Affordable Care Act-Position Paper

Affordable Care Act-Position Paper

Position in Favor of the Policy

Affordable Care Act increased insurance coverage in the country. According to McIntyre and Song (2019), the law provided low-income individuals with incentives that enabled them to purchase insurance covers at a relatively low price. Additionally, the law expanded the number of persons eligible for the Medicaid program. Under ACA, individuals from households whose earnings do not exceed 138 percent of the national poverty line are eligible for the Medicaid program (McIntyre & Song, 2019). At the same time, ACA sought to protect insurance holders from malicious health insurance providers. For instance, ObamaCare prohibited discrimination perpetrated against patients based on the latter’s health status (McIntyre & Song, 2019). As a result of the various measures aimed at making the costs of insurance covers lower, the ACA increased the number of Americans who have insurance covers. Wallaceand Sommers (2016) claim that the number of Americans with insurance covers increased by at least 16 million after the enactment of ACA.  As such, various initiatives adopted by ACA resulted in an increase in the number of Americans who have insurance covers. In addition to enhancing the coverage of preventive services, ACA aimed at reducing disparities in access to healthcare. According to Wallace and Sommers (2016), individuals without insurance covers differ substantially from their insured counterparts in the areas of sociodemographics, likelihood to use healthcare services, health behaviors, and baseline health status. People without insurance covers are unlikely to visit hospitals unless they are very sick.

At the same time, ACA enhanced the coverage of preventive services. According to Wallace and Sommers (2016), ACA necessitated the provisions of preventive services care to insurance cover holders. Preventive care ensures that people have their conditions diagnosed as early as possible in order to reduce the cost of treatment. On this note, a study that showed that eligibility to Medicaid program was associated with increased probability of a person receiving a pap test (45%) and a mammogram (60%)(Wallace & Sommers, 2016). Preventive care may translate to people living longer and having an improved sense of wellbeing.

Position Against the Policy

One of the negative implications of ObamaCare is that this piece of legislation resulted in a significant number of Americans losing their insurance covers. According to Manchikanti, Helm Benyamin and Hirsch (2017), 6 million Americans lost their insurance as a result of the Affordable Care Act. This is because ACA resulted in an increase in the costs of insurance premiums. The new insurance premiums were unaffordable to a substantial proportion of America’s population.

At the same time, the ObamaCare did not directly result in a decrease in the number of uninsured Americans. The increase in the number of insured Americans following the enactment of ACA to a larger extent is based on the Medicaid expansion. Manchikanti et al. (2017) say that “Thirteen million of 20 million newly insured were confirmed to be enrolled in Medicaid” (p. 115). This suggests that the Medicaid program should be heralded for increased insurance coverage in the country and not the Affordable Care Act.

Besides, ACA resulted in an increase in out-of-pocket expenses and costs of health insurance. For instance, the out-of-pocket expenses increased by 12% between 2014 and 2017 (Manchikanti et al., 2017). The increase in the out-of-pocket expenses and costs of health insurance premiums is not a perfect reflection of the changes in people’s earnings or inflation rates. For instance, the insurance premiums paid by employees increased by 20% between 2011 and 2016 in comparison to 6% change in overall inflation and 11% for worker’s earnings (Manchikanti et al., 2017). The increase in costs of health care insurance premiums resulted in many Americans losing their covers. Also, the increase in-out-of pocket expenses mean that a person may avoid visiting a  healthcare facility despite him or her having an insurance cover in a bid to avoid incurring higher costs when buying drugs or paying for the consultation.

Response to the Argument in Favor of the Policy

            The Affordable Care Act had mixed results for different demographics. This piece of legislation increased the insurance coverage in the country. However, the ObamaCare Act focused on expanding insurance coverage among the poor but ignored the middle and working classes. Individuals with household earnings of more than 40% of the national poverty line constitute 40% of the America population (Manchikanti et al., 2017). This group does not receive any support from the ObamaCare despite it contributing a significant proportion of the country’s population.

At the same time, Manchikanti et al. (2017) argue that cost reductions associated to ACA do not consider “Factors such as the recession, increased out-of-pocket costs, increasing drug prices, and reduced coverage by insurers” (p. 11).  This means that it is possible that the reduced costs of healthcare that occurred after the passage of ACA are not as a result of the efficacy of this piece of legislation but can be attributed to changes in the country, such as the effects of the recession. Also, the positive effects of ACA, such as reduced healthcare costs, are countered by an increase in drug prices and out-of-pocket costs.

Additionally, ACA aimed at enhancing the utilization of preventive care. However, “Only 3% of health care expenditures have been spent on preventive services while the costs of managing chronic disease continue to escalate” (Manchikanti et al., 2017).  This means that the federal government does not provide an adequate amount of money to facilitate the delivery of preventive care. Also, previous researches that have examined high-deductible health plans have found out that patients tend to reduce their use of potentially important care when they are faced with higher cost-sharing (Wallace & Sommers, 2016). Also, having an insurance cover does not mean that a person will get access to the services he or she needs. For instance, a 2015 study revealed that a third of insured Americans were unable to access certain healthcare services they needed, such as prescription drugs and dental care (Manchikanti et al.., 2017). This means that increased insurance coverage does not directly translate to increased access to healthcare services for all people.

Response to the Arguments Against the policy

            The number of Americans who became insured as a result of ACA is higher than their counterparts who lost their covers. According to a 2015 study conducted by the RAND Corporation, “From 2013 to February 2015, 22. 8 million Americans became newly insured and 5.9 million lost coverage” (Manchikanti et al., 2017, p. 117). This study demonstrates that the number of those who became insured was far higher than those who lost their insurance covers after the passage of ObamaCare. As such, ACA had more pros than cons as far as increasing the number of Americans with insurance covers is concerned.

Also, one may claim that the benefits associated with an increased number of Americans with insurance covers should be attributed to the Medicaid expansion. Thus, the Medicaid program should be given more credit and not the ACA as far as the increase in insurance coverage in the country. However, Medicaid expansion was part of the ACA. According to McIntyre and Song (2019), one of the provisions of Obamacare Act was the expansion of Medicaid program for people earning not more than 138% of the national poverty line. As such, it is evident that the benefits associated with Medicaid as far as the increasing the number of insured Americans is concerned can directly be attributed to ACA.

Besides, one may suggest that the ACA had negative effects on the costs of health insurance premiums and out-of-pocket payments. This assertion is justified since it is supported by existing data, as demonstrated above. However, there is a silver lining in regard to the per capita healthcare expenditure. On this note, the U.S per capita health expenditure has declined significantly. As a result, the country’s global ranking as far as the per capita health expenditure has changed from position one to three (Manchikanti et al., 2017). This suggests that the ACA has had some positive implications on the country’s health expenditure. At the same time, Wallace and Sommers (2016) argue that ACA is associated with enhanced access to preventive care and better health outcomes. This may justify the higher out-of-pocket payments and costs of insurance premiums associated with the passage of ACA.

References

Blau, B. M., Daines, B., Karl, J. B., & Wade, C. (2016). Key Stakeholders’ Stock Returns and the Affordable Care Act. Journal of Insurance Regulation, 35(9).

Manchikanti, L., Helm, S., Benyamin, R. M., & Hirsch, J. A.  (2017). A critical analysis of Obamacare: Affordable care or insurance for many and coverage for few. Pain Physician, 20, 111-138.

McIntyre, A., & Song, Z. (2019). The US Affordable Care Act: Reflections and directions at the close of a decade. PLoS Medicine, 16(2).

Wallace, J., & Sommers, B. D. (2016). Health insurance effects on preventive care and health: a methodologic review. American Journal of Preventive Medicine, 50(5), S27-S33.