PUBLIC LAW 111–148—MAR. 23, 2010

November 1, 2020

Health care cost in the United States have been out of control since 1900s, reaching far beyond the rate of general inflation. Rising healthcare cost have become so astronomical with burdensome government rules and price controls. Extended life and healthier living become cumbersome when making healthcare decisions. The government should commit to providing employees with health coverage options designed to meet most of the needs of a large and diverse workforce. The strategy is to focus on better ways to control costs, while continuing to offer a health plan that’s both comprehensive and affordable. Americans should have choices and control over cost. Insurance premiums and out of pocket high cost are too extreme; however, healthcare markets are more effective through the Patient Protection and Affordable Care Act commonly called Affordable Cares Act (ACA).

Past Presidents such as Bill Clinton in the 1990s had an interest to pass healthcare reform but private insurers feared that government supported insurance would in binge on their businesses. When Barack Obama became president in 2009, the report shows, 45 million Americans were uninsured. A growing number of American healthcare employers had cut health insurance from their benefits. The growing cost of medical care became a lead cause of bankruptcies, foreclosures, and family crisis. Obama made health reform his chief mission which was the beginning of the agenda setting. Identifying issues and perceptions to identify problems sets the agenda. Members of congress debated how much of a role the government should have in healthcare. After many compromises, the Patient Protection and Affordable Care Act made it through congress and Obama signed the law in 2010. The immediate goals of the Patient Protection and Affordable Care Act were to make health insurance available to more people while making healthcare affordable and expanding the Medicaid program, though some states opted into that theory. Formation and adoption will begin when the federal government created a healthcare marketplace, which is a service that allows Americans to shop for and enroll in affordable health insurance. The Patient Protection and Affordable Care Act policy implementation created government standards for minimum services that cover private insurance plans and stop private insurance from denying or charge people more based on pre-existing health conditions. In 2014, an individual mandate went into effect which required Americans a penalty if they decided not to buy a health insurance plan. Through these provisions, the Patient Protection and Affordable Care Act managed to achieve many of Obama’s goals. By 2016, nearly 20 million previously uninsured people had acquired healthcare. Despite that accomplishment, some criticize the Patient Protection and Affordable Care Act for the individual mandate penalty, and the government regulation of what they see as a private industry. By 2014, republicans and the house of representative had already voted more than 50 times to repeal the measure to block by the senate each time. President Trump appealed on Affordable Care Act and signed an executive order to allow the sale of cheaper health insurance policies with fewer benefits. He also signed a tax bill that repealed the individual mandate clause. Trump principles of health care reform are deregulation, consumer empowerment by making people care about what it cost by giving control of the money, improve price transparency, and adding competition to the equation. While the debate continues over the best methods to increase American access to health care, the Patient Protection and Affordable Care Act remains a pivotal piece of legislation in our history. Once policy implementation has been initiated, the evaluation of the enacted legislation can begin

"This paper reviews the Patient Protection and Affordable Care Act (ACA) progress, identifies its shortcomings, and offers official policy recommendations on how the law may be improve and analyze the process through the scope of the institutional theory that looks at the ways government structures are arranged, their powers, and their rules for decision making." (Kraft & Furlong, pp. 88-89).

Agenda Setting

Access to doctors and hospitals with private insurance are reduced under the Patient Protection and Affordable Care Act causing a lack of mechanism process to take place. However, plans went from broad coverage to narrow in terms of the network that accepted patients with this insurance. For example, a person that has cancer go to a specialist to find out they reject your insurance. In addition, specific doctors are restricted under the Patient Protection and Affordable Care Act. Fewer oncologists, cardiologist, mental health specialists and primary care providers. The choice of insurance plans is reduced once the regulations were in place the insurers withdrew. What should happen is that Congress must focus on making health insurance more affordable whether they are democrat or republican.

The Republican say we should give refundable tax credits to buy insurance. The goal should be to reduce the price of medical care. Once you reduce the prices of medical care insurance becomes obvious much cheaper as do the expenses of government programs. Is it feasible to shop for medical care? How can you shop for medical care when one is in the back of an ambulance where only 6% of medical care is an emergency? Access to doctors and hospital in private insurance are reduced under the Patient Protection and Affordable Care Act. Plans went from broad coverage to narrow in terms of the network that excepted patients with this insurance. For example, a person that has cancer go to a specialist to find out they reject your insurance. In addition, specific doctors are restricted under the Patient Protection and Affordable Care Act. Fewer oncologists, cardiologist, mental health specialists and primary care providers. The choice of insurance plans is reduced once the regulations were in place the insurers withdrew. What should happen now, Congress should focus on making health insurance more affordable whether they are democrat or republican. The Patient Protection and Affordable Care Act gave subsidies for insurance coverage, increases access to medical care, use of preventive services, and treatment and management of chronic diseases; enhances financial security; and improves health outcomes. “Due to the unorthodox nature of the ACA's final passage in Congress, after Democrats had lost their majority delay in the Senate” (Haeder 2012; McDonough 2011), the drafting errors that were cleaned up if harmful interpretations appear when passed.

Formulation and Adoption

The design and drafting to develop a course of action to bring a his, her, their, etc. resolve. was introduced by Charlie Rangel, Democratic U.S. Representative for New York’s fifteen congressional district, sponsored the introduction of Bill 3590 (H.R. 3590), the Patient Protection and Affordable Care Act. “He has been cited as the most effective law maker in the house and a prime contributor to President Obama Patient Protection and Affordable Care Act, to the House of Representatives on September, 17, 2009” (H.R. 3590).

The Patient Protection and Affordable Care Act was passed in the house on October 8, 2009. Passed and agreed two in house on motion to suspend the rules and pass the bill agreed to by the yeas and nays, two to three required to 416-0. The attendance count was 468. The committee passed to the Senate on December 24, 2009. Passed and agreed to Senate with an amendment to the title by yea and nay vote, sixty to thirty-nine. resolved in the house on March 21, 2010. Resolving differences-house action, on motion that the house agree to the Senate amendments agreed by a recorded vote 219-212 roll no.1 Cleared for White House on March 21st2010. Presented to President Obama on March 22, 2010 and signed by Obama on March 23, 2010. Became law on March 23, 2010 law 111-148.

Too much government in health care using institutional methods can consume extreme measures. The intentions of limited government authority over citizens are for protecting their liberty but will also have an impact on the policy maker process (Kraft and Furlong, 2018, p. 43). For growth in the economy to occur, power sharing with separate institutions is what the American people argued. The institutional theory must be considered for social or economic progress to occur, thus causing the government needs to become involved. Patient, doctors, and families are making medical decision not your federal government or Washington DC. We need a comprehensive solution for healthcare that is affordable that save hundreds and billions of dollars. The government institutional theory wants to assign an insurance company to cover healthcare, which doesn’t make any sense at all.

Implementation

Provisions of the Patient Protection of Affordable Care Act intend to address rising healthcare cost. In some cases, states may make provisions or defer to the federal government to do so such as establishing a temporary high-risk pool or creating and administering health benefit exchanges. Many provisions of the Patient Protection of Affordable Care Act were implemented by states in their efforts to expand access to care and improve health system performance. These state experiences can help inform implementation efforts within and between states.

Obama met to agenda set with CEO’s Americans the largest insurance companies and state insurance commissioners to discuss how to implement health insurance reform. Everyone involved in the debates, patients, hospitals, doctors, nurses, businesses large and small, democrats and republicans knew something had to be done about Americans health broken healthcare systems. It was no longer working for families who were seeing more and more of their incomes eaten by healthcare cost causing hardship by working people. Working for small business burdened by the weight of premiums had doubled since the last decade. The number of Americans without insurance kept raising compounded by recessions. People losing their jobs and thus losing their healthcare.

The law implemented a healthcare reform that cost cuts and made coverage more affordable for families and small businesses. A reform that brings down our government long term deficit. A reform that extends the opportunity to purchase coverage to the millions who don’t have insurance. And include stuff consumers' protections to guarantee greater stability, security, and the control of who has health insurance.

Small business owners could be eligible for a healthcare tax cut worth tens of thousands of dollars to help cover their employees. Critical relief was offered to business to provide coverage to their retirees who are not eligible for Medicare. Seniors who fall in the Medicare prescription drug coverage gap are receiving two-hundred-dollar checks to afford medicine. Strengthening Medicare by going after waste and fraud and abuse in the system. Young adults can stay on their parents plan until they are 26 years old. Uninsured Americans locked out of their insurance market because of their pre-existing condition can enroll in a new national insurance pool to purchase quality affordable healthcare. States enrollment is increasing as they opt to run their own insurance pool using funds from the new law. The new competitive market-place through insurance exchanges, discrimination against American with pre-existing conditions will be banned for good. An Individual and small business will have the same access to the same insurance plan that members of Congress have for themselves. The departments of health human services and labor and treasury has issued new regulations under the Patient Protection Affordable Act that puts an end to some of the worst practices in the insurance industry and put in place the strongest consumer’s protection in history. On day one in 2014, implementation occurred when exchange of state health insurance started to operate. “Small and individual corporations’ subsidies begun to flourish” (Rosenbaum, 2009). A true patient bill of rights.

“The institutional theory making a government decision not to intervene in market but instead to allow the laws of supply and demand to work.” ((Kraft & Furlong, pp. 88-89).

Evaluation A&B

Ultimately, All the reforms are about ending a status-quo. They are about offering stability and security to Americans that need it. There are those that are repealing the reform. They want to go back to the previous system. Going back to discriminating against children with pre-existing conditions and dropping coverage to the sick or reinstate life-time limits on benefits. This fact is the reason the Patient Protection and Affordable Care Act exists. Americans who work hard and do the right thing expecting to get a fair share. These efforts are still alive and moving forward even if it looks like it lost. Every time this country moves forward, it’s because Americans summons what’s best for each of us to make life better for all of us.

Immediate Improvements in Health Care Coverage for All Americans- (Sec. 1001, as modified by Sec. 10101). No insurance plan can reject you, charge you more, or refuse to pay for essential health benefits for any condition you had before coverage started. The reform is not to punish the insurance companies. It provides a critical service and employ large numbers of Americans. The private insurance has the opportunity to prosper and compete from the millions of new customers. What Americas expect in return is accountability, fairness and security. We expect to get what we pay for and to make American healthcare system more consumer driven and more cost effective that gives a peace of mind having access to insurance when it is needed. No more discriminating with children with pre-existing conditions, no more lifetime limits or restricted annual limits on coverage. Americans will be able to keep their doctors or pediatrician they choose, no referrals needed. These implementations protect the consumers. The Patient Protections and Affordable Care Act gives new tools to promote competition, transparency and better deals for consumers.

People with preexisting medical problems have health insurance protections through President Barack Obama’s health care law, which Trump is trying to dismantle (Hope, 2020).

ABC News reported Alecia, a professor born with a disease called sarcoidosis a skin disease that eventually moved to her brain. When it hit her brain, she automatically was eligible for disability for the rest of her life. She chose to educate herself to the highest degree to become a Ph.D. professor. She pays $7,000 a year in addition to copayments. The institutional theory would lower prices paid to health care providers for services lowing cost to consumers in the form of premiums. She is concerned that Trump will remove the Patient Protection & Affordable Care Act that provides coverage for pre-existing conditions. If removed, within a 36 to 72-hour period without medication, she would be dead. Her question to Trump was, “what it is that you're going to do to assure that people like me who work hard.” It's not her fault she was born with this disease or that she is a black woman (ABC News, 2020).

Conclusion

Many people are dying from preventable diseases than need be. “The role of health care reform in shifting the focus from a disease-oriented health care system toward one of wellness and prevention is helping Americans remain healthy and fit and prevent people from succumbing to preventable diseases” (Benjamin, 2011). Some people argue that free market capitalism is the best approach allowing competition to drive down cost to allow more people the affordability to buy insurance. Then, there are others saying health care is a guarantee. The institutional theory influences rules among the decision makers that could possibly help or hurt. The Patient Protection and Affordable Care Act is a private market system though there are government regulations that have legitimate claims but also government control mandating things. Americans are split on the decision of health reforms as it relates to increased taxes and spiked insurance premiums. Angie Craig, Democratic U.S. Representative for Minnesota’s 2nd district, sponsored the introduction of Bill 1425 (H.R 1425) State Health Care Premium Reduction Act “This bill allows states to lower the cost of premium and to expand access to healthcare to more Americans” (Craig, 2019). No matter where one stand, we have a right to quality and affordable healthcare coverage. The Affordable Care Act is perhaps the greatest overhaul of the US health-care system. People win and the insurance company lose.

Reference

ABC NEWS (2020, September) Trump on ABC News town hall: We will protect coverage for preexisting conditions. Retrieved October 27, 2020 from https://abcnew.go.com/2020/ video/trump -abc-news-town-hall-protect-coverage-preexisting-73037392.

Benjamin, R. M. (2011). The National Prevention Strategy: Shifting the Nation’s Health-Care. Retrieved on October 31, 2020, from https://www.nursingessayhub.com/

H.R. 3590. Congress.Gov. (2009-2010). Patient Protection and Affordable Care Act. 111th Congress. Retrieved on October 31, 2020.from https://www.congress.gov/bill/111th-congress /house-bill/3590/all-info?r=1

Creative Budget Solutions: Invest in Medicaid Buy-In Programs. Retrieved on October 31, 2020. from https://jfactivist.typepad.com/jfactivist/medicaid/page/2/

Crowley, R.A., & Bornstein, S.S. (2019). Improving the Patient Protection and Affordable Care Act's Insurance Coverage Provisions: A Position Paper from the American College of Physicians. Retrieved on October 31, 2020, from https://www.acpjournals.org/doi/

10.7326/M18-3401.

Haeder, Simon F. 2012. “Beyond Path Dependence: Explaining Healthcare Reform and Its Consequences.” Policy Studies Journal 40, no. s1: 65–86.

Hope, Y. (2020), No, Trump didn’t save pre-existing conditions. Retrieved October 27, 2020 from https://apnews.com/article/ce8b02c23096381739418e48fee5c6e1.

H.R 1425- State Healthcare Premium Reduction Act. (2019). Retrieved October 31, 2020, from https://www.congress.gov/bill/116th-congress/house-bill/1425.

H.R. 3590 – The Patient Protection and Affordable Care Act. (2009). Retrieved October 30, 2020, from https://www.congress.gov/bill/111th-congress/house-bill/3590.

Kraft, Michael E., Furlong, Scott R. (2018). Public Policy: Politics, Analysis, and Alternatives

(6th ed.). Thousand Oaks, CA: CQ Press.

McDonough, John E. 2011. Inside National Health Reform. Berkeley: University of California Press. Google Scholar Crossref.

Rosenbaum S. (2009). THE PATIENT PROTECTION AND AFFORDABLE CARE ACT: IMPLICATIONS FOR PUBLIC HEALTH POLICY AND PRACTICE,34, 130.

Abstract/Executive Summary

The Patient Protection and Affordable Care Act, sometimes call (ACA) made it through congress and Obama signed the law in 2010. The immediate goals of the Patient Protection and Affordable Care Act were to make health insurance available to more people while making healthcare affordable and expanding the Medicaid program. “Before the Patient Protection Affordable Care Act was passed in 2010, according to Dirigo review, there were nearly 49 million uninsured Americans; this is a large number when you consider other countries insurance rates.” (Dirigo, 2010) High rates of uninsured are a problem, and medical bills can be huge. You can go bankrupt in paying rates even if you have the financial support of an insurance company. The bad advantage is the number one reason people appear not to be buying plans is still the cost. Some can’t afford plans, and no Medicaid is available. Others fall into a family glitch, where they can’t get subsidies for family members because they have individual insurance from their jobs. Some can’t afford insurance cause, even with subsidies, they still can’t afford insurance. So, the ACA was successful in expanding healthcare insurance coverage in the United States. The Center Budget and Policy reports, more than 20 million people were getting coverage in the years passed, and the un-insurance dropped in 2018 (Budget and Policy, 2019).

Scope of Problem

The biggest objection to the ACA was cost. American is a very individualist country. People, businesses, and state governments don’t like to be told what to do, especially if they have to pay for it, even if it’s good for public health (McConnell, 2014). The Affordable Care Act is designed to slow rapidly rising healthcare cost and provide quality health and affordable insurance to every legal resident in the United States. “Although the law has never enjoyed widespread support, polls show that most Americans want the law reformed and improved rather than repealed.” (Hamel, et al. (2020) Appealing to America was companies requiring insurance to be sold to all and with pre-existing conditions. Repealing the ACA policy appears to improbable. From a realistic view, reforming the ACA is not significant enough in light of employers' Medicare and Medicaid and health care spending. Change to expand affordable insurance can compromise the ACA to improve the healthcare financial crisis.

“The most controversial and received the most push back out of anything is the ACA requiring states to expand their Medicaid program, a government-run health insurance program for low-income Americans administered thru a state and federal partnership.” (NCSL, 2020) Though Medicaid was an original requirement, the ACA was struck down by the supreme court, and states can now opt-in to decide whether they want to extend Medicaid, which they are no longer required to do.

It is expensive for states to cover; therefore, the federal government agrees to cover the cost of Medicaid expansion for the 1st three years and slowly phase out federal funding after that. “As of 2020, the state government is only paying 10% of the cost of extending in their state.” (Healthcare.gov, 2018) In addition to expanding Medicaid, ACA established penalties for large employers that don't provide health insurance. This has affected business that were over the limit of employees. More employers were cutting health insurance from their list of benefits.

The disputed part of the law was the ACA individual mandate, requiring the individuals who don't have coverage from other sources to buy insurance for themselves or face a penalty. The law established individual markets for people to shop and purchase insurance plans and buy one for themselves. This provision existed to encourage young and healthy people who wouldn't otherwise buy health insurance to sign up to keep the premium payment low. “As of January 2019, the individual mandate is at zero dollars; it no longer exists.” (Paychex, 2020)

Before the ACA, insurance companies could refuse to cover people with pre-existing conditions or charge much more than the average healthy person. People with pre-existing conditions or are chronically ill use healthcare the most. So, they're the most expensive to the health insurance company. To offset adding more sick people, you would also add more healthy people to the pool to make sure premiums weren't incredibly high for everyone.

Policy Alternatives

Before the ACA, could we choose free-market in health care? Employees can only take insurance plans offered by their employers. Low-income people and the elderly are forced into government insurance programs without free-market choices. Meaningful reform and achieving lower costs require patients to be in charge of their health care. This effort can be obtained through provider's transparency, changes in the tax code and less dependence on the employer or sponsored coverage, insurance reform, eliminating mandates, reform of Medicare, and use of subsidized high-risk pools to deal with a pre-existing condition.

Although the law has never had full support, I support the law reformed to improve its approach rather than repealed. If you repeal the ACA, subsidies will allow people to buy insurance in the exchange. It will disrupt the insurance in the insurance market place. Without the exchange, the individuals would lose their coverage. The insurance companies will also pull out of the total individual market where people buy insurance without subsidies. Many people will be without insurance. If you repeal the ACA and get rid of the funding mechanisms, the federal deficit would increase. Many people who lose their insurance will still need healthcare but can’t pay for their healthcare. Hospitals do provide healthcare without payment from individuals, yet hospitals will have to recover the care cost. They will bill the people who have insurance to provide free care who don’t have insurance. It’s like the common phrase, robbing Peter to pay Paul. Premiums will increase because of the repeal of the ACA.

Policy Recommendation

Ultimately, reforms are more about stopping the existing conditions, offering stability and security to Americans who need it. “Some states are repealing the reform, going back to discriminating against children with pre-existing conditions.” (HHS.gov, 2014) Dropping coverage to the sick or reinstate lifetime limits on benefits is the reason the Patient Protection and Affordable Care Act exist. Americans who work hard and do the right thing are expecting to get a fair share. These efforts are still alive and moving forward, even if it looks like it’s lost. Every time this country moves forward, it’s because America seeks healthcare quality and fairness.

Will healthcare cost ever be predictable? No one knows; however, America recognizes the uncertainties the country faces with healthcare. A primary concern should be, who should make critical healthcare decisions that affect your life? Should the government officials determine what plan, benefits, or treatments available to you? You would have more authority if you controlled your healthcare decisions and the dollar amount that enforced decisions.

Before the ACA, healthcare stability was weak. The ACA promoted a more stable environment that lessens the threat of losing healthcare coverage. If you get are sick, you could be dropped from your healthcare insurance, now you have access to shop for suitable healthcare plans. Another provision is adult dependency, giving children coverage under the adult healthcare plan until the age of twenty-six. More people, young and old, are getting more healthcare coverage. People with low income can benefit from expanding Medicaid, providing funds from the government that is free or low insurance cost based on income or household status.

To strengthen the ACA, my recommendation is to focus on the flow of funding. Do we have the capitalism to soar? To help with the deficiency would be to fiancé the growth of money thru taxation. No one loves taxes, but it is a mechanism that can be used to finance healthcare. Taxes are mandatory and progressive, and as we know, the rich pay more than the poor, thus using that money to fund healthcare.

Secondly, I recommend supporting healthcare financing thru premiums. The cost of health insurance depends on who buys health insurance. The health insurance pools people together. For example, two people at the beginning of the year purchase insurance and maybe have the same risk but at the end of the year, the healthy person thru their premium has virtually subsided the sick person. It was fair at the beginning of the year because everyone was pitching in pooling their risk. So, you’re paying for your own risk and people at a higher risk with benefits, called cross-subsidy, forcing everyone to be in the pool. The sicker people have premiums they can’t afford. The Affordable Care Act pushes those groups together, bringing the healthy people in with a premium slightly higher than the fair compensation to fiancé the sicker people.

Lastly, I recommend a person get rewarded monetarily for good heal