The Patient Protection and Affordable Care Act, also known as The Affordable Care Act (ACA), is a policy, or federal statute, signed into law by Barack Obama on March 23, 2010. The enactment of this policy serves as one of the largest changes to the American healthcare system since the passage of Medicare/Medicaid in the mid-60s (Cohen et. al, 2015). Because of its importance in the overall landscape of daily American life and medical infrastructure for generations to come, it’s equally important that the policy is analyzed, and its impact is understood so that it can be improved upon in the future and dealt with properly in the present.
01. Definition and Overview of the Affordable Care Act
What is the Affordable Care Act?
The Affordable Care Act is a federal statute, also known as a law or policy, that is meant to streamline the current market-based U.S. medical and health insurance system/industry with one that attempts to ensure that all citizens are covered under some type of insurance plan and can receive the medical coverage they need (Congressional Budget Office, 2011).
What is the nature of the problem being targeted by the Affordable Care Act?
The problem being targeted by the Affordable Care Act is the fact that the U.S. medical infrastructure is market-based which often has the effect of leaving people who don’t fit the insurance companies’ requirements without any way to seek medical care. The problem was presented by the 111th Congress, which is responsible for the policy along with former President Obama (Kaiser Family Foundation, 2013). There needed to be a way to create some type of universal health care without dismantling the insurance industry. This becomes a dual problem because people need to be able to go to the doctor when they are sick but there would be great economic consequences to dismantling an entire industry within the country and would require a very large overhaul.
What is the control of the Affordable Care Act?
There are several other policies that are together with the Affordable Care Act, the basis for the social benefits system of the United States, especially considering that a lot of the policy is simply an expansion of previous social policies such as Medicare and Medicaid. It is essentially a single-payer healthcare system that is supported by an expansion of the previous social healthcare services, while also introducing new regulations to insurance companies to ensure maximum coverage (Kaiser Family Foundation, 2013).
Choice Analysis
One of the biggest problems within an analysis of this policy is the maintenance of the single-payer market system over simply instituting a universal healthcare system. Because of a previously instituted policy, 1986’s Emergency Medical Treatment and Active Labor Act or EMTALA, everyone who comes into an emergency room must be treated and when they can’t afford to pay, the government eats the cost (Butler, 1989). This could be used to argue that the government already eats the cost of universal healthcare, and in fact, eats a larger cost because it pays market cost instead of having already previously defined a budget. This system expands social services but maintains a single-payer healthcare system.
The Affordable Health Care Act attempts to match this by instituting several provisions and allocations such as subsidies, tax breaks, and the previous mention expansion of social benefits, which are regulations forcing insurance companies to accept people they otherwise might not have based on pre-existing conditions or more arbitrary factors. There were also clauses issuing tax penalties against employers who do not pay for their employees’ insurance to incentivize companies to maintain paying for their employees’ insurance. Because this was not a truly universal healthcare strategy, US citizens couldn’t simply be signed up for the plan and instead how to figure out their new medical coverage by themselves, essentially through their own research, but the overall reforms instituted restrictions on price and exploitative tactics, and to increase the overall quality of the US medical institutions. The social bases of allocating these resources were the belief that this would be an all-around better alternative for the lower class (Butler, 1989).
02. Historical Analysis
What policies were developed earlier to solve this problem?
The interesting thing about this policy is that it was the same one proposed by the Republicans, through work done by The Heritage Foundation when they rejected Bill Clinton’s proposal claiming it would do too much damage to the nation’s towering debt (Butler, 1989). This single-payer healthcare system has always been the Republican compromise to universal healthcare, and the current rejection of it by its originating party is a little strange.
How has The Affordable Care Act developed over time?
The Affordable Care Act has a nearly 30-year-old history within the government. It has had many names including 1993’s Health Equity and Access Reform Today Act and the Healthy Americans Act. The overall structure of the policy hasn’t changed much at all, but it has been denied multiple times. Often, it will get bipartisan support but then lobbyists make it clear that they won’t support the politician’s campaign next election, and the policy fails to go through (Cohen et. al, 2015).
What does history tell us about effective/ineffective ways to deal with this problem?
History doesn’t tell us a lot about this situation because unfortunately, this seems to only be a problem in the U.S. Other first-world nations have already instituted their own versions of these programs, and every single one of the nation’s attempts to pass the current policy took decades and was constantly foiled by the very industry it was trying to preserve. But overall the past, present, and future point to universal healthcare (Cohen et. al, 2015).
To what extent does the current policy consider lessons learned from history?
It is the exact same policy with the exact same pitfalls it always had. This time it managed to get through and was immediately gutted by the new Congress. The policy does not aim to avoid the mistakes of the past, and in fact, repeats them almost in their entirety.
Are we repeating mistakes from the past, if so, why?
We are repeating mistakes simply because no one can do anything differently. If the insurance companies are the ones stopping you from reforming their industry then simply take them out of the equation, and do not try to work with something that has no incentive to work with you. If you want to create universal health coverage for Americans in some way, then you can’t take orders from the people who will be put out of business by what you are trying to accomplish. The medical infrastructure of the country should not be trying to turn a profit and that’s the biggest mistake from the past.
03. Social Analysis
The problem the Affordable Care Act is trying to solve
The problem that the Affordable Care Act is trying to solve is the fact that there are millions of Americans without health insurance, and no medical coverage, which means when the time comes for them to seek out medical assistance, they can’t afford it and do not receive the help they need. This is compounded by the fact that this sort of problem affects the most vulnerable members of society with even more adverse circumstances, causing them a lot of damage in the long run. The goals of the Affordable Care Act were to alleviate as much of that suffering as possible while maintaining the current industry mostly as is.
What are the major social values that relate to the problem and what conflicts exist?
The major values that affect and relate to a problem like this are the ideas of whether one should help people in need or make it the individual's responsibility to look after themselves. If they cannot provide for themselves, they can’t have anything. Or the notion that you should help other people when you can, the idea of pooling resources together to provide something better than anyone could have on their own. It’s basically a conflict between being in a society where you work together with people and living in a culture that is “dog eat dog.”
What are the goals of the Affordable Care Act?
The goals of the Affordable Care Act are to provide coverage for all US Citizens under a single-payer healthcare system, which would function as if it were like universal healthcare. This would prevent “free-loaders,” or people paying for things they thought they should not have to pay for, such as other people's expenses (Cohen et. al, 2015).
What are the hypotheses implicit or explicit in the Affordable Care Act’s statement of its problems and goals?
The hypotheses are essential that it’s more important to provide affordable coverage than provide real medical benefits nationally. This means that some entity wants to make money from the healthcare industry. Also, affordable means that you still pay, and that there is still money made somewhere. The nature of the policy makes it clear that it would rather preserve an industry than create medical infrastructure in its nation that can last for generations.
04. Economic Analysis
Macroeconomic Analysis
On a macro level, the government did not see nearly the impact that some people thought there would be. If the program was handled responsibly with proper allocation of resources, it had no real negative or positive macro impact which is actually very good because it seems to be what the government wanted. Essentially, this is a reform on the current policy that would simply provide coverage for many Americans. There were complaints at a state level involving the expansions of social services, but the government did its best to match the states for expenses following the expansion.
Microeconomic Analysis
On a micro level, for individuals, this was a successful reform for the insurance and healthcare industries. It reduced the cost of medical work for a lot of people and overall did a lot of good for the most vulnerable members of society. On a micro level, this affects the taxes of the 1% but at negligible damage to their bottom line. This allows everyone more economic freedom and could be considered a boost to the economy. It’s important to note that this had a net beneficial effect on the lives of many underprivileged Americans while not doing damage to the other classes in the attempt, and that is an economic success on a micro-level.
Opportunity Cost
It’s honestly a bad opportunity cost simply because it’s a policy that has been trying to get through for decades and has been stopped by the very industry that it would put out of business. It would be more effective to simply negate the industry and institute a state solution that provides infrastructure instead of coverage. This system keeps an unnecessary middleman alive for the sake of not doing surface damage to the economy. On one hand, it would be a hit to a lot of people for the insurance industry to be liquidated, but a lot of those people can be transitioned to government work, and subsidies can be provided for those who were affected badly by investments. Overall, it’s a high-cost system but still better than the previous system.
05. Political Analysis
Who are the major stakeholders regarding this policy?
The major stakeholders in this policy are the insurance companies, their shareholders, the American people, and the politicians who need them for re-election. Each of these groups is either trying to get the most they can out of the situation or are altogether unhappy with how things are going. The insurance companies know that universal health care would be the end of their industry and their shareholders certainly don’t want that either. The American public is being pulled in two different directions that are really the same direction. This means that the Affordable Care Act is the same policy the Republican party had been pushing for decades but when the Democrats presented it to them, they denied it because their voters, frankly, disliked the Obama administration.
How has The Affordable Care Act been legitimized? Is that basis still considered legitimate?
A lot of the basis for its legitimacy is the fact that it really did get millions of Americans covered with insurance, added to the fact that for most of its political career, it was exactly the compromise most of the government wanted. The fact that the current reform would wipe away that progress only legitimizes its success even more.
What are the political aspects of the implementation of this program?
The most political aspect of the implementation of the program is its long life as a Republican policy that then got morphed into a Democratic policy by the political climate of the time. So, it took a lot of time and effort for any part of the system to go through. There were a lot of committees and rumors, such as “death panels” that would decide whether your grandma was too old to be alive. There was a lot of political mudslinging over this, but it was mostly from politics and not the policy itself (Butler, 1989).
To what extent is The Affordable Care Act an example of national decision-making, incremental change or change brought about by conflict?
The Affordable Care Act is in a lot of ways all three. It appears it’s something the nation has wanted for a while, considering we have Medicare and social security already. Also, adding to the fact that many other first-world nations have universal healthcare systems, it’s no surprise that Americans might want their own sort of system. The policy itself presents incremental change toward the wider goal of protecting everyone with national coverage, not itself an end-all and be-all. Finally, there has been a lot of fighting politically, socially, and nationally over health care so if wasn’t caused by conflict then it certainly stirred conflict up.
06. Social and Economic Justice
Upon reviewing the NASW Code of Ethics pertaining to social and economic justice for oppressed and at-risk populations, discuss what social and economic justice is accomplished through this policy.
The social and economic justice accomplished with this policy regarding the NASW Code of Ethics is that more people were given the coverage that they desperately needed to be able to seek out medical help when needed with no great personal cost to the most vulnerable members of their society. According to the Congressional Budget Office (2018), most of the cost of providing people coverage was made up for within the taxes of the top 1% of income earners, which was not enough to damage their overall security while maintaining our ethical standards not to do harm to others and in fact improve their lives.
What are the gaps?
The gaps are that there are caps to this sort of infrastructure, meaning that a company wants to turn a profit, not ensure that every American is to receive the health care they need. This means that there will always be gaps in coverage in the spaces where the business thinks it couldn’t turn a profit. It seems unethical to deny someone proper assistance because you wouldn’t be able to make any money from it. If it’s not in insurance companies' best interest to pay out to their customers, if it’s in their best interest that they get paid and no one ever goes to the doctor at all, then they shouldn’t be the healthcare system.
07. Policy Evaluation
What are the outcomes of the Affordable Care Act in relation to its stated goals?
The Affordable Care Act in relation to what was previously in place has greatly improved. Its stated goal was not for a truly universal healthcare system within the United States, but its goal was mostly to provide some type of insurance so that Americans may seek out medical care when they needed it. According to the Congressional Budget Office (2018), around 22 million people who previously would not have had coverage currently do. While one can always state that it would be preferable to have real universal coverage, that is a huge challenge, and considering all the challenges this sort of system faced just trying to become a policy, it is not surprising this sort of compromise was made.
What are the unintended consequences of the policy?
Some of the unintended effects of the Affordable Care Act are the changing of previous policies so that some people simply didn’t have the sort of coverage they had before and were left to sort it out using the provisions allocated by the Affordable Care Act. It also had strange political consequences, despite ACA being a Republican design it was dubbed “Obamacare” and attributed to him, though the policy is much older that his administration.
Is the policy cost-effective?
The policy is not cost-effective because it maintains a market system that is more expensive than any universal system while trying to maintain an expanded social service that wasn’t really equipped to handle the problems it already had. It succeeds in maintaining a status quo with improvements and regulations, but it is the fact that it doesn’t go far enough and keeps the market and all the expenses that go along with private companies. It also hopes that a fearful industry will not do its best to find profit where it can because its business model is becoming obsolete and considering most of the first world has universal health care systems, has been outdated for a while.
Current Proposals for Policy Reform
Current proposals for policy reform included the left-wing and right-wing varieties, the left-wing wants the policy to go even further and simply become a universal health care system, with many such systems being proposed, seeming to be copies of the Affordable Care Act in some respects. The Republicans, however, have already instituted their reform known as the AHCA, or the Affordable Health Care Act, which is essentially a stripped-down version of ACA that would reduce the gains made by the previous policy. This could potentially leave more people uninsured. It mostly operates as a tax break for the wealthy, recovering the money lost in the previous policy reforms (Congressional Budget Office, 2018).
A proposed policy that identifies the gaps in the policy under review
A proposed policy that addresses the gaps in the current one will always simply be a system of universal healthcare, like those of the other first-world nations, covered by taxes. Most would be easy to obtain if many major businesses in the U.S. paid taxes, instead of trying to work around markets and people’s attempts to make money. It could be argued that ACA was simply a step in the right direction but not what the nation was hoping for. This sort of policy is truly meant to reduce inequality amongst the American people, and if that is the aim then it should try its best to do so and not just make a halfhearted attempt.
References
Cohen, Alan B.; Colby, David C.; Wailoo, Keith A.; Zelizer, Julian E. (June 1, 2015). Medicare and Medicaid at 50: America's Entitlement Programs in the Age of Affordable Care. Oxford University Press.
Butler, Stuart M. (1989). 'Assuring Affordable Healthcare for All Americans' (PDF). The Heritage Foundation.
'CBO's Analysis of the Major Health Care Legislation Enacted in March 2010'. Congressional Budget Office. March 30, 2011.
'Health Coverage & Uninsured'. Kaiser Family Foundation. June 20, 2013.
CBO-The Distribution of Household Income, March 19, 2018.
'Analysis Of A Permanent Prohibition On Implementing The Major Health Care Legislation Enacted In March 2010'. Congressional Budget Office.
'Chart: Comparing Health Reform Bills: Democrats and Republicans 2009, Republicans 1993'. Kaiser Health News. Maggie Mertens, 2010