Running Head: AFFORDABLE HEALTH CARE ACT

AFFORDABLE HEALTH CARE ACT

POLICY ANALYSES
Amber Thomas
Wayne State University
S W 4710

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DESCRIPTION OF SOCIAL PROBLEM
The Patient Protection Affordable Health Care Act signed into law on March 23, 2010 by
President Barack Obama. This law was enacted with the intention to ensure every American
would be able to afford health insurance. In 2011, 48.6 million Americans were uninsured
(15.7%) of the population (United States Census Bureau. 2011). Young adults and the poor
population make up the majority of the statistic due to financial issues or denied because of
preexisting conditions (Baltic, 2013). As well as making health insurance accessible to everyone,
the Patient Protection Affordable Health Care act intends to prevent and lower the financial debts
incurred by health care.
POLICIES THAT ADDRESS THIS CONCERN
The ACA was designed so that Americans take increased personal responsibility towards
healthcare costs. Expenses related to healthcare can lead to excessive costs on average $6,350
per visit for a single person and $12,700 for a family (Fontenot, 2012). Out-of-pocket costs are
expected to increase for the average American. The cost of healthcare coverage differs from state
to state. One major requirement of all health care plans under ACA is that all plans must meet
minimally decent standards of coverage (Orenlicher, 2012). The ACA reform left it up to states
to choose whether or not to expand Medicaid. Low income adults living in states that opt out of
Medicaid expansion will be left without health insurance coverage. Citizens with incomes
below 138% of the federal poverty level are eligible for Medicaid through the ACA compared to
the previously Federal poverty level of 100% (Orenlicher, 2012). As a result, more people
nationwide will qualify for Medicaid.

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Any person whose income falls between 133% and 400% of the federal poverty line can
qualify for sliding scale subsidies, so that insurance expenses do not exceed 8% to 10% of their
income (Battistella, 2010). Persons are no longer denied health care coverage for preexisting
conditions. The ACA act also enforces insurers to spend a minimum of 80% to 85% of premiums
of medical services in addition to improved drug benefits (Battistella, 2010). The goal of
providing affordable health care insurance is to increase the occurrence of regular check-ups and
to decrease the high costs and poor outcome care (Orenlicher, 2012).
In 2011, only 52.4 percent of employers offered healthcare insurance (Fontenot,
2014). Employers are subject to changes in following compliance of the Affordable
Care Act. Employers now have to determine eligibility for hourly and seasonal
employees based on standardized look-back periods; Ensure employee health plan
offerings provide coverage that meets the affordability requirements in accordance
with the essential health benefits provision; and capture the reasons why employees
opt out of employer sponsored health plans for Internal Revenue Service audit reports.
(Fontenot, 2014)
REASONS WHY THE TYPICAL AMERICAN WOULD BE DENIED HEALTHCARE
INSURANCE
Americans living with mental health illnesses or health issues residing in states
that chose to reject Medicaid expansion will no longer have access to healthcare.
Georgia, Louisiana, Mississippi, Missouri, Oklahoma, Tennessee, and Texas have the
highest rates of mental illnesses for ages eighteen and older (Flaskurud, 2014). These

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states are also listed amongst the twelve other states that opted out of the Medicaid
expansion. Unfortunately, Americans in these states will be forced to pay for another
insurance carrier, instead of being insured by Medicaid which is free. Before the
implementation of the ACA, Americans were denied coverage for preexisting
conditions. At the end of the day, these people need medical care because their lives
are just as important as anyone else. Before the Affordable Health care act was enacted,
particular services and treatments were denied to those living with a mental illness. Now, 32.1
million Americans will have access to mental health and substance use disorder benefits
(Fontenot, 2014). Lifetime caps were imposed upon patients with excessive medical
expenses. So once a specific amount is used a patient would no longer be eligible for
additional coverage. Young adults between the ages of 18-34 have the most difficult
time obtaining health insurance. Some reasons for young adults not purchasing health
care insurance are due to unemployment, lack of health insurance literacy, and
underemployed. Although about 15% of the population is uninsured, young adults
aged 18-24 make up 25% of that statistic (Baltic, 2013).
HOW WAS THE AMERICAN HEALTH CARE SYSTEM BEFORE THE AFFORDABLE
HEALTH CARE ACT WAS PASSED?
Health care insurance originated during World War II. The government enacted a
wage freeze to prevent competition for higher wages. In turn, employers offered health insurance
benefits to promote employment. As the years progressed, free health insurance and health care
became synonymous with employment. On July 30, 1965, President Lyndon B. Johnson passed

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the Medicare and Medicaid as a part of the Social Security Act. Medicaid granted women with
children, minors, and people with disabilities free health care coverage. Medicare is accessible
for patients over the age of 65. Over time, the cost of healthcare transitioned into a limited
deductible and a copay. Congress passed the Emergency Medical Treatment and Active Labor
Act in 1986, in which hospitals can no longer deny care to the indigent. The emergency
department is only required to return the patients medical condition to normal (Orentlicher,
2012)
THE AMOUNT OF AMERICANS INSURED CURRENTLY AND BEFORE THE ACA
As of July 2013, 15% of Americans are currently uninsured and 85% of the population
was insured. According to the Congressional Budget Office, 25 million people are expected to
gain healthcare coverage by 2020 (Baltic, 2013).
HOW IS THIS LAW PROJECTED TO IMPROVE THE HEALTH CARE SYSTEM OR
MAKE IT AFFORDABLE?
Health insurance plans now offer free preventive plans with no copayment or
coinsurance under the ACA marketplace. Patients may now receive benefits such as colorectal,
depression or diabetes screening; diet and smoking cessation counseling; and a wide variety of
immunizations at no cost (Fontenot, 2014). Similarly, women will now have access to breastfeeding assistance, breast and cervical cancer screening and other services specific to women's
health at no cost. (Fontenot, 2014). People with preexisting conditions can no longer be denied
health care coverage. They have the same right as someone with no preexisting conditions to
purchase any plan. Before the ACA was implemented, young adults were removed from their

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parents coverage at age twenty one. The new ACA allows young adults to continue on their
parents health care plan at no additional cost regardless of status until the age of twenty six.
Access to preventive care and regular care can reduce the long term costs of
treatment, reduce mortality, inhibit and reduce the spread of diseases. All of these outcomes are
positive effects of the Medicaid expansion. Mental illnesses can be diagnosed and treated early
thereby preventing excessive costs of treatment in the long run. Medicaid expansion is expected
to reduce morbidity and mortality of chronic diseases (Flaskerud, 2014). By having access to
care, there is a lower likelihood of spreading a disease. It is expected that maintaining public
coverage will become expensive for federal and state governments. Because of the new
qualifications, American citizens covered under unsubsidized private health care may switch to
Medicaid or subsidized private health care coverage (Fontenot, 2012). Health insurance
companies can no longer charge rates various rate based upon health status or race. In addition to
this provision, health plans cannot end a patients health policy for no reason other than fraud.
PREVIOUS POLICIES ADDRESSING THIS ISSUE AND THE EFFECTS IT HAD ON
AMERICANS LIVES
Since 1912, multiple presidential administrations including Theodore Roosevelt, Franklin
D. Roosevelt, and Harry Truman have all tried to institute a health insurance. Only President
Barack Obama has successfully enacted nationwide health coverage. Theodore Roosevelt
campaigned for national health insurance but when he lost his presidential campaign in 1912, the
American Medical Association took up the cause. Conservatives from the insurance industry, the
pharmaceutical industry, employers, and labor unions all opposed national health insurance,

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which ultimately outweighed the American Medical Association support. Another push for
healthcare came in 1917, during the World War I. Germany was the first country to
institutionalize government sponsored national health care, so critics opposed the U.S. efforts
again for healthcare since the U.S. was engaged in war with Germany (Orentlicher, 2014).
President Franklin D. Roosevelt attempted to push national health insurance but physicians
strongly opposed the reform which ultimately made Roosevelt drop the proposal. For a long
time, healthcare was optional and Americans could choose a health insurance plan that focused
on Social Security benefits (Orentlicher, 2014).
In the 1990s Oregon expanded its Medicaid program through the Oregon Health
Care Plan. Anyone or any family with income up to 100 percent of the federal poverty level
qualified. The results were that the uninsured decreased from seventeen percent to eleven
percent. But within ten years the uninsured returned back to the same percentage leading the
public to think that the policy had failed (Orentlicher, 2014).
Indiana created a plan called Healthy Indiana Plan which offered affordable insurance
to the first eligible uninsured people who signed up. Interestingly, funding came from an increase
in the cigarette tax. It was expected to expand coverage for 130,000 people. The ACA was passed
in 2010 before the Healthy Indiana Plan reached a third of its projected enrollment (Orenlicher,
2014).
Another policy that addressed healthcare was the provision of the CLASS Act into
the Affordable Care Act. While the ACA was still in formation, Congress proposed a provision
called the CLASS act. Basically this act was a government sponsored long term

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insurance program. In 2011, the Department of Health and Human Services rescinded the act,
claiming that the government would be unable to fund long term care (Orenlicher, 2012).
LOCAL, STATE, AND FEDERAL POLICIES
The Supreme Court approved nearly all clauses of the ACA including
individual responsibility requirement, health insurance exchange and subsidies, and
the Medicaid expansion. The Supreme Court allowed states to make the decision of
whether or not to expand Medicaid eligibility. In exchange for expanding Medicaid,
the state can receive federal matching funds towards Medicaid (Lischko, 2013). The
federal and state governments will have to maintain a balance in implementing the
Patient Protection Affordable Care Act. States have been given the duty to carry; out
federal requirements. Responsibilities include requiring their citizens to obtain health
insurance if its affordable, requiring their larger employers to cover their employees
or face penalties, expanding Medicaid eligibility to all legal residents under the age
sixty-five with income up to 133 percent of the federal poverty level, establishing
American Health Benefit Exchanges and Small Business Health Options Program, and
significantly dictating state regulation of insurance (Lischko, Amy 2013). Modified
adjusted gross income referred to as MAGI is a specific formula used to calculate
income and determine whether or not pregnant women, children, parents, and childless
adults meet financial requirements for Medicaid. This complex formula is based solely
on income excluding assets (Lischko, 2013).
PROS AND CONS OF ACA ON AT RISK POPULATIONS

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With many more people eligible for healthcare, this may lead to an influx of
patients. Ultimately, Doctors and hospitals will face the stress of an increased
workload. Already people have to wait weeks at a time to be seen by their primary
physician, the influx of patients could make the wait even longer. Another perceived
con is that employers will cut jobs because they cannot afford to cover their
employees. Tax payers share the burden of health care services covered through the
Emergency Department visits by people were uninsured and unable to pay
(Woolhandler, Himmelstein, 2011).
Pros include the increased new people who now have access to health care who
did not have access previously. Surely the uninsured poor population will benefit the
most. Now they can have access to health care insurance at no cost. Forcing people to
have health insurance reduces the percentage of people who are uninsured and rely
solely on ER for their health care.
PEOPLE THAT OPPOSE THIS POLICY
Americans who were insured before the ACA reform will most likely resent the
new healthcare changes. Many Americans health care plans are expected to go through
a period of changes that could be unfavorable. Ultimately health care costs will
continue to rise which translates into raised insurance premiums and reduced benefits.
Some insurance companies oppose this health care reform. Small businesses oppose
and conservatives oppose because they believe in the minimal role of government and
the freedom of individuals to choose to be insured or not. Profitability factors are

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compromised due to the fact that insurers are required to spend a certain percentage of
premium dollars on medical benefits (Battistella, 2010). After a while, the government
may resent the healthcare reform. Projected cost of Affordable Health Care act is just
under a trillion dollars for the first decade of implementation (Battistella, 2010).
Subsequently, the federal deficit will expand by more than 500 billion dollars for the
first ten years and 1.5 trillion for the decade after.
INTERVIEW
It was extremely difficult to get in contact with a legislature due to the fact that this is an
election year. Legislatures are campaigning and receiving hundreds of phone calls and emails on
a daily basis. Finally I got in contact with Senator Gretchen Whitmer legislative assistant Sicindi
Shell representing Ingham County. The first question I asked was, How do you feel the
economy has adjusted to the new ACA reform? Sicindi responded with, I think anything thats
new takes a while to level out. Indicators show that real estate and job markets are improving but
Im not sure if that is related. I then asked about her opinion on whether or not the ACA reform
has been beneficial to Michigan residents. Sicindi believes the ACA is definitely beneficial. It
includes a population that is considered the unhealthiest. As a result citizens will become
healthier therefore eliminating the frequency of emergency hospital visits. Lastly, I asked for her
opinion of Affordable Health care in regards to job outlook. Sicindi feels that if all things work
as designed and you have people utilizing it. The industry growth will lead to jobs in healthcare.

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CONCLUSION
The Patient Protection and Affordable Health Care Act is an effective way to
leverage the surmounting costs of health care. Since this law is expanding various mental and
psychological services, the need for social work services will increase as a result. The ACA will
make insurance affordable for anyone regardless of race, sex, class, or income by offering a
multitude of various health insurance carriers. Those who cannot afford to purchase a health plan
are eligible for Medicaid ensuring every American can have access to health care. The Patient
Protection and Affordable Health Care Act is expected to improve the health care system
essentially creating a healthier country mentally, physically, and psychologically.

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Dauner, K. N., & Thompson, J. (2014). Young adult's perspectives on being uninsured and
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S. Shell, personal communication, October 24, 2014

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United States Census Bureau. (2011). Health Insurance Highlights: 2011. Retrieved from
http://www.census.gov/hhes/www/hlthins/data/incpovhlth/2011/highlights.html