The Affordable Care Act's Impact on American Healthcare
The Affordable Care Act is one of the most significant events in the Obama administration since it has had a significant positive impact on healthcare. The Affordable Care Act (ACA) has recently come under attack, as current President Trump has been a vocal opponent of its implementation. Many perceive this as a reversal of the advances made under the Obamacare statute. Although seven years is a small time span to accurately examine the ACA's impact, it is critical to identify how it has fared to date and the impact on American healthcare. The ACA is one of the most influential health care insurance that has been available to Americans until today and this is based on its measurable effects. Since 2010 the number of uninsured persons has increased drastically and many people that previously were not eligible to gain insurance became eligible. It is estimated that between 7 million and 16.4 million young adults became eligible to be part of their parents' health care policies (Anderson, 2014). Those groups that have for ages had been vulnerable and lacking insurance became the biggest beneficiaries. These groups include low-income persons, black communities and the young adults.
Improvements in Healthcare Insurance
Based on a survey conducted by Allison, (2017) it was not noted that a majority of newly insured persons were very much pleased and content with the new health care coverage system. Additionally, over two-thirds of those seeking an appointment with specialists and physicians were able to do this in less than a month. That notwithstanding for more than a decade it became the first time that Americans reported fewer problems with their medical bills. It is certain to note that the Affordable Care Act has resulted in the improvement of the healthcare insurance through a variety of mechanisms. For instance, as at the beginning of 2015, it was noted that over 11 million Americans had settled on a health plan via the health insurance marketplaces. In ensuring that the insurance has remained affordable since the implementation of the ACA the federal subsidies were set in place in which over 87% of Americans have qualified for. It is important to note that the law has provided the states with the ability to expand their Medicaid programs to be able to include persons whose average monthly incomes fall below the federal poverty line. Many states have embraced this opportunity and as a result, the number of Medicaid enrollments have increased. This is due to the fact that most Americans that have resulted to seek insurance via the ACA insurance marketplaces have discovered that their eligibility for Medicaid is affirmed via the pre-ACA regulations. The immediate result is that over 10 million Americans have now been able to enroll in Medicaid since the ACA became enacted (Allison, 2017).
Social Determinants of Health (SDH) and the ACA
SDH has prevented many groups of people from getting the most from the advancements in health care. Such advancements may include the advancement in vaccines. The implementation of the ACA was meant to address the social determinants of health via a two-pronged approach that emphasized on the community and individual responsibility for wellbeing. It is significant to note that the act has provided two resource classes for the aforementioned two responsibilities. These include ways that would result in desirable actions at the individual level through undertaking campaigns that would allow people to come up with informed choices (Sommers et al 2013). That notwithstanding the ACA has set up measures that ensure that grants are provided at the community level of the local organizations. It is certain to note that the reduction of health disparities has become one of the central goals of the Affordable Care Act. It is based on this that the ACA has dedicated funds for the setup of an internet portal which has allowed individuals to keenly track their own health. However, despite there being improvements, overall the lack of targeting risk populations through efforts such as rural dissemination and language translation, has shown not to translate better health for communities that have been affected by the social determinants of health.
Community Empowerment and the ACA
Community empowerment has been critical to the ACA address to the social determinants of health. It has taken a larger community level scope as a way to reduce the social determinants of health. The ACA has allowed for the granting of money to community departments and organizations that have over the years been able to address healthy living in particular areas that are known to have ethnic and racial disparities (Sommers et al 2013). It is important to note that these community grants have served as a tool to improve the overall well-being of communities that have been known to be marginalized.
Proposed Changes to the ACA
The 'repeal and replace' of the ACA was one of the major campaign points that President Trump relied heavily on in a bid to be elected. Despite there being major changes in the healthcare since the ACA was implemented, the changes on the ACA have elicited sharp criticism. The proposals have been seen as being negative to the gains already made under the ACA. One of the areas to be affected would include the Medicaid which had contributed to more than half of the insurance coverage gains under the ACA. The proposal has highlighted a phase-out in the expansion of those to be covered. The changes highlight that states would receive extra funding only for those that are enrolled by 2020. Additionally, the changes would put an end to an open-ended match that states have been receiving for all other beneficiaries of the Medicaid. Further, the changes proposed are expected to put an end to cost-sharing subsidies.
The premium credits would no longer be adjusted based on the insurance costs. Instead, what has been proposed is the subsidies will be offered to those individuals that earn up to $75000. Based on insurance mandate, the changes to the Obamacare will involve the repealing of penalties for those that fail to pay insurance and those employers that fail to provide coverage to their employees. The removal of the fines is meant to prevent people from getting into the market only when they perceive they need care. As a result, insurers will be required to charge 30% more premiums per year (Allison, 2017). Based on the age-based premiums, the new changes allow insurers to charge older people five times more than imposed in the Obamacare act. The main of this provision is to allow younger people to be part of the individual insurance market. This is a complete departure from the provisions set under the Obamacare act which ensured that persons over 65 years would not be charged more than three times the premium charged for persons in 20 to 25 age bracket. It certainly remains to be seen if the changes would surpass the gains made under the ACA or if they will reverse the gains made.
References
Allison, J. R. (2017). The Affordable Care Act and Prescription Drug Expenditures: A Comparison of the Near Elderly and Elderly(Doctoral dissertation, Georgetown University).
Anderson, A. (2014). The impact of the Affordable Care Act on the health care workforce. Backgrounder, (2887).
Sommers, B. D., Buchmueller, T., Decker, S. L., Carey, C., & Kronick, R. (2013). The Affordable Care Act has led to significant gains in health insurance and access to care for young adults. Health affairs, 32(1), 165-174.
