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Nathan Smith
Professor Eaker
March 29, 2014
ENGL-1102-001
Voices of the Affordable Care Act (ACA)
Regarding what has come to be known as Obamacare, or the Affordable Care Act (ACA),
there are primarily three groups of people whose voices are most readily voiced in the debate
over the act and its policies. People employed by hospitals in border states, small business
owners, and the previously uninsured all hold a great deal of sway in the conversation regarding
the ACA.; however, it is important to note that each has its own outlook on the issue due to the
circumstantial factors which give the group its common identity and outlook. Additionally, this
outlook is genuinely restrictive, in that an individual would generally have no impetus to address
the issue at an angle that varies from their own unless they address the issue with an objective
lense, and it is with this restrictiveness in mind that this paper goes about analyzing each facet of
the discussion occurring between the individual groups. It is important to note, though, that
certain groups may share a common voice even though they share a nuanced opinion because of
the similarity in their arguments.
One such case where many people who are diverse when considered individually, but
will overall share a voice are people that are employed by hospitals. People employed by
hospitals, and the hospital administration themselves, are quite adversely impacted by the policy
changes of the ACA when the hospital resides on one of the border states; this is largely due in
part to the great increase in migrant population, and number of individuals who are impacted by
the migrant population on an individual or system-wide level. The change that lays responsibility
on hospitals for care received increases the financial burden for hospitals in border states by a
great degree, but will also likely have an impact on the quality of care received. Preventative care
is necessary in preventing emergency-room visits and maintaining quality of life, but with care
restricted to mainly naturalized citizen, it will be difficult for the migrant population to receive
care outside of major impairing events. Individuals like pregnant women are at greater risk for
emergency complications, and while lawfully residing pregnant women and children may
receive care without a waiting period, in states that do not elect this option, these children
and pregnant women must still wait five years or more before they can get affordable health care
coverage (Immigrants). The significance of this addendum is that pregnant women whom still
retain their immigrant status will likely be unforthcoming in order to receive medical care, and
those that do and are unable to afford the emergency care inadvertently lay the burden of cost
upon the hospital. If that were not enough, the ACA mandates that future tax exemption for
hospitals occur on the basis of care outcomes. Although the purpose of this policy was to
increase transparency concerning the special benefits and incentives tax-exempt hospitals receive
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by imposing additional requirements, the actual effect merely strains the financial situation of
the hospitals, since health outcomes are largely determined by the amount of preventative care
received (Sharamitaro 1). With so few of the immigrant population able to receive preventative
care, the health outcomes of the immigrant population will decline and hospitals will likely
receive poor outcomes and criticism irrespective of their efforts to provide reasonable care. The
pressure of impending taxes, and the additional burden of patient unreliability all contribute to
the financial burden that will be directed towards hospitals in these transitory states.
Small business owners, like hospitals in dealing with financial burden and shifts in
financial burden, have long-since been at odds with the need to provide health coverage to their
employees, since it is often costly for them to do so, and they often lack the raw capital to
provide coverage to every employee at a desirable level. The changes in the ACA impose a tax
penalty for small business owners who do not provide proof of insurance for their employees;
however, new insurance plans are being offered to employers in an attempt to help them
affordably provide coverage. The penalty imposed to employers requires a business to qualify
as a large employer, and businesses with fewer than 50 FTE employees or less are not
subject to the penalty (Lowry & Gravelle 5). The benefit of this particular is that it mainly
targets employers who are in a position of affordability which they can already afford coverage
due the the larder income and employment basis. Additionally, the ACA mandates that
employers limit waiting periods to no more than 90 days, enabling those who come into
employ to receive care expediently following their employment (Pyles 1). Employers in general
do not see this change as one beneficial to them since it is they who will have to foot the bill on
the policy change; however, the tax exemption for doing so, and the increased affordability of
existing plans may help to circumvent or even reimburse the cost.
However, probably the most populous voice in the discussion of the effects of the ACA is
that of the previously uninsured due to the summational cost incurred to the mass as a whole.
Whether they were uninsured out of economic decision or due to lack of need, both face an
additional cost in their daily lives as a direct result of the implementation of the ACA, through
tax due to being uninsured or due to policy cost. The uninsured masses are comprised mainly of
the midwest and southern states, where the availability of health care, namely hospitals,
decreases. If one does not have feasible access to care, it is only logical that one not pay for
health coverage. As a direct result of this, many individuals in this situation are being "unfairly"
taxed because many are simply in too rural of an area in which to fully utilize their health
privileges. Of those that were uninsured, 5.4 million of those who registered on the ACA website
were previously uninsured, meaning that of the 7.1 million enrollees, 77% were previously
uninsured (Hiltzik par 5); what this statistic tells us, is that the majority of the people signing up
for care are those who were previously uninsured, with few signing up on the basis of more
affordable care. Furthermore, it is likely that those signing up for care via the ACA website are
merely doing so to circumvent the tax penalty imposed upon those who do not obtain coverage.
Similarly, those that choose to remain uninsured do so with the added burden of a tax. Many
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individuals who opted to not obtain insurance and choose to do so will face the full burden of the
tax being imposed, effectively forcing people to make a choice between two costs.
Highlighting this is the large number of uninsured individuals living in California; while nearly
72 percent of the remaining uninsured in California are predicted to be exempt from the
penalties in 2019, over a million more face harsher taxing due to their insurance status (Lucia
9). While those 72%, whom are exempted up to the year of 2019, may be free from the burden of
additional taxation, they still face the looming face of additional expense should policy change,
and will eventually face that burden in the near future. The future for those who remain
uninsured is uncertain, and although some may receive reprieve in states such as California, the
same is not true across the U.S., and many of the uninsured dread what future policy may hold.
Overall, each group has their own set of views which shape their specific opinion on the
subject of the ACA, but each of them carries their opinion with them into the communal
discussion of the ACA, which serves to create the general mood of the discussion when their
numbers are taken into account and the impact of each group established. These cooperating
opinions, or contrasting, work to motivate change in policy, and understanding each is essential
in determining the motivation behind each, potential opinions of other related groups, and the
various effects that policy change may enact.











Works Cited
Immigrants and the Affordable Care Act (ACA). Affordable Care Act. National Immigration
Law Center, Jan. 2014. Web. 19 Mar. 2014.
Sharamatiro, Anne. "Healthcare Reform: Impact on Hospitals." Ed. Cora Drew. Health Capital
Topics 4.1 (2011): 1-2. Web. 29 Mar. 2014.
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Lowry, Sean, and Jane Gravelle. "The Affordable Care Act and Small Business: Economic
Issues." Congressional Research Service, 25 Feb. 2014. Web. 22 Mar. 2014.
Pyles, Jim. "How the Affordable Care Act Affects Small Businesses and Individuals." Powers,
Pyles, Sutter & Verville, P.C., Jan. 2013. Web. 30 Mar. 2014.
Hiltzik, Michael. "A Look at How Many Obamacare Enrollees Were Uninsured: 5.4
Million."Los Angeles Times. N.p., 3 Apr. 2014. Web. 3 Apr. 2014.
Lucia, Laurel, Ken Jacobs, Miranda Dietz, Dave Graham-Squire, Nadereh Pourat, and Dylan H.
Roby. "After Millions of Californians Gain Health Coverage under the Affordable Care
Act, Who Will Remain Uninsured?" UCLA Center for Health Policy Research. UC
Berkeley Labor Center, Sept. 2012. Web. 31 Mar. 2014.