On March 23, 2010, the Affordable Care Act, commonly referred to
as Obamacare, was signed into law. The Affordable Care Act has distinct goals
in which it is in place. The act focuses on making health care insurance more
affordable to more people (HealthCare, 2017). Households within 100 to 400
percent of the federal poverty level are provided with subsidies. Furthermore, the
act expanded the Medicaid program in a way that it would cover all adults with
an income below 138 percent of the federal poverty level. The government
further supports the innovative methods of health care delivery that is
designed in such a way to lower the cost of overall health care.
While there are
benefits to the addition of the Affordable Care Act, there have been concerns
to the impact it will have to society. The act will further increase the budget
deficit. It is a concern the Affordable Care Act contains cuts in spending for
Medicare that will significantly impact the quality of care seniors have access
to (ProCon, 2017). Fewer provider options are available to seniors, forcing
some elderly patients to find new health care providers. The Affordable Care
Act has created a two-tier health care system in the United States which has
further forced citizens out of the top tier of health care and into the bottom
tier (ProCon, 2017). With an increase in health care coverage for Americans,
the demand for health care providers has also increased, therefore wait times
for health care providers is much longer.
Major Changes to the Affordable
Health care reform occurs when care is focused around patients
instead of health care physicians or around the hospital. This means that the
financial incentives will reward for better health care outcomes instead of
filling hospital beds. There are recognizable changes that could be made to the
Affordable Care Act to create a more positive transition of health care reform
in the United States.
One of the most difficult and daunting aspects of the current
Affordable Care Act is insurance exchanges. The actuarial risk is what drives
the cost of insurance (Harvard, 2016). Insurance exchanges under the ACA allow
people to easily opt in and out. An example would be a healthy individual who
decided to opt out of the ACA’s requirement to pay for insurance by deciding to
pay a penalty that is low in cost compared to if the individual would have
purchased health care insurance. Health adults often prefer to take changes
without insurance and will choose to jump into the exchange during the
open-enrollment periods when the individuals become ill. By doing so, this will
skew the risk pool overall which leads to an excessive premium hike (Harvard,
2016). The risk pool issue must be addressed with three potential alternatives.
Continue insurance exchanges as
is however create penalties that are near equal to the least expensive policy
offered. By creating this penalty, it will reduce the number of health
individuals who avoiding signing up. By making it mandatory for individuals to
stay in the pool for at least a year and shortening the enrollment period, it
will further help insurers better predict cost of coverage for individuals each
year (Harvard, 2016).
States within the nation create
and manage insurance exchanges however allow states to option to come together
in regional pooling arrangements and reinsurance markets (Harvard, 2016).
Provide everyone will Medicare.
This would be designed for those who do not have employer offered health
insurance and would be administered as Medicare is currently. Employers could
have the option of opting in fee coverage for employees and reduction of
expenses would occur due to the single administer (Harvard, 2016).
Expansion of Medicaid
While there has been an expansion of those insured, a significant
amount of those who are newly insured are receiving coverage through the
Medicaid expansion. Some states, however, have chosen to not receive funding
for the Medicaid expansion, further reducing those could be covered in these
states. An option for states is to provide block grants for the states managing
the control of the population (Harvard, 2016). If states did not increase the
eligibility requirements, this would allow things to run smoothly and keep
uninsured at a relatively low number.
Many Americans are considered
to be have a modest income falling between 138% and 400% of the poverty level
(McDonough, 2016). The current Affordable Care Act guidelines for affordability
in regards to premium tax cuts are not at a point that is affordable enough. Due
to these costs, nearly 7.1 million Americans who are uninsured are eligible for
tax credits however choose to not use them (McDonough, 2016). Premium payments
are set to increase at nearly 10 percent each year. A proposal for a maximum
cap for household insurance costs should be put into place.
Tiers for Health Care Insurance
Determining the best tier for health care insurance can be
complicated. The Affordable Care Act, or ACA, is an insurance mandate system in
which requires all to purchase healthcare and if individuals fail to do so, are
required to pay a fine. In a single payer system, there is minimal competition
among payers which can reduce the control health care providers over standard
of care. A two-tier system typically will refer to the difference between
quality and type of health care received by most people and the higher-income
healthcare people receive. While there can be an entity for healthcare coverage
offered by the government, higher income individuals can afford to pay more to
receive better health care.
A newer way to offer insurance options is in a “medal-tier” which
offers bronze, silver, gold and platinum categories (Healthcare, 2017). While
this is has nothing to do with quality of care, it is focused around how much
you and the plan of choice will split for health care costs. For example,
bronze category has the lowest monthly premium, however when needed it has the
highest cost for care. On the flip side, platinum has the highest premium cost,
however lowest cost of care when needed with low deductibles (Healthcare,
2017). Another benefit to the metal tier categories is lowering premiums based
upon an individual’s income. All plans for individuals include free preventive
care as well as some discounted or free services once one meets his or her
deductible (Healthcare, 2017).
Middle Income Families pay more for Same Services as Low/No Income
Health care cost are a significant burden on families. The
middle class has felt an increased burden due to all health care costs, short
and long term. Americans who are living with minimal income have often felt the
struggle to meet basic needs even with government programs that assist
individuals (ASPE, 2015). As of 2013,
14.5 percent of the population was in poverty, an average of 45.3 million
Americans considered to be poor (ASPE, 2015). Poverty
and poor health care has gone hand in hand over the years. Those who have more
income ted to have a longer life and live healthier (UofW, 2016). Those who
have no coverage tend to forego any presentative health care measures and will
wait until they are severely ill prior to seeking any medical attention. Children,
specifically, tend to see the negative health effects when living in poverty.
High costs and incomplete coverage have faced many health insurance customers
despite the Affordable Care Act (UofM, 2016). There are two main reasons in
which low or no income families receive assistance. For starters, there are
programs that have eligibility limits that far exceed the current poverty line.
The eligibility limits allow the various benefits offered to be phased out as
families income rises instead of cutting families off abruptly once income
rises above the poverty line (Parrott, 2013). Secondly, when families have
income drop temporarily such as a parent loses a job or a divorce occurs,
families can receive assistant for part of the year (Parrott 2013).
While health care services are relatively the same for both low
and middle income families, may wonder why middle income families should pay
more for similar healthcare services. Dependent upon the range of income in
which a household makes should determine the cost that a family puts into
health care service. The Affordable Care Act should save more money for those
who struggle to afford health care coverage so they can still receive care for
medical conditions. Families that make more, such as the middle class, should
pay more into health care despite the slowing wages the middle class has faced.
reform in the United States is a hot topic and will continue to be for years to
come. While the Affordable Care Act was a start to a new chapter of health care
in the United States to provide more with health care coverage, it does have
weak areas in which need to be improved. High costs and payments will continue
to be difficult to maintain. Government within the United States will need to
continue to make adjustments to provide healthcare services to all Americans.