Public Health Legislation 1

The Affordable Care Act

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The Patient protection and Affordable Care Act (ACA) health care legislation has been very

instrumental in bringing reforms to improve the quality, affordability, and equality of health care.

This act became law on March 23, 2010 and began implementation on January 1, 2014. The new

law brought a myriad of changes, imposing new responsibilities on the employer and individual,

health insurance firms, the existing Medicaid health systems, as well as inclusion of financially

marginalized groups such children and the elderly. However, along the way were several

intermediate steps and unforeseen challenges that came along. This paper seeks to illuminate the

impact and progress of the ACA in regards to the health sector, its legal framework, economic

and social sectors. This review is informed by data obtained from multi sector stakeholders,

public data agencies and public research findings (Barak Obama, 2017).

The ACA public health policy came to being through amendments, extensions, and revisions of

the pre-existing federal laws such as the Medicaid and Medicare to establish a new legal

framework that was all-inclusive and spanning from birth to death (Rosenbaum, 2017). Prior to

this, the health care legal framework favored the employed leaving out a vastly large section of

the population that was uninsured to pay directly for medical care. In a bid to promote universal

health, this act sought to reduce the gap of the uninsured population of the United States of

America setting a target of at least 94% insured citizen enrollment.

The ACA constitutes ten legislative parts, which collectively aim to achieve the following

objectives. The first aim being to achieve universal health coverage via shared responsibility

between the government, employers, and the individual citizen. The next target was to improve

the quality, access, and affordability of health care for the American people. The third objective

sought to increase healthcare efficiency and reduce wastage of resources to ensure accountability

among the major stakeholders. A fourth aim was to boost primary and preventive health care
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access to promote longer life and avoid unnecessary hospital visits trough better preventive

intervention. The fifth objective was to invest more research into the healthcare system through

formation of committees and bodies that would offer continuous support on how best to tackle

challenges and implement policies such as individual subscriptions and price regulation

(Rosenbaum, 2017).

Since its enactment into law, the ACA has seen the uninsured rates decrease from 16 percent in

2010 to 9 percent in 2016. Healthcare payment systems are also increasingly shifting from the

traditional Medicare format to newer payment methods such as Accountable care organizations

(ACOs) and bundled (Piper, 2017) payment system. This has seen slow but sustainable growth in

the enrollment of citizens benefiting from the ACA. Despite of this progress, there remains great

room for improvement.

An individual’s wellbeing can be viewed as a liability or an asset. Since health care has monetary

value attached to it, one’s health status it trickles down to the economy and the federal budget.

The productivity of the human resource is also determined by their well-being. It was thus

deemed imperative by the ACA that health insurance reforms be rolled out for children in

schools, adults who work, and the retired and elderly to manage associate costs better.

Wider and improved coverage

The largest decline in the number of uninsured individuals since the recession of 2007 has been

witnessed with the implementation of the ACA. The department of Health and Human services

points at 20 million new subscribers to the ACA in 2016 alone. However, the lawmakers had

underestimate the sheer magnitude of the task ahead when creating this act. The states suffered

huge drawbacks due to the slow pace of decision making in regards to resolving arising issues
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with the adoption of the ACA. However, the federal government could not impose the changes

directly onto its member states. Some were seen to adopt innovative strategies to implement the

new healthcare law by making their own preliminary decisions and joining the dots to bring the

act to life to the best of their abilities. Each facet of this new law required serious bureaucratic

procedures ranging from financial assistance for the moderate-income people, federal state

support for expansion of Medicare and Medicaid, to improving existing insurance policy

frameworks, and everything in between. All in all positive reforms such as reduced insurance

premiums and inclusion of child cover to 26 years has seen the number of the uninsured

population decrease significantly, implying better healthcare for more people (Barak Obama,

2017).

Transformation the Health Care Service Delivery

The law adjusted premium rates for Medicare and Medicaid insurance firms to align with the

actual cost they incurred. In effect, this new regulation saw a decrease in insurance premiums

paid for healthcare. The law went a step further to address the issues of fraud in the healthcare

industry. The law introduced checks to the registration of private healthcare firms and introduced

stiffer penalties for those found guilty of fraudulently charging the exchequer. In addition, the

law introduced a value based system where a criteria for evaluating the financial value of service

was agreed upon for those who paid upfront for treatment. These checks worked together to

create transparency and boost efficiency in the quality of care provided.

By introducing alternative payment methods, the ACA has increased flexibility for many of US

citizens. Bundled payment system for instance covers all services provided during a clinical visit.

The law mandated the Centre for Medicare and Medicaid Innovation (CMMI) to spearhead the

testing and implementation of alternative payments to suit different capacities of the legal US
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residents. These amendments were made in a view of broadening the scope of payments beyond

individual services or entries, to accommodate the entire service offered during a clinic session

(Rosenbaum, 2017).

Closing the expenditure gap

Streamlining the healthcare insurance premium rates has seen lower deductions from the gross

salary remitted to many employees. The broadening of the premium collection avenues has seen

to it that better services are offered at lower cost for the individual subscriber. These

amendments have presented a long run wage increase.

Out-of-pocket Spending

The quality of medical care has improved with the introduction of the ACA with the rate of

hospital acquire conditions such as infections, misdiagnosis and wrong prescriptions. The

Agency for Healthcare Research and Quality estimates that these reductions prevented 87000

deaths in a period of four years. Medical patient readmission rates after 30 days were also seen to

decrease sharply from 19% in 2010 to 17% in 2015 (Barak Obama, 2017).

ACA and the pharmacy sector

There exists insufficient data on how prescription drug use, cost, and coverage has changed since

the introduction of the ACA law. Some experts predict a future rise in prescription drug use,

while other are not showing too much excitement over changes in current trends. One thing that

remains clear is that new dynamic policies have been adopted by the ACA concerning the

pharmaceutical industry. The ACA introduced prescription drug benefits as one of its

transformative agendas, which covers both small markets and individuals who contribute to the

care. Prior to the act, medical policies purchases excluded drug benefits. As such, one had to pay
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for drugs separately and mostly out of the pocket. The law mandated member states to provide

prescription drugs to their clients who were under the Medicaid program. 23 percent of adults

(19 – 64 years old) failed to consume prescribed drugs citing cost concerns. However, the plans

may differ according to the package purchased. The ACA provides plans formulated differently

for the same prescription drugs. This criterion has the potential to affect patients suffering from

chronic illnesses (Omolola E. Adepoju, 2015).

The future of the ACA

The Republican administration has set out publicly its intent to repeal the Affordable Care Act

and introduce a second alternative. Such a change is likely to bear significant impact on access to

healthcare for the entire public sphere. A repeal of the ACA would roll back on all previously

gains that were achieved and may see the uninsured population rates return to previous levels.

Some propose a change on the basis of the existing ACA framework and work on the demerits of

the ACA under the auspices of a new framework.

The republicans have tabled different proposals to adopt as new healthcare plans mostly pegging

their debates on the financial implications brought about by ACA care plan including subsidies

and so forth. One scenario proposes the elimination of subsidies while retaining reduction in

premium contributions to healthcare providers. Healthcare providers had accepted the payment

reductions in exchange for higher member enrollment rates to compensate for the reduced funds.

It is such consequences that the republicans fail to consider in their quest to repealing the ACA

law. The burden of uncompensated care will remains unresolved as with other implications of

repealing this law (Glied, 2017).

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References

Barak Obama, J. (2017, December 18). JAMA. Retrieved from PMC:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5069435/

Glied, S. (2017, April 18). NCBI. Retrieved from PMC:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5343718/

Omolola E. Adepoju, M. A. (2015, November 18). NCBI. Retrieved from PMC:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4627524/

Piper, K. (2017, December 18). NCBI. Retrieved from PMC:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4031738/

Rosenbaum, S. (2017, December 18). NCBI. Retrieved from PMC:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001814/#B19