The Patient Protection and Affordable Care Act (ACA)also referred as Obamacare, was passed by 111th United State Congress and then was signed into law on March 23, 2010, by President Obama. Healthcare in America is excessively expensive and unaffordable for people with or without insurance. Doctor visits, medications, diagnostic tests, and healthcare in America is unaffordable to low income and middle-class families. The ACA main purpose is to lower the health care cost over time. ACA has reduced the cost of medical care making it more sustainable and has together improved the quality of the health care services for all the Americans. Since ACA requires individual to pay the premium regarding their income, ACA has made health insurance affordable by providing insurance to unemployed or have a low paying job and to people having a pre-existing condition such as cancer and heart disease. Also, ACA has been providing free preventive care so that people are not exposed to chronic diseases in future. Republican are against ACA and they believe that ACA has been increasing the cost of health and is a burden to business and federal state governments. They are in favor of replacing Affordable care act. Affordable care act should not be repealed as it has been providing insurance to people with pre-existing conditions, emphasizing free preventive health care and it has been reducing number of uninsured American by making the health insurance more affordable.
Before ACA, people with pre-existing conditions were automatically disqualified to get health insurance in many states. People with a pre-existing condition were charged a higher premium due to their conditions. This was because the insurance needs to pay more for those with a pre-existing condition as it was more expensive to cover sick people rather than healthy ones. It was estimated that about 18% of individual's market application was denied before the ACA's coverage expansion. Most of the states even consider the conditioned that had not been diagnosed, but that produce signs and symptoms as a pre-existing and are not allowed from having a health coverage. After the 111th United states Congress enacted the Obamacare, insurance companies were prohibited from denying coverage to children for a pre-existing condition on September 23, 2010. If people with pre-existing conditions are left untreated then they might become homeless or in prison. So, the insurance company should provide better health care facilities to them. Mental health disorders are common pre-existing conditions found in America which are due to anxiety and depression. Researchers found that depression affects more than 6.5 million out of 35 million Americans older than age 65. People should receive proper health treatment that includes counseling and preventive care, so that they can have a healthy and better life. ACA has encourage all the insurance plan to cover the 10 essential health benefits that includes the treatment of chronic disease, addiction, mental health, maternity care, preventive serves which protects the patients from getting
The cardiovascular disease is one of most leading causes of death in the United States mostly due to hypertension. By increasing the number of insurance to people, ACA has been improving the hypertension management. From one of the studies, it shows that there was a 5.1% increase in the treatment rate among hypertensive patients due to the expansion of affordable health insurance. The main barrier for the better treatment of hypertension is lack of insurance. With the help of affordable care act, people can receive more treatment for hypertensive through different free preventive care services like routine blood pressure checkup and also ACA had played a vital role in lowering the patients out of pocket cost for antihypertensive medication.
Even, ACA has worked on several measures to improve the access to diabetes care to cure and improve the health of diabetic patients. Before ACA, insurance company charged the diabetic patients with higher prices than other regular patients and also they denied the insurance if the patients were diagnosed with a diabetic. Affordable care act believes that with the increase of people signing the health coverage and the development of quality of health care and preventive care, more physician has to meet up the need for health care. ACA also states that there is a shortage of physician which might have a negative impact on health care and cause some issue in access to care. Also, the health insurance marketplace estimated that after fully implementing ACA and Medicaid expansion in all states, and it might need about 2.5-3% increase in the primary care workforce or around 4000-8000 primary care physicians. The increase of coverage to people might worsen the current shortage of primary care physicians in the USA. To help this situation, ACA has worked on many actions by supporting the physicians, encouraging the placement of physicians to underserved areas and also encouraging physicians to focus on primary care.
Affordable care act has been improving the quality of health care in America by emphasizing free preventive care including maternity and newborn care, domestic violence screening, lab test to diagnose diseases including mammograms and colonoscopies. Before ACA the states’ income eligibility thresholds for parents were much lower than the federal minimum of 133% FPL for pregnant women. So many women would lose Medicaid coverage 60 days after the birth of their child. Even now, around 19 states which have not passed the Medicaid expansion still has the same problem. In 2015, Medicaid has covered nearly one in four (23%) adult women with any mental illness and 28% of adult women with a serious mental illness.
Preventive health care is important to have a healthy life. It helps to detect health-related issues and do early diagenesis if needed so that in future we can have a better quality life. ACA has been providing free preventive care which helps people to get proper treatment before they need to take an expensive emergency service. In the year 2010, Affordable Care act I have made preventive care more accessible and affordable by increasing health promotion and disease prevention. Preventive services are for short and long-term benefits which helps in reducing acute care, hospitalization, and emergency departments. Also helps in lowering the expenditure of healthcare by improving our health.
From much research study's, it is found that around 60% of deaths per year in U. S by the preventive diseases like cancer, diabetes, strokes, coronary heart disease. If people get more preventive service when they need to like counseling to help people to stop smoking or abuse of drugs, colorectal and breast cancer screening, then we can save more than 100,000 lives per year. Also, people can avoid life-threatening disease through immunization and also promote herd immunity, which will also help protect people around from getting sick. ACA provides free vaccination for flu, pneumonia and hepatitis B. Under affordable care act males and females have been getting a free screening test which is very important depending on age and health. ACA provides free prostate cancer screening to men over 50, females and able to get free mammograms. Other different screening tests like blood pressure, diabetes, and high cholesterol test are helping people avoid risks of cardiovascular disease.
ACA also emphasized on the preventive care of young adults who are more susceptible to preventable health condition like substance use, mental health problems and sexually transmitted diseases. About 70% of young adults have not received any preventive care or counseling regarding such problems. ACA have focused on providing free counselling to young adult so that they are aware of being a victim of substance abuse and destroying their health. Preventive health services may help in reducing the disparities in a person’s health and it is an important step in treating and managing the chronic illness. Furthermore, it is found that enrollment in health insurance has positively increased the higher number of people using preventive care which directly leads to a better and positive outcome in the future. "Quality healthcare is about keeping people healthy, not just treating them when they are sick" McNerney. Also it has helped in reducing the mortality and morbidity in a young adult population and enhancing the positive health outcomes as they grow older.
The U. S Surgeon General reported there are almost around 94 million engaged in binge drinking, using illicit drugs, or misusing prescriptions drugs. The Center for Disease Control and prevention, state that 4700 Americans died by the use of overdose drug and around 29,000 died due to opioid use. Also, U.S is reported about a quarter of the worlds drug-related death. People with opioid use disorder can be well treated if there are proper health services, like preventive care. ACA has helped in improving the services by expanding the number of providers offering substance use treatment and making it easier to find.
Beside the positive side of preventive health services, Republican states that increase in preventive health care has cause more increasing in the health cost, as testing and treating chronic disease are more expensive. The fact is that if there are more preventive services then people will not suffer from chronic illness as they can diagnose the disease before it gets worse. The risk of spreading disease will decrease which directly have positive impact on the overall health of Americans as well as the cost of health coverage.
The pre-reform health care had problems that includes lack of health insurance coverage for 18.5 percent of the nonelderly population, high premium and copayment for the insured, decline of employer sponsor insurance and leave area across the nation where access to medical care is limited, typically low income and rural areas. So as to solve these problems ACA, was introduced which implements the significant change in Medicaid program, newly systematized for delivering subsidies and enrolling individual in a coverage. ACA has made the health insurance affordable to all the Americans by providing subsidies. ACA has expanded Medicaid to 138 percent of the federal poverty level and have provided this coverage to adult without children. Studies show Medicaid expansion in California has successfully affected a large and growing proportion of the nonelderly, low-income adult population. Also, there increases in enrollment in California's Medicaid from average of 7.6 million before the ACA to 12.2 million in November 2016, the largest growth in Medicaid coverage among all states.
Then, affordable care act also made several revisions on Children's Health Insurance Program known as CHIP. It has allowed more children to get insurance and provide free and low cost coverage to kids along with many preventive health services. CHIP has been providing health insurance to more number of children under affordable care act. Before ACA, college students need to pay out of pocket for their medical care and that would leave them with an endless pile of medical debt. Some students need to cancel their treatment or surgery as they were not able to afford the cost of health care. Also, children up to the age of 26 can be covered under their parent’s health insurance. In the past, insurance companies used to charge higher premium to women than men. ACA is not biased and provide equal and better health to everyone. This helped in lowering the cost for everyone else by adding the premium from their relatively healthy people to insurance company revenues.
Elder peoples with Medicare Part D, used to pay only some cost of prescription drugs, they receive $250 in 2010. Later in 2011, they were given 50 percent off in brand name prescription drugs, and a 7 percent discount for the generic medicines. By 2020 ACA will eliminate the Medicare Part "doughnut hole" which covers 100 percent of prescription drug cost for people who have Medicare part D. Senior citizen do not need to pay out of their pocket. There is a controversy that federal states do not have right to force people to get insurance. Indeed, if everyone has insurance they will be aware of the disease as they will frequently visit the doctor when they are sick, instead of waiting until their illness turns into emergency which might be very expensive to treat. If all people are healthy, then it will positively lower the cost of health care for everyone.
Affordable care act has provided many subsidies which include that employers with more than 50 employees must offer an affordable coverage to the all their employee, or else they need to an additional non-deductible tax of $2000 per full time employee. Because of this the employee were not required to pay more than 9.5 percent of their family income for health coverage which was a good part. Many small businesses try to maintain their employee number below 50 it is very expensive for the company to cover the healthcare expenses of all the employee. Many business companies are trying to hire only part time works and limiting the number of employee. So, many people are worried about not getting job due to the employer mandate. ACA has been providing health care tax to small business which is about 25 or less full time employment. Small business had a huge problem providing insurance coverage to their employee
Affordable care act encourages paying penalty for being uninsured if an individual does not come under the exemptions like financial hardship, religious objection, American Indian, undocumented immigrant. The structure of penalty for not having coverage has been shown in the table below. Many people state that fines for not having coverage are too small to encourage the middle-income American to enroll in health insurance plan. ACA encouraging people to get insurance coverage by making them pay penalty if they do not have one has a great positive impact on their health as well the health care system. It has led to make country healthier by promoting the quality of health of people in American and also helped to lower the medical bankruptcies filed as well.
Table 1: Penalties Under the Individual Mandate
Year
Percent of Income (%)
Per Adult Penalty ($)
Household Penalty ($)
Prior Tax Year Filing Threshold Individual under 65 ($)
Prior Tax Year Filing Threshold – Married filing jointly under 65 ($)
Affordability Standard (%)
2014
1
95
285
10,000
20,000
8
2015
2
325
975
10,150
20,300
8.05
2016
2.5
695
2,085
10,300
20,600
8.13
The purpose of affordable care act is to make sure all American have access to affordable health insurance and promote the quality of health care. ACA has made it possible by providing the coverage for many uninsured people by making health coverage more affordable by providing subsidies. No one can be denied to get a health coverage for their pre-existing condition or any other health condition. ACA has made the preventive care more accessible to everyone. Also, people from low income and middle-class families can get a quality of health care through affordable coverage.
Besides having many benefits of Affordable care act it is still not clear to most of the people because of there are more influence about the negative sides about the program than the positive one. This had cause the most of the people to ignore the positive side of it. If ACA is repealed, then millions of families will lose their coverage. If ACA is repealed what will happen to the American grappling with opioid addiction who suddenly lose their coverage? What will happen to pregnant mothers, children with disabilities, poor adults and senior citizen who need long-term care once they can no longer count on Medicaid?
We didn’t fight for the Affordable care act for more than a year in the public square for any personal or political gain- we fought for it because we knew it would save lives, prevent financial misery, and ultimately set this country we love on a better, healthier course.
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