Outline
Abdulallah
Arbabzadah
History
209S
3/16/16
3/16/16
Research
Paper
Why the Affordable Care Act is
Successful in accomplishing its Goals
On March 23, 2010 an historic act was
signed into law. The Affordable Care Act, otherwise known as ObamaCare, became
America’s first major successful healthcare reform law since the passage of
Medicare and Medicaid under the Johnson administration. With such a radical
transformation of the way healthcare was distributed to Americans many
questioned whether or not it would be successful in accomplishing its goal of
reducing the uninsured rate. Also questioned was why the Affordable Care Act
was successful in being passed while other major healthcare reforms were not.
This paper will answer the following questions: Was the Affordable Care Act
successful in accomplishing its goal of reducing the uninsured rate? Why was
the act successful in passage while other healthcare reform attempts were not?
My thesis is the following: The Affordable Care Act was successful in accomplishing
its goal in reducing the uninsured rate and it was successful in passage while
other healthcare reforms were not because President Obama let Congress drive
the reform effort while previous efforts were mainly pushed by the President.
Reducing the Uninsured Rate
The Individual Mandate
The Employer Mandate
No Denial for Pre-existing Conditions
Creation of Health Insurance
Marketplaces with Subsidized Coverage
Expansion of Medicaid
Expansion of Coverage to Dependents
under the age of 26
The Progressive Era’s Reform Attempts
Initial Attempts at Reform
World War One’s Effects on Reform
President Franklin Roosevelt’s Reform
Attempts
Beginnings of Reform Attempts
President Truman’s Reform Attempts
President Johnson’s Attempts
(Successful for the Elderly and Poor, but not Reform Overall)
President Nixon’s Reform Attempts
President Clinton’s Reform Attempts
President Obama’s Reform Attempts
First Five Pages
Abdulallah
Arbabzadah
History
209S
3/16/16
3/16/16
Research
Paper
Why the Affordable Care Act is
Successful in accomplishing its Goals
On March 23, 2010 an historic act was
signed into law. The Affordable Care Act, otherwise known as ObamaCare, became
America’s first major successful healthcare reform law since the passage of
Medicare and Medicaid under the Johnson administration. With such a radical
transformation of the way healthcare was distributed to Americans many
questioned whether or not it would be successful in accomplishing its goals of
reducing the uninsured rate, controlling healthcare spending, improving health
outcomes of beneficiaries, providing high quality affordable care to Americans,
and reducing medical debt. This paper will answer the following questions: Was
the Affordable Care Act successful in accomplishing its goals. If so, then why?
If not, then why not? What are the benefits of the act? What are the drawbacks?
My thesis is the following: The Affordable Care Act was successful in
accomplishing its goals in reducing the uninsured rate, controlling healthcare
spending, improving health outcomes of beneficiaries, providing high quality
affordable care to Americans, and reducing medical debt.
Reducing the Uninsured Rate
The Individual Mandate
The individual mandate, one of the most
known parts of the Affordable Care Act, is also one of its most controversial.
It first was an idea thought of by the conservative Heritage think tank but it
was quickly adopted by the Obama administration as a vehicle to stop the free
rider problem of healthcare reform.[1] The individual mandate’s
purpose is to reduce the uninsured rate directly by imposing financial
penalties on those who do not have health insurance. The maximum fine, know
applicable to all people (with certain exceptions) is $695 per adult plus
$347.5 per child with a maximum of $2,085 per family or 2.5% of a household’s
income, whichever is greater.[2] It induces insurance
coverage since people want to avoid the fine and have health insurance instead.
The penalty, while not greater than the cost of health insurance, has been
successful in reducing the uninsured rate. Since its inception in 2014 the
uninsured rate has fell dramatically from 18% in 2013 to 11.6% in 2015.[3] This shows that the
individual mandate, a crux of the Affordable Care Act, has worked to reduce the
uninsured rate dramatically. This also shows that the Act is working at
accomplishing one of its core goals, reducing the uninsured rate.
The Employer Mandate
Along with the individual mandate, the
employer mandate has been one of the more controversial parts of the Affordable
Care Act. It requires businesses with 50 or more full-time employees (workers
who work 30 or more hours per week) to provide health insurance to them.[4] This was controversial
because some feared that it would cause businesses would switch to part-time
workers to avoid providing costly healthcare for employees.[5] This has largely been
disproven.[6] Involuntary part-time jobs
have been falling while voluntary part-time work has risen and since the
Affordable Care Act was passed we have seen record job growth.[7] The employer mandate works
at increased the insured rate by making sure that businesses that can provide
health insurance to their workers – namely large businesses – provide it to
their workers. And 96% of businesses are unaffected by this since they have
less than 50 full time employees and even more so 96% of large businesses that
are affected by the mandate already provide health insurance to employees.[8] So the employer mandate is
successful at lowering the uninsured rate because it makes it ensures that all
large businesses offer insurance (not just the 96% of large businesses that
provided it before the law was passed).
No Denial for Pre-existing Conditions
No denial for pre-existing conditions,
coupled with the individual mandate, forms the crux of the Affordable Care Act.
Without it people with past ailments as little as heartburn could be denied
healthcare coverage. Because of the inclusion to the Affordable Care Act of no
denial due to pre-existing conditions up to 50% of Americans who have one now
cannot be denied care due to their pre-existing condition.[9] The no denial due to a
pre-existing condition was implemented in 2014. Since the end of 2013 to the
end of 2015 the uninsured rate has fell from 18% to 11.6%.[10] This shows that it is
working to reduce the uninsured rate. The Affordable Care Act is working at
accomplishing its goals.
Creation of Health Insurance
Marketplaces with Subsidized Coverage
One of the main mechanisms of expanding
coverage with the Affordable Care Act is the creation of health insurance
marketplaces with subsidized coverage. Health insurance marketplaces are online
portals where consumers can shop and compare private, for-profit healthcare
plans with subsidized coverage.[11] The subsidies are pegged
to income and leave a certain percentage of the premium to be paid by the
consumer based on his or her income.[12] The percentage of income
to be paid towards the healthcare premium is pegged to the silver level plan.[13] There are four tiers of
healthcare plans.[14] Bronze, which has the
premium paying 60% of healthcare costs based on actuarial tables, silver, which
has the premium paying 70% of healthcare costs, gold, which has the premium
paying 80% of healthcare costs, and platinum, which has the premium paying 90%
of healthcare costs. The varying levels of coverage ensure consumer choice and
competition among plans. The insurance exchanges are projected to cover 14
million people this year.[15] This shows that the
Affordable Care Act is working. Millions have gained coverage through this
provision of the act.
Expansion of Medicaid
The Medicaid expansion, along with other
aspects of the Affordable Care Act, was controversial from its onset. Could the
federal government really compel all states to expand coverage with the
underlying threat of losing all pre-existing
funds for the joint state-federal program? NFIB v. Sebelius settled this
question. States could not be compelled to expand coverage but instead would
have the option to expand coverage – a setback for backers for healthcare
reform.[16] Even with fierce
Republican opposition to expansion – 17 states still have not expanded the
program – it has largely been a success.[17] An estimated 11.7 million
Americans have enrolled in Medicaid since its expansion.[18] The Medicaid expansion
has been therefore largely successful in reducing the uninsured rate and hence
force the Affordable Care Act as a whole has been successful in reducing the
uninsured rate.
Expansion of Coverage to Dependents
under the age of 26
Expanding coverage to dependents under the
age of 26 to their parents’ healthcare plans has long been one of the more
popular and most known aspects of the Affordable Care Act. In 2015 3 million
young adults stayed on their parents’ plan.[19] This shows that
Affordable Care Act works. Millions of young Americans have gained insurance
coverage due to this provision.
[1] "The Individual Mandate:
Health-care's Inherent Controversy." The Individual Mandate: Health-care's
Inherent Controversy. December 16, 2011. Accessed January 20, 2016.
http://theweek.com/articles/479459/individual-mandate-healthcares-inherent-controversy.
[2] Rae, Matthew, Anthony Damico, Cynthia Cox, Gary Claxton, and Larry
Levitt. "The Cost of the Individual Mandate Penalty for the
Remaining Uninsured." The Cost of the Individual Mandate Penalty for
the Remaining Uninsured. December 9, 2015. Accessed January 20, 2016.
http://kff.org/health-reform/issue-brief/the-cost-of-the-individual-mandate-penalty-for-the-remaining-uninsured/.
[3] Marken, Stephanie. "U.S.
Uninsured Rate at 11.6% in Third Quarter." Gallup.com. October 8, 2015.
Accessed January 20, 2016. http://www.gallup.com/poll/186047/uninsured-rate-third-quarter.aspx.
[4] "ObamaCare Employer
Mandate." Obamacare Facts. Accessed January 22, 2016.
http://obamacarefacts.com/obamacare-employer-mandate/.
[5] "Impact of ObamaCare on Jobs:
Does ObamaCare Kill Jobs?" Obamacare Facts. Accessed January 22, 2016.
http://obamacarefacts.com/impact-of-obamacare-on-jobs/.
[6] "Impact of ObamaCare on Jobs:
Does ObamaCare Kill Jobs?" Obamacare Facts. Accessed January 22, 2016.
http://obamacarefacts.com/impact-of-obamacare-on-jobs/.
[7] "Impact of ObamaCare on Jobs:
Does ObamaCare Kill Jobs?" Obamacare Facts. Accessed January 22, 2016.
http://obamacarefacts.com/impact-of-obamacare-on-jobs/.
[8] "The Affordable Care Act
Increases Choice and Saving Money for Small Businesses." Whitehouse.gov.
Accessed January 21, 2016.
https://www.whitehouse.gov/files/documents/health_reform_for_small_businesses.pdf.
[9] Greenberg, Jon. "Obama Says
Half of Americans Have a Pre-existing Condition." @politifact. September
27, 2013. Accessed January 22, 2016.
http://www.politifact.com/truth-o-meter/statements/2013/sep/27/barack-obama/obama-says-half-americans-have-preexisting-conditi/.
[10] Marken, Stephanie. "U.S.
Uninsured Rate at 11.6% in Third Quarter." Gallup.com. October 8, 2015.
Accessed January 20, 2016.
http://www.gallup.com/poll/186047/uninsured-rate-third-quarter.aspx.
[11] "What Is the Health Insurance
Marketplace?" Obamacare Facts. Accessed January 22, 2016.
http://obamacarefacts.com/insurance-exchange/health-insurance-marketplace/.
[12] "What Is the Health Insurance
Marketplace?" Obamacare Facts. Accessed January 22, 2016.
http://obamacarefacts.com/insurance-exchange/health-insurance-marketplace/.
[13] "What Is the Health Insurance
Marketplace?" Obamacare Facts. Accessed January 22, 2016.
http://obamacarefacts.com/insurance-exchange/health-insurance-marketplace/.
[14] "Types of Health Insurance
Plans." Obamacare Facts. Accessed January 22, 2016.
http://obamacarefacts.com/insurance-exchange/health-insurance-plans/.
[15] "ACASignups.net."
ACASignups.net. Accessed January 22, 2016. http://acasignups.net/.
[16] Chicago-Kent College of Law at
Illinois Tech. "National Federation of Independent Businesses v.
Sebelius." Oyez. https://www.oyez.org/cases/2011/11-393 (accessed January
22, 2016).
[17] "Where the States Stand on
Medicaid Expansion." Where the States Stand on Medicaid Expansion.
Accessed January 22, 2016. https://www.advisory.com/daily-briefing/resources/primers/medicaidmap.
[18] "ObamaCare Enrollment
Numbers." Obamacare Facts. Accessed January 22, 2016.
http://obamacarefacts.com/sign-ups/obamacare-enrollment-numbers/.
[19] "ObamaCare Enrollment
Numbers." Obamacare Facts. Accessed January 22, 2016.
http://obamacarefacts.com/sign-ups/obamacare-enrollment-numbers/.
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