The ACA (Affordable Care Act)

The ACA (Affordable Care Act)

The ACA (Affordable Care Act), is the extensive healthcare restructuring that was enacted by the Obama administration in 2010. Commonly accepted as Obamacare, the regulation included the listing of health-related provisions to expand the coverage of health insurance (Center et al.,2017). At the time, the country had a high number of citizens who did not have health insurance. However, the recently elected President Trump and his administration have vowed to repeal and reinstate a better healthcare plan that will benefit all citizens. Congress is expected to repeal the Affordable Care Act before the end of their terms. The Republican party made numerous failed attempts in 2017. Regardless, by the end of 2017, the party was able to repeal the core element of the legislation, the individual mandate. The alterations affected other legislations such as the TCJA (Tax Cuts and Jobs Act). Support systems are yet to be developed to sustain the available individuals in the market place. They were to be completed in 2018. However, the individual market place is already experiencing an increment in premiums of up to 10%.

Nevertheless, there are high probabilities that the repeal process will experience additional challenges before significant alterations are achieved. The notion is based on the present bipartisan tensions and intraparty conflicts plaguing the government. The expected problems are further complicated by the present restrictive Republican Senate majority members. According to the ANA (American Nurses Association), the Senate has made limited progress in the repeal and replacement of the ACA, mainly due to the majority politicizing the process.

Question 2

Among the first actions of President Donald Trump after entering into office was placing an executive order that suggested all federal agencies comply with the ACA. The executive order was set as a gap stop while the government developed the planned repeal and replacement legislation. The first attempt at replacing the ACA was with the failed enactment of the American Health Care Act that repealed and replaced various ACA aspects (Kaplan & Pear, 2017). The most defined replacement as individual mandates, the government intended to provide insurers with funding to stabilize premiums. The strategy was aimed at encouraging market place participation through the “Long-Term State Stability and Innovation Program” (Kaplan & Pear, 2017). In other words, it repeals the core elements of the ACA, such as the tax augmentations, grants, fines, and directives.

The second attempt was with the Health Care Freedom Act (HCFA). The Act attempted to repeal the ACA’s mandate of all Americans having a cover. Secondly, larger employers would be required to offer all employees coverage. However, it would repeal the medical device tax for three years and defund Planned Parenthood for one year. Finally, it made it easier for States to control the Federal insurance conditions. The overall effect of the signing on to law the HCFA was that over 15 million Americans would have healthcare cover (Gamage and Shanske, 2017).

Additionally, the bill has capped and reshaped Medicaid limiting its expansion by defunding various critical aspects. In other words, by eliminating individual mandates, the coverage to all Americans will be halted as it also included citizens with costly preexisting conditions. Secondly, with reduced coverage, the healthcare system can be overloaded with ill patients, such as now during the COVID-19 pandemic. Finally, the elimination of tax modifications restricts the governments’ ability to make healthcare affordable (Butler, 2017). Overall, the new legislation has removed the requirement for all Americans to have healthcare coverage. The other aspects of the ACA are still in effect, confusing the healthcare sector. The effects of the legislation changes are not limited to the patients but also affect nursing as a practice.

Question 3

During the 2016 presidential elections, candidates emphasized on the divide between the different perspectives on the Patient Protection and Affordable Care Act of 2010. Current President Donald J. Trump pledged to revoke and replace the ACA. However, during the first weeks of office, the Republican congressional leader opted to repair the ACA. The implementation dates were moved from 2017 to 2018, coupled with the numerous scandals and publicity deeds, the nursing practice is severely affected (Furman, 2018). The ACA is still identified as the base of the American Health Care Act. However, the government has not yet released a payment reform strategy. The complicated health and payment reforms both in and outside the ACA makes it difficult for nurses to distinguish health policy issues. According to Rambur, the government’s changes focused on a payer-driven reimbursement system. However, it identifies how it is to fail due to the reduced number of covered patients. Nursing is to face challenges such as reduced employment rates and high turnover due to reduced wages (Butler, 2017). An additional aspect of the ACA that was revoked was the prohibition of insurance providers from denying coverage to individuals with preexisting conditions. The supreme court supported the element during its implementation. However, the changes have created complications resulting in unversed nuances with the determination of insurance rates.

Conclusion

Overall, the AHCA enactment paved the way for replacement of the controversial ACA; the new law offered citizens tax credits designed to promote the purchase of health coverage. Additionally, the funding for Medicaid will end starting in 2020; the changes further defined the already present socio-economic class differences between states. Finally, part of the ACA’s objectives was the reduction of uninsured citizens as well as expand Medicaid. The government would then absorb the expenses, the AHCA, on the other hand, reducing the number of insured citizens while stopping the support for Medicaid. The resultant effects are reduced coverage for individuals in weak performing states such as Florida, where the majority of its populations are elderly citizens.