{"id":11582,"date":"2023-11-25T15:01:54","date_gmt":"2023-11-25T15:01:54","guid":{"rendered":"https:\/\/nurs.essaybishops.com\/analysis-of-the-patient-protection-and-affordable-care-act\/"},"modified":"2023-11-25T15:01:54","modified_gmt":"2023-11-25T15:01:54","slug":"analysis-of-the-patient-protection-and-affordable-care-act","status":"publish","type":"post","link":"https:\/\/www.studyproessays.com\/nursing\/analysis-of-the-patient-protection-and-affordable-care-act\/","title":{"rendered":"Analysis of the Patient Protection and Affordable Care Act"},"content":{"rendered":"
\n

Overview<\/em><\/em><\/h2>\n

Health care and healthcare policy has continued to evolve over the last century. At the end of the 19th<\/sup> century due to the advancements made in the medical and research field, public health projects were implemented to fight some of the leading causes of disease and to provide health awareness and to raise the overall health of the general population. Some disease were practically eradicated. With concern of the general health and welfare of the nation, healthcare programs<\/a> were extended into the schools through school nurses. (Fillmore) <\/p>\n

During the first part of the 20th<\/sup> century, the US witnessed the establishment of the first large medical insurance company, the rise of private health insurance, and employer and labor union sponsored health care. (Fillmore) However, it was not until the 1930s-1940s that the federal government began to consider the true need for all citizens to have fundamental healthcare. Franklin D. Roosevelt, during his 1944 State of the Union Address, established the political idea that citizens of the United States should have the fundamental right to adequate health care. This political philosophy been the premise on which governmental health care policy has founded upon. Over the past half-century, government\u2019s involvement in health care and in the development of healthcare policy had increased due to the rapid rise in healthcare cost and general concern over rising health issues minorities, and individuals living in poverty<\/a>. \u201cWithout adequate health care, no one can make full use of his or her talents and opportunities. It is thus just as important that economic, racial and social barriers not stand in the way of good health care as it is to eliminate those barriers to a good education and a good job.\u201d (Kaiser Health News, 2009) <\/p>\n

Healthcare Reform Legislation<\/em><\/h2>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Historically
\nthe United States has tried to avoid providing universal healthcare for all
\ncitizens. Instead, financing healthcare continued to be linked to employment. (Landreanau, 2003) In part, this avoidance has been directly related to the
\ngeneral public\u2019s view of democracy, laissez-faire economics and a general fear
\nthat government sponsored universal healthcare can lead to socialism. It has
\nonly been during times of great economic and social need that the federal
\ngovernment has been able to successfully implement healthcare policies and
\nprograms on a broad spectrum. Debate over national health insurance has been
\nraging for over a half of century. <\/p>\n

\"\"<\/figure>\n

1930-1950s<\/h3>\n

Beginning with
\nthe heavily contested Social Security program of 1935. The Social Security Act
\nprovided grants for Maternal and Child health. As early as 1943, proposals by
\nSenators Wagner and Murray in conjunction with Representative Dingell
\nintroduced a bill to provide a universal comprehensive health insurance as part
\nof social security. The proposed changes would have provided a birth to death
\nsocial insurance for the American public. The proposal did not pass during the
\n1943 legislative session. In 1944, the Social Security Board advocated for a
\ncompulsory health insurance as part of the Social Security System. In 1946,
\neven with a new executive in the White House, advocacy for a national health
\nprogram continues. In 1946 and 1947, a revised Wagner-Murray-Dingell bill is
\nreintroduced to Congress for a National Health Program. This bill has executive
\nsupport, but Congress failed to act upon the bill. The nation continues to
\ngrapple with how to deal with the increasing number of citizens\u2019 without
\nhealthcare. In 1954, to provide incentives for employers to provide employee
\nhealthcare coverage and in keeping with the philosophy of limited government
\nintervention into this area, the Revenue Act of the 1954 was passed. This act
\nprovided tax deductions for employers that contributed to employee health plans. (Kaiser Family Foundation, 2017)<\/p>\n

1960-1970s\u00a0\u00a0\u00a0\u00a0 <\/h3>\n

In the 1960s,
\nthe United States healthcare system continued to grapple with the question as
\nto how to provide healthcare coverage for unemployed individuals, the elderly,
\nand children. In 1965, the US began to see major healthcare change. With the
\npassage of the Social Security Amendments Act of 1965, Medicare and Medicaid were
\nestablished. These programs are still in existence today and have continued to
\nbe expanded upon. (Kaiser Family Foundation, 2017) <\/p>\n

The 1970s
\nbrought a season of inflation, high unemployment, and unrestrained rising
\nhealthcare costs. These concerns were creating a growing concern politically,
\nsocially, and economically. Once again, policymakers began to advocate for
\nNational Health Insurance. In 1973 President Nixon signed the Health
\nMaintenance Organization Act. This piece of legislation was beneficial because
\nit removed barriers that prohibited HMOs at the state level, provided
\nsubsidizes for qualified HMOs and mandated employers who provided employee
\nhealth insurance to offer HMO options when possible. President Nixon hoped that
\nHMO Act would be a springboard for his Comprehensive Health Insurance Plan. \u201dThe national health insurance bill that I will be submitting
\nto the next session of this Congress will allow patients to use such insurance
\nto join HMO\u2019s. For that reason, it is particularly important that this
\ndemonstration effort get underway immediately and build upon the momentum which
\nhas already been achieved in this field.\u201d (Nixon, 1973) This proposal
\nnever saw fruition because it was overshadowed by the political scandal
\nsurrounding his presidency and subsequent resignation. As the economy continued
\nto decline, policymakers began to focus on the necessity to contain healthcare
\ncost in addition to providing coverage for uninsured. (Kaiser Family
\nFoundation, 2017) <\/p>\n

1980-2000<\/h3>\n

Each decade continue to expand government\u2019s role in healthcare and the provisions provided to the public. Debate was often heated among policymakers about the expansion of government into healthcare, but governmental programs continued to expand due to concern for the general health and welfare of the public. In 1980, the Medicare Catastrophic Coverage Act was passed. In 1990, the Clinton Administration decided to make National Health Coverage a priority. Even though the proposed Health Security Act of 1993 failed to pass, once again the Nation is facing the questions of how to deal with rising healthcare cost,
the free market, and the uninsured. Despite the expansion various government sponsored health program and government based incentives, the number of uninsured continued to rise. (Cohen, et.al, 2009) <\/p>\n

\"\"<\/figure>\n

From 1968-1980, for individuals under age 65, private insurance coverage was 79%. This percentage remained relatively until the recession of the 1980s. From 1980 until 2007, the percentage of individuals under the age 65 with private coverage continued to decline at an average rate of 1% per year. This downward trend of private, employer-sponsored insurance continued to illustrate national need for healthcare coverage for all citizen. (Cohen, et.al, 2009)<\/p>\n

\"\"<\/figure>\n

As states
\nbegan to realize that comprehensive healthcare reform was not going to happen
\nquickly at the national level, several states began to invest research and
\nfunds into designing comprehensive healthcare reform at the state level. Massachusetts
\nand Vermont successfully pass legislation in 2006. These plans become a working
\nmodel for the Patient Protection and Affordable Care Act of 2010. <\/p>\n

Patient Protection and Affordable Care Act of 2010<\/em><\/h3>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 The
\nPatient Protection and Affordable Care Act, frequently called \u201cObamacare\u201d was
\nsigned into law March 23, 2010. This revolutionary, controversial, single piece
\nof legislation expanded government\u2019s role in healthcare and mandated a basic
\nlevel of healthcare. It transformed the relationship between the individual,
\nbusiness, and the federal government. (Twight, 2009) Prior to this sweeping
\npiece of legislation, the decision to have or not have health insurance was an
\nindividual choice. It was considered a fundamental right to make an informed
\nchoice. Prior to the passage of the Patient Protection and Affordable Care Act,
\naccess to health care was limited to those that could most afford it, despite
\ngovernmental programs such as Medicaid and Medicare. <\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 One
\nunderstands how this sweeping piece of legislation was initially favored and
\nsupported by many. The \u201cpolicy window of opportunity\u201d was open due to
\nskyrocketing health cost, limited access to health services, rising health
\nproblems, increasing premiums, and patient spending on deductibles outpacing
\nwages. (Altman, 2016) In 2008, 27% of the nonelderly with three or more chronic
\nconditions spend more than 10% of their income on healthcare. In 2010, the
\nUnited States spent 2.6 trillion dollars on health care. (Henry J Kaiser
\nFoundation, 2012)<\/p>\n

\u00a0After an approximate 50 year period of
\nincreasing governmental involvement in healthcare and public acceptance through
\nprograms such as Medicaid, Medicare, Veteran Health Affairs (VA), a large
\nportion of society seemed eager to see this type of legislation become a
\nreality. Proponents of a national health care system were able to garner the
\nsupport of the majority in the Legislative Branch and Executive Branch and with
\ncreative marketing and \u201cpoliticking\u201d ensured that the bill became law. <\/p>\n

After a decade
\nit is time to evaluate the policy.<\/p>\n

There are
\nseveral main components to the Patient Protection and Affordable Care Act. First,
\nit prohibits insurance companies from denying coverage for individuals with
\npre-existing conditions and coverage cannot be revoked except for incidences
\ninvolving fraud. Second, each state is required to establish a Health Benefit
\nExchange to allow businesses and individuals to purchase insurance and states
\nare required to establish a minimum of one reinsurance entity to expand available
\ncoverage. Third, individuals must purchase basic health insurance or incur a
\nfine. Fourth, employers with fifty or more employees must provide health
\ncoverage for incur a fine whereas, business with twenty-five or fewer employees
\ncan receive a tax credit for the company\u2019s health coverage expenses. Fifth, states
\nwould be allowed to prohibit qualified insurance plans from covering abortions
\nand no federal funds would be allowed to be used for abortions. Sixth,
\nbeginning 2014, sates are allowed to expand Medicaid coverage to low-income
\nresidents under the age of sixty-five. Finally, expanded coverage for seniors
\nand low-income residents through Medicaid was provided and reimbursement plans
\nwere reformed to curb fraud and to help curb the rising costs of prescription
\ndrugs. (Auerbach, 2017) After
\ntaking a comprehensive look at the Affordable Care Act, two broad categories
\nexists: (1) expansion of health insurance and (2) reformation of the healthcare
\ndelivery system. (Blumenthal, Abrams,
\n& Nuzum, 2015)<\/p>\n

Effectiveness<\/h4>\n

One of the
\nprimary goals of \u201cObamacare\u201d was to ensure that Americans have affordable
\nhealthcare coverage, access to services, and to control health care costs. Under
\nthe law, the number of uninsured nonelderly Americans decreased from 44 million
\nin 2013 to less than 28 million as of the end of 2016. (Henry J Kaiser Family
\nFoundation, 2017)<\/p>\n

\"\"<\/figure>\n

Many Americans
\nwould forego medical treatment due to lack of insurance or lack of funds. The
\nAffordable Care Act was created to ensure that the over health of the
\npopulation improved. Medical professional and government officers agreed that
\nlack of medical care often led to higher medical costs due to untreated illness,
\nlifestyle diseases such as Type 2 Diabetes, Obesity. Since the passage of the
\nAffordable Care Act more Americans report that they have a primary doctor and
\nhave sought preventative medical care within the last twelve (12) months. <\/p>\n

\"\"<\/figure>\n

Surveys show that the newly insured are pleased with
\ntheir coverage. Three quarters of those seeking to make an appointment with a
\nprimary care physician or a specialist secured appointments within 4 weeks or
\nless. (Blumenthal,
\n2015)<\/p>\n

The Council
\nof Economic Advisors (CEA) reports improvements in the area of individual
\nhealth. Reports show the rate of hospital-acquired infections in the United
\nStates declined by 21 percent between 2010 and 2015 with an estimate 125,000
\nfewer patients died in hospitals. Medicare patients\u2019 hospital readmission rates
\ndeclined substantially; an estimated 565,000 readmissions were avoided between
\n2010 and 2015 as a result of the Hospital-Acquired Condition Reduction Program (HACRP) of the
\nPatient Protection and Affordable Care Act (ACA). (The Advisory Board Company, 2016)<\/p>\n

The data clearly supports that more individuals have access to health care
\nand improved health conditions due to measures provided in the Affordable Care Act
\nsuch as the Hospital-Acquired Condition Reduction Program (HACRP), individual
\nwellness programs, preventative care, prohibitions for health care policy
\nrecissions, elimination of annual and lifetime limits for benfits and coverage,
\nenrollment denials due to pre-existing conditions,and most importantly capping
\nout of pocket expenses.<\/p>\n

\"\"<\/figure>\n

\u00a0Yet, in 2016, 27.6 million
\nAmericans still remained uninsured. The uninsured still site cost as the main
\nreason for lack of coverage. Despite the ACA\u2019s insurance subsidies, many still feel that
\ninsurance costs are too high and unaffordable. (KFF Updated: Nov 29, 2017 | Published: Sep 19, 2017, 2017) One
\nof the reasons that individuals may find the cost of coverage prohibitive is in
\npart due to the regulations in the ACA. An example being a married couple in
\nNorth Carolina. The husband is self-employed and the wife is eligible for
\nemployer sponsored health care. The wife may purchase spousal insurance from
\nher employer. The cost of the wife\u2019s spousal plan may be more costly than the
\ncouple can afford to purchase. In this scenario, the husband will not qualify
\nfor insurance subsidies should he wish to purchase insurance outside of his
\nwife\u2019s employer. <\/p>\n

The total
\nnumber of newly insured fell short of the original estimate because many them
\nhad previous coverage but had to reenroll because their plans did not meet the
\nnew standards. (Blumenthal, 2015) Of the 17.7 million persons who gained access
\nthrough the ACA, 14.5 million were enrolled in Medicaid and CHIP programs.
\n(Mofit, 2016) Which questions the success of the healthcare exchanges. <\/strong><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong>Prior to 2010, medical costs were skyrocketing. Uncontrollable costs were
\noutpacing the public\u2019s ability to pay for healthcare. An essential part of the
\nACA is directly related to health care cost containment. Part of the ACA\u2019s cost
\ncontainment plan involved incentives and penalties for medical performance,
\ncoordination of care, bundling payments, and the development of Accountable
\nCare Organizations. \u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0<\/p>\n

\"\"<\/figure>\n

Beginning in 2012, hospitals with higher than expected readmission rates were penalized. Progams were expanded to reduce the number of patient related conditions acquired while the patient was hospitalized. Costs and payments were restructued to help contain rising medical costs. Through Accountable Care Organizaitons (ACOs) doctors, hospitals, and other medical entities come together to coordinate care. The goal is to ensure that medical servcies are not duplicated, ensure quality patint care, and coordinate overal services. Providers that are part of an ACO will share in the savings (financial incentives) but will also experience risk for patients that have greater expenses than what is deeped necessary. (Blumenthal, 2015) Despite strong advocay for this model, it has not been as successful as orginially hoped. Savings has not occurred on the scale that was estimated. \u201cACO growth has slowed and the downward trend is expected to continue (http:\/\/www.fiercehealthcare.com\/story\/3-reasons-slowed-aco-growth\/2013-11-01) because the market is tapped out, there is no proven ACO model and payers are reluctant to offer ACO contracts.\u201d (Sullivan 2013) \u201cThe Pioneer ACO Model is one of the more progressive initiatives coming out of the Obamacare health reform,\u00a0but seven of the pioneer ACOs report no savings, and two others are leaving the program completely. <\/strong>Richard Foster, an analysts with the Centers for Medicaid and Medicare Services, estimates that national health spending would increase by an estimated $311 billion dollars. This projection exceeds increases that would have occurred had the Affordable Care Act not passed. (Mofit, 2016) <\/p>\n

\"\"<\/figure>\n

Efficiency<\/h4>\n

From the
\nbeginning, the ACA has been problematic. Starting with legislative development.
\n\u201cBy our count at the Galen Institute, more than 70 significant changes have
\nbeen made to the Patient Protection and Affordable Care Act, at least 43 that
\nthe Obama administration has made unilaterally, 24 that Congress has passed and
\nthe president has signed, and three by the Supreme.\u201d (Turner, 2016) Therefore,
\nthe law that was passed is not the law that is in existence today. From the
\nstart, it was easy to see that the original objectives of the policy would not
\nbe achieved and that the cost of the program as designed would far outweigh the
\nbenefits to society as a whole. (Turner, 2016)<\/p>\n

One of the
\nfirst issues that must be addresses is the overreaching nature of the legislation.
\nMany individuals object to the ACA because the costs are considered to be too
\nhigh: politically and financially. According to Christopher Conover, Duke
\nUniversity professor of health policy, \u201cObamacare has done more to eviscerate
\nthe rule of law & constitutional design than any other major statute\u201d
\n(Conover, 2016). Opponents claim that ACA will transfer one-sixth of the US
\neconomy into the hands of politicians and agency bureaucrats. (Manchikanti, L.,
\n& Hirsch, J. A. (2012)<\/p>\n

Several major
\nissues have occurred causing Americans concern over the advisability of the
\nACA. First, President Obama promised the American public \u201cif you like your
\nplan, you can keep your plan\u201d. This was not the case. Insured Americans were
\nupset and surprised when insurance companies canceled policies that did not
\nmeet the new minimum standards set by the ACA. Second, new marketplace
\nrestrictions were placed thereby restricting access to providers in an effort
\nto control costs. Third, increased premiums have forced individuals to purchase
\nplans with large deductible and high copayments. (Blumenthal, 2015) <\/p>\n

Americans are
\nfeeling the financial pressure due to the ACA. Premiums have soared. The
\nCongressional Budget office predicts that premiums growth will accelerate over
\nthe period between 2016 and 2025. Projections show increases of approximately
\n60% with an annual increase averaging 8%. (Mofit, 2016) <\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 American\u2019s
\ntax bill is rising due to the ACA. It is projected that between 2016 and 2025 \u201cAmericans
\nwill pay an estimated in $832 billion in taxes, including taxes on health
\ninsurance plans, drugs, and medical devices that will be passed on to the
\nmiddle class. (Mofit, 2016) <\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 The
\nACA provides for health insurance exchanges. These entities are a \u201cHealth Insurance Marketplace, a service available in every state
\nthat helps individuals, families, and small businesses shop for and enroll in
\naffordable medical insurance.\u201d (Exchange \u2013 HealthCare.gov). Though touted be
\nsimilar to health insurance exchanges in the fee marketplace, instead, ACA
\nexchanges are heavily regulated and federally supervised. After six year and $5
\nbillion dollars in expenses, only 13 states are operating their own exchange. Critics
\nsite this a waste of funds. (Mofit, 2016)<\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 In general, American\u2019s have a
\nsomewhat negative image of the Affordable Care Act. \u201cForty-four percent
\nsurveyed in Gallup\u2019s most recent update approve of it, compared with 51% who
\ndisapprove. The public\u2019s approval of the healthcare law has consistently been
\nbelow the majority level in recent years, ranging from a high of 48% shortly
\nafter Obama won re-election in 2012 to a low of 37% approval in late 2014.<\/p>\n

\"\"<\/figure>\n

Equity <\/h4>\n

Reportedly,
\nthis is one the ACA\u2019s stronger points. With new ACA regulations, obtaining
\ncoverage has been made less discriminatory. ACA legislation prohibits age,
\nrace, gender, and disability discrimination. \u201cSection 1557 extends
\nnondiscrimination protections to individuals participating in:<\/p>\n