Patient Protection and Affordable Care Act (ACA; the informal name – Obamacare) is a U.S. Federal law signed by President Barack Obama on March 23, 2010. It is the legislative framework for health care reform, which has become one of the largest-scale projects in U.S. history since the mid-1960s. Moreover, this reform is considered the main achievement of Obama’s presidency. It was the first attempt to reform the U.S. medical system since the 1960s when President Johnson created the state Medicare and Medicaid programs to help pensioners and the poor. The administration of Bill Clinton attempted to carry out the current legislation; however, it was unsuccessful. Despite some positive aspects of ACA, on January 13, 2017, 6 days before Republican Donald Trump’s inauguration, the U.S. House of Representatives voted for a resolution that would initiate the process of repealing Obamacare. Hence, it is necessary to discuss its history, main results, as well as advantages and disadvantages.
The History of Medicare and ACA
Private health insurance does not address the affordability of treatment for many groups in the U.S. That is why the state has been forced to expand its involvement in health care funding. Hence, the Medicare national health insurance program was established in 1965. It was created for citizens of retirement age who wanted to solve health problems. The plan was entirely sponsored by funds deducted from corporate income tax, progressive income tax, and payroll tax. Due to the existence of this system, hospitals everywhere received part of their income, about half of the budget of these institutions, from the Medicare program.
As mentioned above, Medicare served older Americans and solved their health problems. Thus, most often, the program was used to get some preventive services, to undergo hospital treatment, or to be able to call a doctor at home to perform some therapeutic procedures (Kinney, 2015). Unfortunately, the program did not provide for long-term hospitalization and was not designed for disabled pensioners who needed medicines or medical equipment. Nowadays, the program is experiencing difficulties associated with the globally manifested aging of the population when the proportion of people of retirement age increases significantly, and the number of working-age population decreases.
More than that, since the end of the 1980s, health care spending has increased disproportionately in America. For example, over the past decade, the cost of insuring one employee has more than doubled. The insurance market provided by employers is extremely monopolized, which impedes the mobility of labor resources and creates conditions for discrimination of patients both before and after the conclusion of the insurance contract. The ever-rising cost of Medicare is one of the reasons for the acute US budget deficit. That is why the country is trying to reduce the cost of medicine, supporting the introduction of modern technology in the health care system and implementing reforms, one of which was the ACA.
On March 21, 2010, the U.S. Congress approved health care reform named Patient Protection and Affordable Care Act (Rawal, 2016). However, some of its provisions were found by the Supreme Court to be unconstitutional in 2012. In 2015, the Supreme Court heard a case on the legality of the application of tax credits to persons who purchase insurance on Federal exchanges, and this practice was recognized as legitimate.
The ACA Primary Goals
The reform began in October 2013 and involved several elements. The most important component was the introduction of the obligation of U.S. citizens to purchase health insurance if they are not insured (Boothe, 2014). The ACA was also intended to improve the conditions of health insurance for citizens who already have it. Thus, from January 1, 2014, employers and their insurers are no longer able to refuse to provide employees with health insurance. It concerns cases when before the start of the employment contract the employee has already been confirmed severe chronic diseases, such as AIDS or cancer.
Another ACA aim was to create exchanges for policyholders, through which it was possible to obtain a policy for those who could not get insurance from the employer. That meant that citizens are able to purchase insurance without the assistance of employers in specially created centers for this purpose. Moreover, the system of supplying elderly citizens with the necessary medicines was to be improved. It was also expected that the reform would create new 400 thousand jobs, and it would be possible to reduce the cost of an individual patient and invest more money in medicine. The program was designed to last ten years, and such stretched nature of the reform was to allow patients and market participants to adapt to it.
The Results of ACA
Overall, the number of uninsured Americans between the ages of 18 and 64 has declined today compared to 2010. More than 16 million American citizens obtained health insurance coverage within the first five years of the ACA, and young people “make up a large percentage of these newly insured people” (Roland, 2014, para. 8). From a financial point of view, however, the reform proved burdensome for the Federal government and state budgets, as total Federal and state spending on medicine has increased.
As for ACA effects on nurses, more health professionals are now working on their own in many poor and rural neighborhoods. The U.S. Bureau of Labor Statistics (BLS) predicts that “registered nursing is going to be one the fastest growing professions in America until 2025” (“What does Obamacare Mean for Nurses?” n.d., para. 12). What is more, the implementation of Obamacare has resulted in nurses’ increased salaries. Hence, these are the reasons why some health workers do not want this program to be canceled.
The ACA Agencies
In 2010, Congress created the Federal Insurance Office (FIO) by passing the Consumer Protection Act. It was charged to supervise all aspects of the insurance industry. Besides, the Financial Stability Oversight Council (FSOC) was established to monitor the financial services markets, namely the insurance sector, to identify potential risks. The ACA also found an agency, the main function of which was overseeing the Center for Consumer Information and Insurance Oversight (CCIIO), which helped implement many provisions of the program.
In spite of some considerable positive consequences of the Affordable Care Act, this reform meant increased government regulation and required large budget expenditures. As a result, it has been repeatedly sabotaged by some representatives of the House of Representatives and criticized by experts. The main reason for the setback is that the insurance plans offered by companies were unattractive to patients. Furthermore, they cost people more than the payment of a monetary penalty imposed by the state on those who refused to buy insurance.
Boothe, M. G. (2014). The Affordable Care Act: The implications for your tax returns. London, UK: Milton Boothe.
Kinney, E. D. (2015). The Affordable Care Act and Medicare in comparative context. Cambridge, UK: Cambridge University Press.
Rawal, P.H. (2016). The Affordable Care Act: Examining the facts: Examining the facts. Santa Barbara, CA: ABC-CLIO.
Roland, J. (2014). The pros and cons of Obamacare. Sullivan, D. (Ed.). Web.
What does Obamacare mean for nurses? (n.d.). Web.