Affordable Care Act (ACA)

 Affordable Care Act (ACA)

As a nurse practitioner working with vulnerable groups am against repealing the Affordable Care Act (ACA).It has been a decade now since the ACA came into effect and the healthcare policy has faced challenges, particularly from the Republicans. The Trump administration seeks to repeal the entire ACA after previously pushing to remove the law’s protection for people with pre-existing conditions. Although the law has not sufficiently addressed many issues in healthcare as was hoped, its benefits have been far-reaching leading to a decrease in the number of uninsured Americans, making coverage affordable, and expanding access to care. Repealing the ACA would have the unintended consequence of reversing these benefits and locking eligible citizens out of insurance.

In the ten years, the ACA has been in effect, approximately 20 million people have become newly insured, and about 24 million people have attained access to subsidized or free care through Medicaid expansion and marketplace tax credits. Despite the achievements, the law has faced stiff political opposition from its onset. Both sides of the political spectrum have been calling for its repeal, replacement with alternative forms, or modification of the law to address other goals.

Proposals for alternatives range from maintaining the ACA with no changes, replacing the law with a single-payer system, repealing the law without a replacement, to replacing the law with other measures that address expansions through Medicaid and the individual market. Proposals affecting critical provisions of the ACA include repealing the individual mandate, revising market regulations, modifying tax credits, and amending Medicaid expansion.

Repealing the ACA with no replacement would lead to a 19.7million drop in the number of insured Americans from 251.6 million to 231.9 million, a $4,200 increase in the out-of-pocket costs for an enrollee in the individual market from an average of $3,200 to $7,400, and an increase of $33.1 billion in the federal deficit annually because it would eliminate ACA’s revenue-raising provisions.

Two laws were proposed to replace the ACA with a single-payer plan. First, the American Health Security Act, introduced in 2011 by Senator Bernie Sanders, in which a Medicare-for-all plan would replace the ACA as well as Medicare, Medicaid, and SCHIP with a federally managed single-tired coverage. The downside of this Act is that it does not allow private insurance, and there is little or no cost-sharing for enrollees. Second, the Health-Insurance Solution in which Medicare and Medicaid continue with all other citizens having income-dependent coverage and individuals have the option to purchase supplemental private coverage. However, such a plan would face severe obstacles from insurance firms and would entirely alter the landscape of insurance in the country.

The Patient Choice, Affordability, Responsibility, and Empowerment Act (CARE) propose the elimination of the ACA’s individual and employer mandates, flexing of regulations on insurers, eliminating the ACA’s taxes and fees, and withdrawing funding for Medicaid expansion. Also, the Act offers tax credits to low-income individuals but uses a different structure to ACA to assist them purchase insurance. However, premium support provided would not be adjusted to account for healthcare cost growth and regional variation in premium levels despite being based on income and family size. Thus, enrollees would be responsible for any difference between the cost of the premium and the tax credit. Furthermore, CARE would increase the number of uninsured Americans by 9 million.

The American Health Care Act (AHCA) was passed by the House and makes sweeping changes to the ACA which include repealing the individual and employer mandates, establishing work requirements, changing ACA’s age-based banding from 3:1 to 5:1, replacing income-based subsidies, converting federal Medicaid funding to a per capita allotment ending Medicaid expansion by states. Evidence from states implementing waivers on work requirements shows that the programs go against the objective of ACA and Medicaid of expanding health coverage and instead lockout eligible citizens from accessing insurance.

In conclusion, the ACA had been successful in its primary objective of reducing the number of uninsured Americans and expanding access to care. From a health point of view, patients are the greatest beneficiaries of ACA’s provisions. Challenges faced by the ACA are more focused on its implementation rather than its outcomes. Furthermore, ACA has more benefits than each of the proposed Acts. Therefore, it is not to the best interest of vulnerable Americans to repeal the ACA.