Within recent years, the American people have been watching the healthcare system fluctuate as the ideals of those in charge of the democracy have changed. The people may pressure those in charger, however, the changes have been led primarily by the beliefs of those who are in office of this nation. During the presidency of Barack Obama, the Affordable Care Act—also known as Obamacare—was established to encourage an expansion of access to health insurance, protect patients, and reduce costs. As stated, the beliefs and goals of those in office have changed since the time since President Obama, therefore, the support for Obamacare has altered. The leaders of this nation, as well as its people have different views—some are in support and others are in support of a change. With new beliefs and goals, there have been numerous proposals to change the Affordable Care Act—in this paper, the proposal that will be analyzed is the American Health Care Act of 2017.
Analyzing the Health Care Act of 2017 will serve to challenge the ideas of what is present with the Affordable Care Act. The analysis will determine the similarities and differences between these two ideas, as well as create new ideas of where there can be further discussion of the varying topics covered within these acts.
Overall Approach
The Affordable Care Act
President Barack Obama had a vision for the Affordable Care Act to serve to three primary goals: make affordable health insurance available to more people, expand the Medicaid program to cover all adults, and support innovative medical care delivery methods designed to lower the costs of health care generally (U.S. Centers for Medicare & Medicaid Services, n.d.). The feelings toward Obamacare have always been on the highs and the lows—however, they have especially been on the lows since the new change in office. Initial reactions were scattered with many Americans unsure on their feelings toward the benefits of this healthcare act. However, since there has been much debate on replacing this healthcare act, Americans have begun to defend their beloved Obamacare. The overall approach of this plan has been to require most U.S. citizens and legal residents to have health insurance in an affordable way (Henry J Kaiser Family Foundation, n.d.). Americans have begun to defend that approach as this healthcare plan has been under fire.
The Affordable Care Act has an overall approach that looks to create more benefits than penalties. These advances revolve around state-based health insurance exchanges, refundable premium tax credits, new market regulations, expand Medicaid, reduce Medicare spending; goals that are seen to benefit rather than harm the citizens of the United States (Henry J Kaiser Family Foundation, n.d.). However, were these approaches creating complete benefits to all Americans or were there different groups being impacted in more negative of ways?
The American Health Care Act of 2017
The purpose of the American Health Care Act of 2017 can be described as a way to eliminate and enhance what exists with Obamacare. When reviewing the American Health Care Act of 2017, the lines “this bill amends,” “this bill eliminates,” and “this bill enhances” are repeatedly present (Congressional Research Service, n.d.). These are words that make up much of this proposal because it is meant to show the new ideas and goals of those who are in office and even to support those of this nation. The overall idea is to reverse and fix the different impacts of the Affordable Care Act. The healthcare act that was introduced by President Obama had one great impact on the rising leaders of this nation—the millennials. It has been found that the “effects on Millennials are especially pronounced, with increasingly unaffordable premiums, astronomically high deductible rates, and less choice among insurers and doctors” (Piper, 2012). It is said that the American Health Care Act was introduced to combat those effects while supporting the views of those upcoming leaders.
On a broader level, the goals apply to various groups, whether those groups reflect age, class, or other characteristics that influence their relationship to healthcare. The overall approach can be addressed in the simplest of ways; to repeal the ACA mandates, standards for health plan actuarial values, as well as the premium and cost sharing subsidies (Henry J Kaiser Family Foundation, n.d.). This approach serves the purpose on correcting the impacts of the Affordable Care Act for the groups of people who were not receiving benefits from the healthcare act implemented by President Obama.
Individual Mandate
As part of the Affordable Care Act, President Obama created this concept of the “individua mandate” that requires citizens and legal residents to have basic, qualifying health insurance. To add to this, those who do not have this health coverage receive penalty unless they have been accommodated to because of exemptions. This one of topic of this healthcare plan that many questioned and commented on to determining whether it was just or even constitutional. As of 2012, the US Supreme Court in the National Federation of Independent Businesses (NFIB) vs. Sebelius case upheld the constitutionality of Congress having the power to enforce this concept of individual mandate and penalize those who do not adhere to this policy which meant it would not be severed form the Affordable Care Act (Hornbeek, Lanese, Albugmi, & Filla, 2018). Individual mandate was upheld and continued to remain as an active practice.
Many continue to defend individual mandate as a part of the Affordable Care Act, however, the American Health Care Act of 2017 was not a plan to defend this policy. Defenses and motivators for individual mandate revolve around eliminating adverse selection, increasing purchasing decisions, and to protect against those who know that they cannot be denied insurance in the event that they develop significant health needs or are aware that an insurer cannot exclude
coverage for pre-existing conditions (Hall, 2012). These are reasons to support the idea of individual mandate as existing in Obama’s Affordable Care Act, however, is it appropriate?
The American Health Care Act of 2017 does not have direct support for individual mandate, however, there is not a complete opposition. This healthcare plan aimed to eliminate the penalties associated with not having basic coverage yet continuing to encourage Americans to purchase coverage. There are findings to support that there is a psychological influence over people with the individual mandate being present leading to more Americans purchasing coverage (Monahan, 2011). Some could argue that this is in fear of the penalties or it could be that having coverage is seen as norms and humans adhere to norms. With the elimination of the penalty, the American Health Care Act is continuing the support of Americans having health coverage but also protecting them from penalties if they make their own choice to not be covered. This can be seen as a success because the individual mandate is still providing pressure for Americans to be covered but the American Health Care Act is protecting their right to choose.
Women's Health
Individual mandate may be an area that the two healthcare plans both were able to partially succeed, however, in the case of women’s health there are two different approaches with these plans. The Affordable Care Act made great strides to help a group of Americans—women. The American Health Care Bill has been described by multiple organizations such as the Center for American Progress, as one of the worst plans for women. Where do these two healthcare plans differ so drastically that one has the support of the people while the other is under fire by the people?
The Affordable Care Act created great accomplishment for women’s health that many Americans were grateful for. This plan was supporting women’s health regarding pregnancy, preventive care, preexisting conditions, abortion coverage, and other areas of health. Obamacare was able to help one organization that serves women’s health specifically—Planned Parenthood. Planned Parenthood was an organization that received a lot of support based on the details of this healthcare plan because this organization believes in providing affordable healthcare and services for women’s health. The Affordable Care Act produced a budget and increased revenue for Planned Parenthood that faces a hit because of the changes from the American Health Care Act (Primrose, 2012). With these accomplishments for women and an organization that target women’s health, there are concerns of the implications of the American Health Care Act of 2017.
The American Health Care Act of 2017 is not where the fear or negativity arose toward those who do not support women’s health. Women’s health and organizations that support it such as Planned Parenthood have been under attack for years. Americans have been in fear of losing or never gaining access to the different services that the Affordable Care Act actually made possible. President Obama even faced pressure to remove funding from women’s health initiatives such as Planned Parenthood, but he initially refused and remained in support of his Obamacare (Primrose, 2012). The nation has not been particularly interested in women’s health needs since the birth of Planned Parenthood and the interest has only grown because of the increasing desire for social justice by the American people. Despite the fight for social justice and awareness, those in office still fight to revoke power for women’s health and the American Health Care Act did just that.
No, the American Health Care Act of 2017 did not completely wipe out all of the positive change, however, it did make enough changes to create disappointment among Americans. Women were still able to keep the accomplishment of Obamacare such as affordable maternity care, contraceptives, and screenings. The changes that this healthcare plan did call for were the removal of federal Medicaid funding from Planned Parenthood for one year, allowing states with the Medicaid block grant to no longer make family planning a mandatory covered service, redefine qualified health plans to exclude coverage for abortions with few exceptions, and prohibiting federal premium tax credits from being applied to abortion coverage (Henry J Kaiser Family Foundation, n.d.). Women face a significant impact with these changes, however, they attempt to fight to change back. Women who were in support of the accomplishments of the Affordable Care Act have shown resistance and hope to influence those in office to fight for women’s health since what is personal to women has to also be a political debate (Estes, 2017). Women made progress that was partially revoked by the American Health Care Act of 2017.
Financing
Another area in which the two healthcare plans differ would be financing—the Affordable Care Act has specific goals while the American Health Care Act has a variety of goals. The Affordable Care Act was designed to increase the Medicare payroll create new taxes on health insurance, and create new taxes on pharmaceutical manufacturers (Henry J Kaiser Family Foundation, n.d.). These are specific goals because they are large targets that were seen as needs to be executed. The Health Care Act had a wide range of goals that went from suspending the increasing Medicare payroll tax for high-wage individuals, taxing pharmaceutical manufacturers, repealing the limit on contributions to Flexible Spending Accounts, capping the federal Medicaid funding, and so on. This healthcare plan is one with a large agenda which could be beneficial, or it could fail.
The Affordable Care Act was looking to tackle large goals whereas the American Heath Care Act planned to tackle those goals and more. The American Health Care Act identifies a major provision as advancing, refundable tax credits based on age rather than income (Wilensky, The Economics and Politics of the American Health Care Act, 2017). This is a plan to accommodate and replace the income-subsidies for those not covered by Medicare or Medicaid in place by Obamacare. The American Health Care Act has other goals regarding finances, as stated, there is a more exhaustive listed compared to Obamacare. There is a plan to enhance Medicaid matched rates and work on converting it to a per capita block grant program (Wilensky, The Economics and Politics of the American Health Care Act, 2017). Are more goals better than a few targeted goals? It has been suggested that the Affordable Care Act is a large expense for little gain, while the American Care Act is too much to tackle. Which would be the more effective plan?
State Role
Surprisingly, the Affordable Care Act and American Health Care Act have some similarities regarding state role. The Affordable Care Act provided a foundation that the American Health Care Act used to elaborate on. The plan that President Obama created was that there would be a state-based health insurance exchange, an office of health insurance consumer assistance, and a permission for states to create a basic health plan for a specific group based on demographics/income (Henry J Kaiser Family Foundation, n.d.). The American Health Care Plan included each of these goals to an extent with added details. The initiative for this plan would be establishing new Patient and State Stability Fund, establish a new “Federal Invisible Risk Sharing Program,” establishing a state-based health insurance exchange while also allowing premiums, recreating state waiver programs, and continue to administer the Medicaid program with Federal matching funds (Henry J Kaiser Family Foundation, n.d.). Again, the American Health Care Plan supports some of the Affordable Care Act and has a more exhaustive goals list.
For the Affordable to Care Act to be successful, there was a need for support. The state policies and implementation practices were detrimental to determine whether this healthcare plan would survive (Weil & Sheppach, 2010). The states played a large role in whether this healthcare plan would be successful—their role was necessary for success. With the American Health Care Act still going through revisions and through the proper course to be enacted, there is little literature to determine the state’s role. With the two plans being very similar there could be the assumption for the same amount of state involvement. The Affordable Care Act needed help from the states in order to reach levels of success, so the American Health Care Act will need the same or more support from the states. States were assigned core support functions in order to create the needed support to the Affordable Care Act, so a similar approach could be taken with the American Health Care Act (Weil & Sheppach, 2010). The two healthcare plans are similar in what they need from the states and how the states will be implemented because of the specific goals.
Medicare
Obamacare meant to include coverage enhancements, changes to provider payments, and other alterations. The changes that this healthcare plan intended for were prohibiting Medicare Advantage plans from imposing higher cost-sharing requirements, eliminating cost-sharing for Medicare covered preventive services, reduce payments for Medicare Advantage Plans, Increase Medicare premiums for higher income beneficiaries, as well as various quality, payment and delivery system changes (Henry J Kaiser Family Foundation, n.d.). President Obama created goals for Medicare with the American people in mind, with the plan to benefit a large number of Americans.
The Affordable Care Act created positive changes for Medicare that allowed for growth while the American Health Care Plan could end up causing one of the slowest growths in history. During the transition from the presidency of President Obama, the nation experienced the slowest period of Medicare growth in years which can be associated with the changing views (Wilensky, Let’s Not Forget About Medicare, 2017). This views that were arising are ones associated with the American Health Care Plan. If the American Health Care plan were to ever pass into law, the nation may not experience the steady growth that was once being experienced.
Each healthcare plan has its own approach for Medicare, but are either of those plans making the correct approach? A suggestion based on research states that the changes to Medicare should be a change in structure, an increase in eligibility age, and a change in benefits that is modified or related to income (Wilensky, Let’s Not Forget About Medicare, 2017). Are either of these healthcare plans looking to make these changes? These changes may be secondary goals that are not as publicly displayed, however, these are the goals that should be sought out. The Affordable Care Act and the American Health Care Act may not be approaching Medicare effectively.
Conclusion
The Affordable Care Act and American Health Care Act of 2017 differ but they also have some similarities. With politics, there are plans passed and the ones following the initial plan will attempt to be drastically different. In this case, the overall approaches are meant to make the two healthcare plans looks drastically different, but after analyzing the stances on different topics, they are more similar than different. The American Health Care Act boast to undo and fix the problems that the Affordable Care Act created even though many of their points are simply making alterations to the existing ideas. There are some topics in which the two healthcare plans differ which would lead to the American Health Care Act overriding what currently exists. However, there are more similarities than there are differences between these plans regarding many topics. Each plan has its intended goals which could be altered or even elaborated on to be more appealing.
The issue with the need to choose one program of the other is that the places where the plans differ end up differing in support of different groups. Choosing a plan is all based on who is making the selection and how selfish they are. Many Americans are choosing to identify specifically based on their political party, some identify based on their various demographics. Will a selection for a better healthcare plan be made so one specific group wins or will a compromise be made? A compromise means that neither plan will, but a new plan will come from it to benefit a larger portion of people. Selecting a program is dependent on who is making the selection.