The assignment aims to discuss the public policy of the government of the states of America related to health and health care sector. The provisions of the act introduced by the Obama government have created a political turmoil in the US senate.
The report has analyzed the effect of the act on socio-political level. The government’s intention to cover the population with health insurance has brought some major changes in individual insurance market, which includes new spending, this in terms are funded by the new taxes and curtailing some Medicare advantages and rates.
The report discusses the development of the act, various aspects that a welfare state intend to include in a public policy. The challenges thrown by political opponents, the support of the proponents and different controversial element surged in different levels of the society. The assignment concludes with the way the nurses are involved and affected with these changes and some recommendations that the act may include.
Shortening of the Patient Protection and Affordable Care Act due to Affordable care act (ACA) or Obamacare became a law when 111th US congress enacted and US President Barack Obama signed it. The nickname of the law that is Obamacare was first use by the Republicans, the opponents. Later it was supported by the Democrats and initially used by Obama.
The legislation along with Healthcare and Education Reconciliation Act has proved to be the most regulatory overhaul in US healthcare system. The provision started working with decreasing the uninsured number of people roughly and 20-24 million Americans were brought under the health insurance plan (Barnes et al., 2014).
The act aims to take effect from 2010 to 2020. It gained popularity from 2014 and has been called the most extensive health reform after Medicare and Medicaid in 1965 though few areas are remained untouched. Some changes are brought in employer market by the delivery system to make the law effective and penetrate every part of the population. In the individual, market some people remained unasserted. They are-
- The 8 million illegal immigrants are ineligible to have the insurance coverage.
- Eligible adults who did not enroll in Medicaid
- Citizens with insurance coverage costing more than 8% of income
- Citizens living in the states out of insurance reach or do not qualify existing Medicaid coverage.
The state has compelled the insurers to guarantee to provide cover to individuals irrespective or age and pre-existing conditions, which ensures the individual children with no insurance coverage by taking assistance from their families.
The insurance premiums must be equal for everyone. It may vary in the case of the oldest enrollees making it three times as large as for the adults.
The National Academy of Medicine has described the essential benefits of the policy as it provides hospitalization, along with emergency services, maternity and care for newborns; care mental health, including behavioral health treatment. The law provides services for women that approved contraceptive and sterilization procedures, counseling and health education (Buse, Mays& Walt, 2012).
In order to provide the population health insurance the state has made buying of insurance mandatory for the citizens and if not then they have to or pay penalty for not buying or delaying to subscribe in any employer sponsored health plan, Medicaid, Medicare or Tricare (Barr, 2016). The purpose of mandating is to secure the system of healthcare from yielding to adverse selection. This usually results in high premiums with little coverage for the uninsured.
The Federal subsidies that are given for the policies that are bought via an exchange are arranged for the poor people with incomes below 100% to 400% of the poverty line.
Risk Corridor Programs:
This program has been modeled on Medicare prescription drug benefits, which aims to encourage the insurers (Policy issues, 2017). The program operates to increase the participation so that completion increases and rate of insurance premium declines. Thus, the insurers providing qualified health plans are attracted and will be paid from general government revenues. Temporary reinsurance programs will be availed by the insurers against unexpectedly high claims.
Expansion of Medicare:
The expansion covers all the legal residents of any state below poverty line with including the adults without children depending on them. However, the Supreme Court orders the federal government allowing the states to continue funding at the levels of pre ACA and eligibility.
The State Children's Health Insurance Program :
The application process in the State Children's Health Insurance Program (CHIP) is made simple through this act (Schiller, Lucas & Peregoy, 2012).
Dependent’s insurance plan:
The health policy allows the dependents to continue on their parents' insurance plan until 26the of age. This also includes the dependents separated from their parents, no longer a student; do not depend on their parent's tax returns and unmarried.
Employer mandate aims to encourage the employers to provide insurance to their full time employees once the exchange starts working or pay a tax penalty.
Major Reforms in Delivery System:
The legislation has a delivery system to reform the aim to reduce the healthcare expense initially improving the quality of service. Payment changes are included which aims in depressing the hospital-obtained conditions and re-admissions, payment strategies, Medicare Center and Medicaid Innovation, the Payment Advisory Board, and foundation of Accountable care organizations (Mason, Leavitt & Chaffee, 2013).
The system aims for the replacement of the fee for the service with bundled payments where a single payment will be given to the hospital authority instead of individual payments.
The act has created Accountable Care Organizations with doctors, hospitals and other health care providers to provide high quality services for minimum cost. They receive bonus for reducing costs and enhance health service quality from the US government.
Former US President Barack Obama made the Obamacare or The Patient Protection and Affordable Care Act, known as the ACA, a law in 2010. It made much chaos when the US healthcare made the private health insurers to deny cover insurance illegal. They did it because of pre-existing conditions. The law expanded Medicaid coverage to those adults who could not afford health insurance due to low income. The law also made it mandatory that all Americans must have health insurance or pay a penalty. This ‘individual mandate’ was believed to be necessary for the economy to work. This made the young and healthy people to pay to the system, to reduce the costs of the ill and aged people. According to the contemporary opposition party the Republicans, the law has placed too many burdens on economy and hampers the job creation in US. After Trump became the president, the Republicans have been trying hard to repeal the law but have progressed a little. Republicans in the US have now largely failed to pass inclusive bills to replace Obamacare. Recently the Senate voted on a plan called ‘skinny repeal’ to revoke some parts of the act. Their chief aim is to nullify the ‘individual mandate’ part to remove the direction that requires the employers to provide health coverage for eight years. The amendment would not have touched the Medicaid or the changed federal subsidies that promised the low-income sector to pay for their health insurance premium. The Congressional Budget Office the official body that estimates the cost of proposed legislation says that Obamacare law if repealed, will leave 15 million Americans uninsured, and raise the health insurance premiums by 20% by next year (Tesler, 2012).
American Health Care Act of 2017 has inevitable effects on the stakeholders. Some of the organizations like American association for retired persons and California Pan-Ethnic Health Network oppose the policy as they think it will weaken Medicare and shift costs and risks to aged people (Prince et al., 2015). American Public Health Association strongly opposes as the government has taken drive to eliminate the Public Health and Prevention Fund has reduced subsidies and the change in Medicaid funding (US Department of Health and Human Services, 2013).National Health Law Program opposes the limitations and views the policies as preventative healthcare services. The advocacy group for older adults with low income opposes the law as it leaves millions of older adults uninsured (Friedberg et al., 2013). Only American Public Health Association termed the law as a good start because it places trust in the individual’s decisions by making beneficial use of health savings accounts.
The healthcare providers of America like American Academy of Family Physicians, American Congress of Obstetricians and Gynecologists, Association of American Medical Colleges, American Academy of Pediatrics and American College of Physicians think that the law will reduce healthcare coverage as well as benefits. The organizations like. The insurance companies and trade groups criticize the legislation because of the cuts to Medicaid. They intended to avoid the immediate threat of abolishing subsidies for the low-income group. They are not confident to include the creation of high-risk pools, as they were not funded before. On the other hand, the insurer like Anthem Insurance has supported the law as they find these policies will be beneficial for both the insurers and the patients.
The other interest groups like American Civil Liberties Union and Freedom Partners Chamber of Commerce have also opposed the act due to its inception.
Involvement of the Nurses:
American Nurses Association has opposed the AHCA and criticized the law for deducting the Prevention and Public Health Fund (American Nurses Association, 2017). The association thinks that the act will definitely endanger the lives of the patients and restrict them to access the care. As the act alters some of the pre-existing conditions, it will act upon the health of the people.
Keeping all these oppositions into view it can be recommended that the tax credits should have been revised so that it can be beneficial to all age groups like senior citizens and children as well as match with a family’s income.
Therefore, from the above discourse it can be deducted that the Affordable care act or the Obamacare has proved to be beneficial for the American population. Most of its provisions are advantageous to each income group. Despite the fact that it has faced hard oppositions from the opposition party, health providers, various interest groups and stakes holders, the act by Obama government has won popularity because of its welfare intention. The above discourse has therefore successfully descried the policies in detail, discussed its provisions, the challenges that the government has faced, the economic growth and finally the success to protect the interest of the people of America by providing the insurance coverage irrespective of age, gender and income.
Barnes, A. J., Unruh, L., Chukmaitov, A., & van Ginneken, E. (2014). Accountable care organizations in the USA: types, developments and challenges. Health Policy, 118(1), 1-7.
Barr, D. A. (2016). Introduction to US Health Policy: the organization, financing, and delivery of health care in America. JHU Press.
Buse, K., Mays, N., & Walt, G. (2012). Making health policy. McGraw-Hill Education (UK).
Friedberg, M. W., Chen, P. G., Van Busum, K. R., Aunon, F. M., & Pham, C. (2013). Factors affecting physician professional satisfaction and their implications for patient care, health systems, and health policy. Rand Corporation.
Mason, D. J., Leavitt, J. K., & Chaffee, M. W. (2013). Policy and Politics in Nursing and Healthcare-Revised Reprint. Elsevier Health Sciences.
Nursingworld.org. (2017). American Nurses Association. Nursingworld.org. Retrieved 23 September 2017, from https://www.nursingworld.org
Prince, M. J., Wu, F., Guo, Y., Robledo, L. M. G., O'Donnell, M., Sullivan, R., & Yusuf, S. (2015). The burden of disease in older people and implications for health policy and practice. The Lancet, 385(9967), 549-562.
Schiller, J. S., Lucas, J. W., & Peregoy, J. A. (2012). Summary health statistics for US adults: national health interview survey, 2011.
State.gov. (2017). Policy Issues. State.gov. Retrieved 23 September 2017, from https://www.state.gov/policy/
Tesler, M. (2012). The spillover of racialization into health care: How President Obama polarized public opinion by racial attitudes and race. American Journal of Political Science, 56(3), 690-704.
US Department of Health and Human Services. (2013). Health resources and services administration. Critical Care Workforce Report. Requested by Senate Report, 108-91.