The urgency of the modification of the U.S. healthcare legislation was caused by a number of concerns and shortcomings of the then existing regulations. According to Ogundipe et al. (2015), “rising costs of health care coupled with lack of access to health insurance affected many Americans” (p. 51). A considerable part of the population remained uninsured, and the percentage of such people was growing. This paper analyzes the intended purpose of the Patient Protection and Affordable Care Act (PPACA), determines whether the quality of health services has improved, and identifies and discusses the four mechanisms that have been implemented.
Intended Purpose of the PPACA
The PPACA was adopted in order to address all the issues mentioned above. Ogundipe et al. (2015) state that the basic goal of the reform was “to increase access to health care while reducing or eliminating many of the consequences of not having health insurance” (p. 53). The measures stipulated by the law were aimed both at reducing the cost of health insurance for particular citizens and at modernizing the health insurance market. These include, but are not limited to, the obligation to acquire health insurance, the introduction of tax credits for individuals and families, the expansion of the Medicaid, and the establishment of health insurance marketplaces. These policies are interrelated and together address the intended purpose of the reform.
The expansion of the Medicaid program and the creation of health insurance marketplaces implemented by states or the federal government for them enable people to meet the obligation to acquire insurance adequately. Ogundipe et al. (2015) provide data that the PPACA will allow covering 37 million uninsured Americans (p. 54). The act also prohibits insurance organizations to apply several restrictive provisions in insurance policy regarding refusal to provide insurance in some instances, insurance limits, withholding of insurance benefits, and cancellation of insurance. Thus, people who already have insurance become more secure and appear in more advantageous conditions.
This leads to the assertion that the PPACA has taken significant steps towards its intended purpose. It should be noted that this objective has not yet been fully achieved, as not all relevant forecasts have been implemented. Furthermore, the measures provided for in the act are of a continuing nature in order to allow market participants to adapt to it. Nevertheless, it should be mentioned that the act has several opponents.
The PPACA has many critics who believe that its application will cost excessively much, although, in the distant future, the law will be designed to reduce budget spending on the health care system. One of the first victories of the opponents of the act is the June 2012 U.S. Supreme Court decision, which recognizes that the refusal of states to expand Medicaid within their jurisdiction is legitimate. Moreover, since the adoption of the act, the Republicans have repeatedly voted in favor of repealing the act in whole or in part. At present, the fulfillment of the intended purpose of the PPACA largely depends on whether it will be able to withstand the legislative struggle of its supporters and opponents.
Quality Issues and Mechanisms Implemented
It should be noted that the reform was intended to improve the quality of the health care system. The authors of the article declare that expensive cost of services, insurance companies’ disadvantageous policies, and, as a consequence, a considerable quantity of the uninsured Americans negatively affect the quality of provided health care (Ogundipe et al., 2015). People can afford to access a rather narrow range of health services and consult physicians much less frequently. Thus, preventative medicine is almost non-existent and many serious illnesses may not be detected.
The measures stipulated in the act designed to address this issue should be considered in more detail. This is primarily “the individual mandate” that “requires citizens to carry health insurance” (Ogundipe et al., 2015, p. 50). Citizens are liable to a tax penalty for failure to comply with this requirement, but this sanction has been abolished as of 2019. This requirement is the basis for meeting the goal of reducing the number of uninsured Americans and operates in conjunction with three other policies.
Providing tax credits for people with less than average income was intended to assist in obtaining insurance for those who are not impoverished, but still need some financial support. Researchers state that “tax credits became available for Americans with incomes between 100% and 400% of the federal poverty line” (Ogundipe et al., 2015, p. 53). Health insurance marketplaces were also created as an alternative to the monopolized and expensive insurance services market, allowing individuals and small businesses to make more balanced and profitable choices. They should be created either by the states themselves or by the U.S. Department of Health and Human Services that will establish a marketplace within the state.
In order to ensure that the low-income population has access to health insurance, Medicaid was supposed to be expanded. According to the PPACA, “states receive substantial federal funding to expand Medicaid to all residents with incomes at or below 133% of the FPL” (Ogundipe et al., 2015, p. 56). However, the court decision mentioned above has created a dangerous situation where the most vulnerable segments of the population may not receive this assistance.
It should be noted that, to a large extent, the PPACA achieves the objectives envisaged by its initiators. Americans have greater access to health care services, and the number of uninsured individuals is decreasing significantly. It bears mentioning that some provisions of the law has already been repealed. The full implementation of the intended purpose of the act largely depends on whether the corresponding regulations will resist the legislative attacks of its opponents.
Ogundipe, B., Alam, F., Gazula, L., Olagbemiro, Y., Osiezagha, K., Bailey, R. K., & Richie, W. D. (2015). Remaking the American health care system: a positive reflection on the Affordable Care Act with emphasis on mental health care. Journal of Health Care for the Poor and Underserved, 26(1), 49-61.