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Ashton Irvin

Professor Padgett

ENGL 102

2 May 2017

Patient Protection and Affordable Care Act: A Nation Divided

Healthcare has been a topic of debate for many years. However, since the Obama

administration and the enactment of the Affordable Care Act (ACA), this debate has become

more prevalent. Obama was not the first person to think of a solution to the healthcare problem,

but he did take one of the first major steps in implementing it. The Affordable Care Act was

enacted in 2010, and it represents the most significant overhaul of the United States health care

system since the passage of Medicare and Medicaid in 1965 (Rudnicki). This act worked

towards a more uniform health care that helped cover more people in the US. Since its

enactment, more than twenty million people have gained insurance. Throughout Obamas

presidency, many people talked about wanting to repeal the healthcare act, but with Obama still

in office, it was protected. According to the authors of Expected and Unexpected Consequences

of the Affordable Care Act, no matter your position, the ACA is a reality. However, now that

Obama is out of office and Trump is president, the law is no longer under protection

(Oberlander). With the recent election, the future of the ACA is looking uncertain because the

current administration is uncertain with what they want to do with the act (Pollack). The debate

now is whether or not we should repeal the act and replace it or keep it, and the debate is going

to continue unless we are able to reform the ACA. If this act were more popular amongst

Americans and if more Americans shared the same views, more people would want to reform
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Obamacare rather than get rid of it (Oberlander). Instead of completely getting rid of the act, we

as a nation should find a way to implement the positive effects that the ACA has had on

healthcare in the United States and improve the areas where the ACA has been lacking.

Therefore, we need to reform the healthcare act, instead of calling for a repeal.

The positive effects of the ACA can be split into three categories: insurance industry

reform, expansion of coverage, and the triple aim of improved access, improved outcomes, and

reduced costs of care (Rudnicki). The price of insurance varies from company to company, and

they all have different coverages. One of Obamas main intentions for the ACA was to make

healthcare uniform. He wanted everyone to have the same coverage, or the goal as Scott Gottlieb

said was to make sure everyone had exactly the same set of benefits. This is what Obama had

intended for the act, but it was not always expected by the public. I believe that all people had

different expectations for what the affordable healthcare act would be, and this is why it has so

many issues today. Before this, people could choose the insurance they needed based on the

coverage that was necessary. For example, a family would choose a plan with pediatric care

whereas an elderly person would choose a plan that met their healthcare needs. This caused the

price of insurances to vary, but now everyone with Obamacare pays the same amount of money

for the same coverage no matter the actual coverage you need (Gottlieb). A huge appeal that the

ACA has on Americans, is the patient protection aspect. This part of the act ensures that

Americans can still be covered by insurance despite pre-existing conditions which is a problem

many Americans face with some insurance plans. The last category of the positive outcomes

improves access and outcomes and reduces costs of care. According the original goal of the act,

it was supposed to increase the opportunity for thirty to forty million Americans to be covered by

health insurance (Hader). One way that this was achieved is that it allowed more people to
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qualify for Medicaid. This allows more people who are unable to afford insurance to apply for

health coverage through the state. Richard Hader said that the Affordable Care Act was our

opportunity to set the direction of healthcare. This suggests a shift and a hopeful improvement

in not only healthcare coverage but to the health of individuals as well. If the Affordable Care

Act could be reformed more through the publics ideals, then it would be more beneficial for all,

and worth the action and effort.

Despite the positive outcomes of the healthcare reform, it has its flaws. One of these

flaws is that it has changed the way that Medicaid is administered. Obamacare was supposed to

help increase the number of people who could qualify, but it also said that the state could choose

not to expand (Why Is Obamacare so Controversial?). This causes poor and working-class

families that do not qualify to pay for private insurance which can be expensive (Why is

Obamacare so Controversial?). Another problem that Medicaid faces under the ACA is that even

though it recognizes the importance of Medicaid, it does not anticipate the ongoing need to

support safety net providers, and many Americans depend on safety net providers for health

care (Shin). It has been predicted that insurance premiums could rise an average of twenty-five

percent this year, and this is not a recent prediction (Why is Obamacare so Controversial?).

There will also be an increase in government subsidies, but those who have health coverage

under Medicaid, will not be able to benefit from these subsidies (Why is Obamacare so

Controversial?). According to Pew Research, seventy-six percent of people disapprove of the law

because they believe it is too expensive (Motel) for the general public. This raises the question of

whether or not the Affordable Care Act is actually affordable. Pew Research also says that the

number one reason that people disapprove of this healthcare law is because it has too much

government involvement (Motel). This goes into the fact that it is required for all United States
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citizens to have health insurance. If people do not sign up for health insurance, they are fined, so

it is clear to see why this is an issue to many Americans. The laws and the Affordable Care Act

need to be reformed to benefit the general public more, but they do not need to be completely

taken away through a repeal.

Monthly Pre-Existing Condition Insurance Plan Enrollment: SC, NC, GA

6000
5000
4000

Number of People 3000

2000
1000
0
Enrolled through November 1, 2011

Enrolled Through

SC GA NC

(Data obtained from https://data.cms.gov/Health/Monthly-Pre-Existing-Condition-Insurance-

Plan-Enro/dpuq-z7nj)
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In order to expand and achieve universal coverage, the health care act requires all US

citizens to have health insurance. This goes back to Obamas plan to have a uniform healthcare

coverage where people will be paying the same. This sounds like a great plan until people are

having to pay more for coverage that they do not necessarily need. In some cases, Americans

cannot afford Obamacare because the aid that is available is not substantial enough to buy it.

This has caused some Americans to just pay the fine for not having healthcare because the fines

are too small to convince them to enroll (Why is Obamacare so Controversial?). People generally

just want to pay for the services currently needed by them, rather than spending unnecessary

money for a general package of coverage. For some, not being on Obamacare is better for them

because they can choose the coverage they want or need for cheaper. This leads to another major

problem because many insurance companies are backing out of Obamacare because of a lack of

Americans signing up. This causes insurance costs to increase for everyone which then causes

another decrease in participation, and this is due to a lack of appeal from the healthcare act (Why

is Obamacare so Controversial?). When Obama first brought up the act, many people only

looked at the positives because it was said that the goal was to increase healthcare coverage

across the United States. As you can see from the chart above, there was an increase of

enrollment early on, but enrollment began to decrease by 2013. Many people began to see the

negative aspects of the Affordable Care Act because although it increases the coverage a person

receives, it means that people are paying for coverage that they do not necessarily need. If there

could be actions taken to reform the act and make it more personalized, it would benefit the

public well.

In order to shrink the division amongst those that approve and those that do not approve,

our government needs to find a way to incorporate the positive aspects of the ACA while fixing
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the negative aspects that Americans have problems with. Some of the biggest reasons that people

support this law is because it expands health coverage to the uninsured, and it assures coverage

for people with pre-existing conditions (Motel). This is one aspect of the healthcare act that

needs to be carried into the next healthcare reform. A contradictory position on the ACA has to

do with Medicaid. In order to increase approval, we need to keep the part where qualifications

for Medicaid increase, but we need to require states to issue this. This may only directly affect

one group of people, but it will be one step closer to helping solve this problem. In a new,

reformed healthcare act, we need to make sure that people are paying for the coverage that they

actually need instead of just giving people coverage for everything. This could be improved if we

started with a framework for health, rather than health insurance (Rudnicki). This means that if

we are able to give people only the types coverage they need at that time for an affordable price,

we will be able to improve the health of individuals, rather than make them pay for coverage

they do not need. The triple aim goal was a good thought process, but it is the most expensive

option and assumed that if everyone has health insurance, then they also have health care that

they need. However, this is not always accurate, although an individual has health insurance, it

will not always cover the care that is needed. This means that when the ACA was created, it was

designed with a flawed assumption (Rudnicki). Ultimately, the goal of the new reform needs to

target individuals needs to help improve their health, and from here we need to figure out a way

to make quality healthcare more accessible.

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Opposition vs Approval of the Affordable Care Act

50%
40%
30%
20%
10%
0%
percentage of people

public opinion

(Data obtained from http://www.people-press.org/2014/05/05/views-of-the-affordable-care-act-

and-its-future/)

By creating a new healthcare act or policy that fixes the flaws and implements the

positive effects of the Affordable Care Act, we will be able to work towards resolving this debate

on healthcare. The United States has witnessed a major shift in healthcare over the past few

years, and this is going to continue to change whether we reform the act or not. As seen in the

chart above, more people strongly oppose the healthcare act than they approve it. Overall, there

are more people who look at the act as being more negative than it is positive. Personally, I

benefit from Obamacare because most other insurances do not accept me because of preexisting

conditions. However, my parents end up paying three hundred dollars a month for my insurance
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when they only end up paying around four hundred dollars a month for them and my brother. A

reformed health care act needs to include patient protection from pre-existing conditions and

increased coverage while making states implement Medicaid and decreasing the cost of plans so

that more people will be able to afford to sign up. We will never be able to completely resolve

this problem because the debate has occurred for a very long time, but a new, reformed act will

be able to alleviate the problem.

Works Cited

Gottlieb, Scott. "Do You Win Or Lose Under Obamacare? What You Must Know To See How

You'll Fare." Forbes. Forbes Magazine, 20 Nov. 2013. Web. 22 Feb. 2017.
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Hader, Richard. "Affordable Care Act...Ready, Set, Go!." Nursing Management, vol. 43, no. 8,

Aug. 2012, p. 6. EBSCOhost, doi:10.1097/01.NUMA.0000418130.27878.24.

Motel, Seth. "Chapter 2: Views of the Affordable Care Act and Its Future." Pew Research Center

for the People and the Press. N.p., 04 May 2014. Web. 10 Apr. 2017.

Oberlander, Jonathan. "The End of Obamacare." New England Journal of Medicine, vol. 376, no.

1, 05 Jan. 2017, pp. 1-3. EBSCOhost, doi:10.1056/NEJMp1614438.

Pollack, Craig Evan, et al. "A View from the Front Line - Physicians' Perspectives on ACA

Repeal." New England Journal of Medicine, vol. 376, no. 6, 09 Feb. 2017, pp. e8.1-e8.3.

EBSCOhost, doi:10.1056/NEJMp1700144.

Rudnicki, Marek, et al. "Expected and Unexpected Consequences of the Affordable Care Act:

The Impact on Patients and Surgeons-Pro and Con Arguments." Journal of

Gastrointestinal Surgery, vol. 20, no. 2, Feb. 2016, pp. 351-360. EBSCOhost,

doi:10.1007/s11605-015-3032-8.

Shin, Peter and Marsha Regenstein. "After the Affordable Care Act: Health Reform and the

Safety Net." Journal of Law, Medicine & Ethics, vol. 44, no. 4, Winter2016, pp. 585-588.

EBSCOhost, doi:10.1177/1073110516684801.

"Why Is Obamacare so Controversial?" BBC News. BBC, 11 Nov. 2016. Web. 27 Feb. 2017.