Research Paper on the Affordable Care Act

Affordable Care Act


Poverty signifies a condition of privation or a shortage of the normal or socially satisfactory sum of finances or material property. Under the Affordable care Act (ACA), usually referred to as the Patient Protection and Affordable Care Act (PPACA) or Obamacare, underprivileged people and families with incomes from 100% to 400% of federal poverty level (FPL) will obtain federal financial support on a sliding scale if they get insured through an exchange. People with an income of between 133% and 150% of the FPL will be supported in a manner that their premium costs will be 3% to 4% of earnings; small businesses will be entitled to financial support (Haeder & Weimer, 2013). The Affordable Care Act (ACA) or Obamacare entails a blend of actions to control healthcare expenses, and an increase of coverage via public and non-public insurance: wider Medicaid qualification and Medicare coverage, and sponsored, controlled non-public insurance. Alongside the support for non-public insurance as a way of all-encompassing healthcare, the individual mandate was deemed the most excellent means of gaining the backing of the senate since it had been entailed in earlier bipartisan change schemes.

The perception dates back to around 1989, at the time that the conservative Heritage Foundation recommended an individual mandate as a substitute to single-payer medical care (Haeder & Weimer, 2013). The perception was supported for a period by conservative economists and Republican senators as a market-anchored advance to medical improvement on the foundation of personal accountability and prevention of free requirement difficulties. Particularly, the Emergency Medical Treatment and Active Labor Act (EMTALA) of 1986 demands every healthcare facility engaging in Medicare (which almost every single one does) to offer emergency care to everyone that requires it, the government frequently catered for the cost of the ones that had no ability to settle the bills. At the time that president Clinton recommended a medical change bill in 1993 that encompassed a directive for employers to offer health insurance to every employee via a controlled market of health maintenance organizations, Senators from the Republican side recommended a different option that would have seen workers, and not employers, purchasing insurance. Finally, the President’s plan did not succeed in the midst of an unmatched stream of negative publicity financed by politically conservative groupings and the health sector and because of the concerns that it was excessively intricate.

When he failed to gain an all-inclusive improvement of the healthcare structure, President Clinton discussed a concession with the 105th Congress to as an alternative, enforce the State Children’s Health Insurance Program (SCHIP) in 1997. The option suggested by the Republican in 1993, initiated as the Health Equity and Access Reform Today Act, entailed an inclusive coverage obligation with a fine for nonconformity, an individual mandate, in addition to financial support to be employed in state-anchored purchasing groupings. By the close of 2006, insurance coverage bill was enforced at the state stage in Massachusetts; the bill encompassed both a personal insurance coverage mandate and an insurance exchange. A republican governor vetoed the authorization, though following the Democrats overriding his veto; he enacted it into regulation (Cutler, 2014).

 One year following the Massachusetts transformation, 2007, Senators Bob and Ron initiated the Healthy Americans Act that also encompassed a personal mandate, and state-anchored regulated insurance marketplaces referred to as State Health Help Agencies. Initially, the bill drew bipartisan backing though it was disapproved in committee. The majority of the supporters and co-supporters stayed in Congress in the course of the 2008 medical provision contest (Cutler, 2014). Before the close of 2008, most of the Democrats were mulling over employing this advance as the foundation for healthcare improvement. Professionals have articulated that the rule that finally emanated from Congress in 2009 and 2010 has a great resemblance to the 2007 bill and that it was intentionally designed subsequent to the state healthcare plan. The insurance coverage for the poor in society was a great subject of debate in the course of the 2008 presidential primary elections and with the narrowing of the contest; concentration was centered on the designs offered by the two major contestants, Barack Obama and Hilary Clinton. The two contestants had their ideas concerning the coverage of the more than 40 million American residents approximated to lack health insurance every year.

Following his inaugural ceremony, Barack declared to a combined conference of Congress in early 2009, his plans to team up with Congress to build a program for healthcare improvement. In late 2009, the House of Representatives authorized the Affordable Health Care for America Act, and it progressed to the Senate for approval. According to the senators, the bill had not encompassed a language that fulfilled their abortion interests, though they could not factor in supplementary such language in the balancing bill as it would be exterior to the extent of the progression with its budgetary boundaries. After the House of Representatives approved the Senate bill, the next day, Republicans initiated rule to repeal it (Cutler, 2014). Obama approved the Affordable Care Act into law in March 2010 with the correction check, which was referred to as the Health Care and Education Reconciliation Act, being as well approved by the House of Representatives on 21st March, by the Senate through compromise on 25th March, and made law by President Obama on 30th March. By May 2014, about 20 million residents of the US had obtained health insurance coverage under the Affordable Care Act, and the fraction of uninsured Americans reduced from 18 percent last year to 13 percent.                                                 


            The importance of the Affordable Care Act lies in its objectives of raising the excellence and affordability of health insurance, decreasing the uninsured level by extending public and non-public coverage, and decreasing the costs of medical care for residents and the government. The ACA initiated different mechanisms, encompassing directives, financial support, and insurance exchanges, with the aim of raising the level of insurance coverage and affordability (Custer, 2013). It as well demands insurance companies to insure every applicant within fresh minimum standards and provide matching rates irrespective of pre-existing situations or gender. In the past, Medicaid had gaps in insurance coverage for grown-ups since qualification was limited to particular classes of underprivileged people, for instance, children, parents, expectant women, the aged, or the handicapped. In the majority of states, grown-ups with no dependent children were not entitled to Medicaid, irrespective of their earnings, and earnings restrictions for parents were extremely low, frequently less than half the FDL. Nevertheless, a number of states had extended insurance coverage to parents at higher earnings levels or offered coverage to grown-ups with no dependent child.

            The Affordable Care Act sought to fill the gaps in insurance coverage by expanding Medicaid to nearly every nonelderly grown-up with earning at or less than 138 percent of Federal Poverty Level. For the twenty-seven states that are executing Medicaid extension this year, Medicaid insures nearly every nonelderly grown-up with incomes even less than 138 percent of FDL (Custer, 2013). Every state beforehand extended eligibility for children to greater scales as compared to grown-ups through Medicaid and the Children’s Health Insurance Program (CHIP), and in the states progressing with the extension, the median Medicaid, and Children’s Health Insurance Program qualification threshold for children in 2014 is 213 percent of FDL. By and large, most (64 percent) of the approximately 14 million residents entitled to Medicaid this year are grown-ups, though the share differs considerably by state. More than three quarters (approximately 78%) of Medicaid-entitled residents in states that are executing the extension are grown-ups. In states that are not presently executing the Medicaid extension, a number of uninsured residents (approximately four million) are entitled to Medicaid or Children’s Health Insurance Program under qualification conduits in position prior to the Affordable Care Act.

            Nonetheless, considering past higher qualification scales for children as compared to those of grown-ups, the huge mainstream of uninsured people in states not extending Medicaid are children that are by now entitled to though yet to be enrolled in coverage. Some of the Medicaid-entitled people are not enlisted in the coverage because of lack of information concerning their qualification and past enrolment hindrances. With the execution of coverage extensions for the Affordable Care Act, it is probable that extensive outreach attempts and fresh modernized enrolment practices will result in augmented coverage of entitled residents into Medicaid. All over the country, 5 million uninsured people (ten percent of the nonelderly not in the coverage) that would be entitled to Medicaid were their states not to expand, exist in the coverage gap. Such people are all beneath the poverty line thus have very little earnings (Custer, 2013). If they are not given an affordable insurance coverage under the Affordable Care Act, they are likely to stay uninsured.

            The Affordable Care Act is significant as it will assist many presently uninsured people acquire insurance coverage by offering coverage opportunities across the earnings range for low and middle-income individuals. Nevertheless, some people that could have gained coverage via the Medicaid extension will stay out of the reach of the ACA. Moreover, in every state, the importance of the Obamacare will rely on take-up of health insurance amid the qualified uninsured, outreach, and coverage attempts; the considerable aspects in establishing the way the law impacts the uninsured level in the state. The Affordable Care Act encompasses an obligation that the majority of people receive health insurance coverage, though a number of individuals (for instance, the lowest earning, or the ones that do not have an affordable option) are exempt, and some could remain uninsured. Remarkably, there is no limit for state judgments concerning execution of Medicaid extension, and open registration in the markets is being undertaken (Tieman, 2013). Sustained consideration to who receives coverage as the Affordable Care Act is fully executed and who is excluded from its reach, in addition to if and the manner in which their health requirements are being met, can assist inform judgments concerning the expectations of health insurance nationally.

Significant Associated Advocacy Practices and Problems

Considering what Americans, both as persons and society, desire and anticipate from the health care sector, it is argued that four basic advocacy practices, objectives and aspirations, have formed the United States health care sector. To start with, high (or possibly even the utmost) quality of care is anticipated. The rationale for such an expectation is evident; quality care can offer the best health gains. For as a minimum the last century, the US has been among the world leaders in extending the boundaries of medicament and boosting the quality of care. Secondly, there is a great aspiration for freedom of choice in health care. This signifies that people desire deciding the health facility and the best time of receiving health care, the type of care they obtain, and the caregivers that attend to them. In brief, they need to retain management of their health care options (Tieman, 2013).

            Thirdly, the Americans desire their health care to be affordable. When, both as a person and society, expend a lot of their money on health care, they will not have sufficient resources left for every other thing they yearn for or require. Fourthly, the Americans need their fellow residents to partake of the substantial gains of medical care (Tieman, 2013). They are not ready to deny health care to other people that are poverty-stricken thus the establishment of public health insurance programs to offer care to, amid others, the elderly and the destitute.                           

            The Affordable Care Act raises health insurance for children up to the age of 26 years under the parent’s coverage even in cases where they do not reside with their parents and are not reliant. Insurance companies will be barred from imposing charges for the majority of preventive care, and they will not be in a position to cast off clients when they get unwell (Mechanic, 2012). The development of Medicare provider settlements will be slowed to cater for a number of the new expenses suggested. It is estimated that the level of uninsured people will decrease by more than 30 million individuals following all the provisions of the affordable Care Act to take effect by the close of 2019. However, this will still leave more than 20 million people uninsured, encompassing unlawful immigrants and the ones that decide not to get the coverage of health insurance strategies. Individuals that would be spending more than eight percent of their domestic earnings for coverage would not be liable to the demands to acquire insurance coverage; this has been projected to increase the rate of uncovered non-elderly individuals (lawfully in the United Sates) from 82% to 95%.

            Health insurance coverage is significant for every American, and the ACA will considerably transform the nature of coverage available, access, and affordability of the coverage. Even if some people desire no restrictions on the level of treatments available for a person suffering from a mental health disorder, the law currently mandates that every insurer has to provide treatments for people with mental health problems; an extent of treatment that is equivalent with what is extant for other health concerns. This is just like a person that is diagnosed with diabetes at the start of the treatment and instruction is very powerful, and after a period there are lesser appointments (Mechanic, 2012). The main thing concerning the ACA is that a lot of people will have the capacity to obtain new coverage or will observe health insurance for mental health advance significantly. Presently, people frequently wait till things are extremely awful, and then they seek extra aid. However, most of the problems people have encountered in obtaining health care reimbursement ought to reduce, if not vanish, as the medical law reaches its full gear.

Effectiveness of the Practices

            It is believed that the aforementioned four wide-ranging health care advocacy practices are all attractive and very broadly supported in the US (and other countries). In the past, when the health care alternatives were much more restricted, and their outlays were much lesser, it could have appeared likely to accomplish all of them completely (Ghosh, 2013). With the fast and unrelenting development of the American health care sector over the last century, nevertheless, it has turned out increasingly evident that the four advocacy practices are contrastive; this means that they cannot be capitalized on all together. Accordingly, approval of one or many of the objectives has to be compromised to attain the others. Nonetheless, the four advocacy practices are still sought after thus it is vital to commit and prevent the alleged erosion or disregard of any of them.

The determination and power of the health care improvement debate offers an apparent demonstration of the extreme complexity of striking an adequate poise amid these essential advocacy practices in the US (Joondeph, 2011). Should the Affordable Care Act individual mandate to obtain health insurance coverage get overturned, and the majority of Americans decide to remain uninsured, insurance companies may not be in a position to extend risks and outlays across a huge enough pool of contributors, and the whole system may disintegrate. As of this year, due to the effectiveness of the ACA, over 20 million citizens of the US have the security generated by quality, affordable, and accessible health care. It is mainly the citizens that have until lately were not in a position to obtain health insurance coverage that excellently comprehend the great difference that the Affordable Care Act has made.           


The success of the Affordable Care Act is evident in its dedication to assisting as many poverty-stricken Americans as possible, and the policy is expected to become even more triumphant. Nonetheless, conservatives have their right to gather a resolute critique of the Affordable Care Act if they desire, and perhaps even present a genuine substitute (Ghosh, 2013). Unfortunately, though, most of the conservative attacks on the Affordable Care Act do not make much sense, when judged against the conservatives’ own hitherto points of view, not in opposition to bountiful perceptions of excellent strategy.

Challenges lie in the fact that the nations require a strong-willed discussion concerning the current conservative option to the Affordable Care Act, one that would restrict the government while promoting free marketplaces, but still increase access and affordability to the many uninsured citizens. Nevertheless, conservatives have first to discover what they are for, not only what they are in opposition to, which seems to be everything having to do with the Affordable Care Act, irrespective of its similarity to what they support. The questions that come forth include whether the conservatives still support high deductible policies, and whether they do not back an individual coverage mandate anymore (Jost, 2011). To sum it up, conservatives ought to competently outline the options they could come up with to ensure that coverage is effectively spread amid the youthful, the healthy, the elderly, and the sick.     


Custer, W. S. (2013). Risk Adjustment and the Affordable Care Act. Journal of Financial Service Professionals, 67(6), 25-26.

Cutler, N. E. (2014). Job Lock and the Affordable Care Act. Journal of Financial Service Professionals, 68(4), 19-24

Ghosh, C. (2013). Affordable Care Act: Strategies to tame the future. Physician executive, 39(6), 68-70.

Haeder, S. F., & Weimer, D. L. (2013). You can’t make me do it: State implementation of insurance exchanges under the Affordable Care Act. Public Administration Review, 73(1), 34-47.

Joondeph, B. W. (2011). Federalism and health care reform: Understanding the states’ challenges to the patient protection and Affordable Care Act. Publius: The Journal of Federalism, 41(3), 447-470.

Jost, T. S. (2011). The Real Constitutional Problem with the Affordable Care Act. Journal of health politics, policy and law, 36(3), 501-506.

Mechanic, D. (2012). Seizing opportunities under the Affordable Care Act for transforming the mental and behavioral health system. Health Affairs, 31(2), 376-382.

Tieman, J. (2013). Affordable Care Act: we can do this. Health Progress, 94(6), 84-86.