medicare and subsidies provided through state and federal insurance mandates as well as net interest costs. This bodes poorly for PL 111-148, which according to the Government Accountability Office (2012), is expected to add $6.2 trillion to the country’s long-term deficit. In order to reduce budget deficits, Congress will most likely seek to cut discretionary and entitlement program expenditure, coupled with increased taxation. Effectively, since the proposed amendment on PL 111-148 will result in increased government expenditure on subsidies to Americans that have been enrolled and received their prescription and healthcare insurance, it is likely to attract stern opposition (The Staff of the Washington Post, 2010; Government Accountability Office, 2012).

Social Issues

A poll published in March 2014 showed that 49% of Americans supported PL 11-148, which shows that there is a high appreciation of the goal of the law as a whole despite there being controversial provisions. Section 2001of PL 111-148 establishes a new eligibility group, filling the gaps in the Medicaid eligibility, which allowed low-income populations that could not otherwise qualify for health insurance under mandatory categories to do so. It ensures that pregnant women, the elderly and other vulnerable, low-income populations have access to affordable health insurance. The motivation behind the section is clear, and it follows, therefore, that people who fall in the same vulnerability category, but had Medicaid Advantage coverage to benefit from the same. It is a question of equity and protection of the vulnerable populations, and Americans recognize healthcare as a right and the importance of such protections.

Ethical Issues

The ethical principle that supports passage of the proposed amendment is distributive justice because the spirit of PL 111-148 is to expand access for the uninsured and underinsured groups. It is would be counterproductive if the new law creates winners in the newly eligible groups with similarly placed groups losing out. Prior to the ACA, the US was the only developed nation without guaranteed health coverage, with one of the most expensive systems that benefitted high-income groups more than the poor. The primary goal is to make certain that everybody can access a minimal level of care as against pursuing strictly capitalistic ideals.

Stakeholders

Politicians who are responsible for tabling the amendment bill, debating and voting to pass or not to pass it
American Voters who can shape the opinion of the opinions and voting patterns of their elected officials
Political Activists who can create awareness and influence the support for, and against the amendment
Lobby Groups that have influence on Capitol Hill and represent different interest groups (including insurance companies and health care providers) that may be in support or against the proposed amendment

The Media that can shape public opinion and make such opinion known to the politicians

Summary
Section 2001(a) (1) of the ACA mandates states to expand eligibility to cover all citizens below 138% of the federal poverty level (FPL) as from January 1, 2014. This fills the gaps in the Medicaid eligibility by extending coverage to low-income populations that were previously ineligible for compulsory eligibility categories. The newly eligible group comprises individuals who are pregnant, older than 64 years, enrolled in or entitled to benefits under Medicare Part A/Part B and those described under other mandatory groups under section 1902(a)(10)(A)(i) of the ACA. Under section 1201 of the Reconciliation bill, the federal government is expected to subsidize 100% of the cost of coverage for the newly eligible population up until the year 2016, after which the federal reimbursement would be reduced to 90% by the close of 2020. However, the subsidies under section 2100’s do not apply to populations with Medicaid Advantage coverage for citizens enrolled and receiving health insurance and prescription drugs. By amending PL 111-148 to extend subsidies up until 2016 to citizens receiving Medicaid health plans prior to the law, the law will ensure that the cost of coverage for this group is not rise relative to the newly eligible group.
As the Supreme Court dispenses with suits filed by opponents of the law, it is important to recognize that the law is already in force and the group expected to benefit from this amendment are already struggling with the relatively higher costs. It is imperative that the law be amended to render it more equitable. The proposed amendment has nothing to do with the constitutionality difficulties facing PL 111-148, but its implications on the said constituency (Miller, 2014; Mehta & Mehta, 2012). Even with a GOP-led Congress and Senate, political efforts to repeal ACA are unlikely to succeed at least until 2016 because of the President’s likelihood to veto such bills, while defunding ACA may result in a disastrous political backlash for the party ahead of the 2016 elections. Given the fact that the amendment is seeking to extend subsidies for the said population in the short-run, it is more urgent and beside the state and partisan differences surrounding the law. With regard to the law adding to the deficit, it is clear that the deficit has reduced and will remain low for the most part of the proposed law’s implementation and thus radical deficit-cutting measures are unnecessary just yet (Government Accountability Office, 2012; Government Accountability Office, 2012). Perhaps is even more important to highlight the fact that most Americans see health care as a right, which explains the measure of success that the ACA already enjoys, which may grow further with expanded subsidization. The proposed amendment will ensure redistributive justice.

References

Congressional Budget Office. (2015). The Budget and Economic Outlook: 2015 to 2025. Washington, DC: Congressional Budget Office.
Government Accountability Office. (2012). The Federal Government’s Long Term Fiscal Outlook. Washington, DC: GAO.
Langer, G. (2014, March 17). At 49 Percent Support, Obamacare Hits a High. Retrieved Feb 15, 2015, from http://abcnews.go.com/blogs/politics/2014/03/at-49-percent-support-obamacare-hits-a-high/
Mehta, J., & Mehta, J. (2012). How the Patient Protection and Affordable Care Act (PPACA) SupportsFederalism. J Forensic Res 3, e107.
Miller, T. P. (2014, Dec 23). Repeal, Replace, or revise? The choices ahead for Obamacare critics. Retrieved Feb 25, 2015, from https://www.aei.org/publication/repeal-replace-revise-choices-ahead-obamacare-critics/
National Congress of State Legislatures. (2015, Feb 8). State Laws and Actions Challenging Certain Health Reforms. Retrieved Feb 15, 2015, from http://www.ncsl.org/research/health/state-laws-and-actions-challenging-ppaca.aspx
O'keefe, E. (2014, March 21). The House has voted 54 times in four years on Obamacare. Here’s the full list. Retrieved Feb 15, 2015, from http://www.washingtonpost.com/blogs/the-fix/wp/2014/03/21/the-house-has-voted-54-times-in-four-years-on-obamacare-heres-the-full-list/
The Staff of the Washington Post. (2010). Landmark: America's new health-care law and what it means for us. New York, NY: Public Affairs.
Walsh, D. (2015, Feb 4). House votes - again - to repeal Obamacare. Retrieved Feb 15, 2015, from http://edition.cnn.com/2015/02/03/politics/obamacare-repeal-vote-house/
Wills, E., & Kluwer, W. (2010). Theoretical Basis for Nursing 3rd. ed. . New York: Lippincott Williams and Wilkins.