Essay Sample on Historical Overview of the Affordable Care Act

Healthcare stands out as the primary concern in a civilized society. Upholding people’s health is a challenging task and calls for the design and execution of a robust program of public and financial support (Sommers et al., 2013). The fundamental objective of any healthcare bill is to ensure that medical care is reasonably priced and accessible to the broader population. The Affordable Care Act (ACA) was founded on similar objectives by ensuring that people below the poverty line would access quality healthcare. It sought to minimize disparities in access to care by promoting equality through an accommodating insurance system. ACA, also known as Obamacare, refers to a program that offers standardized medical expenses and allows everyone eligible to have coverage. It was signed into law on 23rd March 2010 and aimed at remodeling the US health systems to provide quality and affordable healthcare coverage for all US citizens (Blumenthal et al., 2015). The act transformed the health insurance sector by eliminating a chief discriminatory practice of omitting pre-existing conditions from coverage. A focus on the issues it was founded on, its core goals, eligibility process, beneficiaries, and opinions on the policy are essential to understand how ACA works and determine its effectiveness.

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Period Issues that Galvanized ACA

The cost and conditions of insurance stimulated the development of ACA. Before its implementation, health insurance rates were exorbitant hence unaffordable to many Americans. The only people who lived benefited from subsidies were people living below the poverty line and those above 65 years of age (Griffith et al., 2017). Such people would have their Medicaid premiums subsidized by the government. This arrangement, however, excluded many individuals and therefore left a large population of Americans uninsured (Frean et al., 2017). For instance, some self-employed persons could not access health insurance through their jobs, and minors lacked the means to meet the costs for healthcare. Additionally, in most instances, private health insurance companies denied coverage to people who had pre-existing or chronic medical conditions. Many people, therefore, had no insurance to pay for treatments.

The working poor were left uninsured and needed a program to cater for their healthcare needs. The prevalent misconception was that uninsured people were either unemployed or not wanting insurance (Griffith et al., 2017). However, the uninsured mainly comprised of working families that lacked access to or could not afford insurance or had lost their jobs. McKenna et al. (2018) outline that this group was more likely to die compared to the insured people since they often lacked a usual care source apart from the emergency room visits. Such individuals were more likely to delay or abandon needed medical care and go without preventive care due. The high costs required for medical care for uninsured persons were the primary deterrence to accessing care. It was thus necessary to formulate an accommodating coverage program to cater for all Americans equally by protecting such persons.

Main Goals of ACA

ACA had three main objectives, including reforming the private insurance market, expanding Medicaid to the working poor, and changing how medical decisions were made. In the reformation of private insurance, ACA required firms to provide comparable policies to all individuals with minimal variations allowed (Hellerstedt, 2013). Private insurers were required to accept more risks by avoiding the cancellation of policies or excluding pre-existing conditions and limiting their rate increments. For this approach to work, the government included subsidies to make coverage affordable, and everyone was mandated to purchase an insurance (Silvers, 2013). The aids increased people’s purchasing power leading to the competition insurance sector, which pressured providers to reduce premiums while providing better services and working more efficiently.

The ACA’s second objective was to expand Medicaid to the previously uninsured people. This goal would involve increased federal funding on Medicaid to include more people from the working force (Hellerstedt, 2013). Such people would be required to pay subsidized rates and pay low premiums that they could afford without much strain. As such, lower-wage workers would no longer remain uninsured and would have several benefits under Medicaid coverage (Silvers, 2013). By expanding health insurance, the US would rank better globally in various health indicators, such as life expectancy and infant mortality. Such a rating would be achieved since many people would have access to quality and affordable care.

Finally, ACA sought to change medical decisions to focus more on prevention than treatment. Hellerstedt (2013) highlights that traditionally, healthcare delivery systems majored on medication, and more funds were spent on treating preventable health conditions. ACA aimed at broadening incentives for the provision of preventive care besides providing more funds to public health agencies and communities for primary prevention programs (Silvers, 2013). Besides, the program aimed at improving the efficiency of healthcare by streamlining care delivery. The family practice would shift into a central role with a more effective payment structure hence enhancing the overall community wellness.

Key Features of ACA

The primary features of Obamacare include care, coverage for all, and costs. The act mandates most insurance providers to offer free preventive healthcare services. Such services may consist of cholesterol tests, mammograms, vaccinations, blood pressure, and diabetes screening (US Department of Health and Human Services, 2015). People under ACA are also allowed to seek emergency care in hospitals that are not included in their plan’s network without seeking prior approval (Hamel et al., 2014). Additionally, an individual can select any primary care provider as their doctor. With ACA, one can seek treatment from other specialists, such as OB-GYN, without first getting a referral from their primary care providers. Therefore, care is made flexible and easily accessible under this program.

ACA ensures coverage for all. It offers readily available healthcare plans that are similar for all US citizens regardless of their societal status. The programs are, however, categorized into various groups from which an individual can choose an appropriate option. Obamacare bars insurance providers from disqualifying people or offering limited cover based on their pre-existing conditions (US Department of Health and Human Services, 2015). All people are assured of equal coverage, including those that had other illnesses before applying for coverage.

Additionally, the plan offers subsidies for people who do not qualify for Medicaid and cannot afford based on their income levels. It allows for affordable premiums and deductibles to reduce people’s financial strain when paying for healthcare services (US Department of Health and Human Services, 2015). Individuals are given the right to appeal should an insurance company refuse to pay for a service or treatment. Moreover, insurance providers are barred from canceling one’s coverage if an individual unintentionally omits some information or makes a mistake when filling the application.

Another critical feature of ACA is cost. Previous insurance covers had specific annual limits for coverage beyond which one would incur off-pocket charges for care. Obamacare vetoes such limits on most benefits; hence enrollees do not have to worry about additional costs (US Department of Health and Human Services, 2015). Under this plan, insurance firms are obliged to expend the subscribers’ money by spending 80% of the premiums on direct medical care and enhancing the quality of care (Hamel et al., 2014). ACA also regularly reviews rates to protect enrollees and small businesses from any unexplainable increases. Furthermore, since drugs are comparatively more expensive in the US than Canada and other European countries, Obamacare allows US citizens to purchase medicines from such nations. As such, ACA has placed considerable measures to lower the cost of accessing care and prescriptions.

Eligibility Criteria for ACA

One must meet specific criteria to qualify for ACA. They must be currently living in the United States, a legal resident or a US citizen, and not currently incarcerated. Their income standard must be below 400 percent of the federal poverty level (Griffith et al., 2017). However, this level depends on the number of members in one’s household and the region where one lives in the US. For instance, contiguous standards are different from those of areas such as Hawaii and Alaska. As such, if an individual lives as a single person and makes more than 400 percent of the set income level, they may not qualify for subsidies (US Department of Health and Human Services, 2015). The government makes the last decision on one’s eligibility for these subsidies.

Beneficiaries of ACA

The primary beneficiaries of ACA are small businesses and low-income earners. Small companies are heavy dependants of Obamacare since the program solved the problems they faced before the legislation took place. About half of ACA’s enrolees are self-employed individuals and small-business owners and employees (Rosenbaum, 2011). Such people now have access to more affordable and better health coverage. Previously, small business owners often faced challenges insuring their workers and their occupations. Group plans were prohibitively expensive, and they had no protections for people with pre-existing conditions. Subsequently, most of them remained uninsured. Since the introduction of ACA, many firms have gotten insurance for their employees since the rates are reasonably priced (Griffith et al., 2017). Consequently, small businesses, employees, and owners can now get benefits that they were previously ineligible.

The other group that has significantly benefitted from ACA are the low-income earners who are closest to or below the federal poverty line. Such people have experienced the most significant reductions in un-insurance rates and health-related financial strains (McKenna et al., 2018). Previously, they were forced to delay care due to the associated costs or inability to afford prescriptions. Besides, healthcare access was limited, as they were forced to wait for more extended periods when seeking medical care. Low-income earners also seldom utilized healthcare facilities, which were witnessed by the poor health results for this group (Hellerstedt, 2013). However, after ACA, the numbers for people four times below the poverty line have increased in healthcare facilities. Such individuals can now afford to pay for care and prescription when they need it. As such, financial strains for citizens in accessing care have reduced, and the most vulnerable groups have reaped the highest benefits.

Arguments for ACA

The main groups that advocated for ACA include businesses and low and middle-income families, who would accrue the highest benefits from the program. These individuals reason that under ACA, quality of care will improve while lowering the associated costs. With the program, a substantial part of the cost burden is taken up by providers, and employers liable to pay insurance for employees, which reduces the financial strain for the less-moneyed people (Hamel et al., 2014). The legislation also offers a 35% tax credit on the total healthcare expenses to small businesses, which lowers their health plan costs (Rosenbaum, 2011). Additionally, a full tax credit is offered for companies with less than ten employees.