Irvin 1

Ashton Irvin

Professor Padgett

ENGL 102

11 April 2017

Patient Protection and Affordable Care Act: A Nation Divided

Healthcare has been a topic of debate for many years. However, since the Obama

administration and the enactment of the Patient Protection and Affordable Care Act (PPCA, for

short the Affordable Care Act (ACA), this debate has become more prevalent. Obama was not

the first person to think of universal healthcare as a solution to the healthcare problem, but he did

take one of the first major steps in implementing it. The Affordable Care Act was enacted in

2010, and it represents the most significant overhaul of the United States health care system

since the passage of Medicare and Medicaid in 1965 (Rudnicki). This act worked towards a

more uniform health care that helped cover more people in the US. Since its enactment, more

than twenty million people have gained insurance. Throughout Obamas presidency, many

people talked about wanting to repeal the healthcare act, but with Obama still in office, it was

protected. According to the authors of Expected and Unexpected Consequences of the Affordable

Care Act, no matter your position, the ACA is a reality. However, now that Obama is out of

office and Trump is president, the law is no longer under protection (Oberlander). With the recent

election, the future of the PPCA is looking uncertain because the current administration is

uncertain with what they want to do with the act (Pollack). The debate now is whether or not we

should repeal the act and replace it or keep it, and the debate is going to continue unless we are

able to reform the ACA. If this act were more popular amongst Americans and if more
 Irvin 2

Americans shared the same views, more people would want to reform Obamacare rather than get

rid of it (Oberlander). In order to solve this problem, we as a nation should find a way to

implement the positive effects that the ACA has had on healthcare in the United States and

improve the areas where the ACA has been lacking.

The positive effects of the ACA can be split into three categories: insurance industry

reform, expansion of coverage, and the triple aim of improved access, improved outcomes, and

reduced costs of care (Rudnicki). The price of insurance varies from company to company, and

they all have different coverages. One of Obamas main intentions for the ACA was to make

healthcare uniform. He wanted everyone to have the same coverage at the same price, or the goal

as Scott Gottlieb said was to make sure everyone had exactly the same set of benefits. Before

this, people could choose the insurance they needed based on the coverage that they needed. For

example, a family would choose a plan with pediatric care whereas an elderly person would

choose a plan that met their health needs. This caused the price of insurances to vary, but now

everyone with Obamacare pays the same amount of money for the same coverage no matter the

actual coverage you need (Gottlieb). A huge appeal that the PPACA has on Americans, is the

patient protection part. This part of the act ensures that Americans can still be covered by

insurance despite pre-existing conditions which is a problem many Americans face with other

insurances. The last category of the positive outcomes improves access and outcomes and

reduces costs of care. According the original goal of the act, it was supposed to increase the

opportunity for thirty to forty million Americans to be covered by health insurance (Hader). One

way that this was achieved is that it allowed more people to qualify for Medicaid. This allows

more people who are unable to afford insurance to apply for health coverage through the state.

Richard Hader said that the Affordable Care Act was our opportunity to set the direction of
 Irvin 3

healthcare. This suggests a shift and a hopeful improvement in not only healthcare coverage but

to the health of individuals as well.

Despite the positive outcomes of the healthcare reform, it has its flaws. One of these

flaws is that it has changed the way that Medicaid is administered. Obamacare was supposed to

help increase the number of people who could qualify, but it also said that the state could choose

not to expand (Why Is Obamacare so Controversial?). This causes poor and working-class

families that do not qualify to pay for private insurance which can be expensive (Why is

Obamacare so Controversial?). Another problem that Medicaid faces under the ACA is that even

though it recognizes the importance of Medicaid, it does not anticipate the ongoing need to

support safety net providers, and many Americans depend on safety net providers for health

care (Shin). It has been predicted that insurance premiums could rise an average of twenty-five

percent this year, and this is not a recent prediction (Why is Obamacare so Controversial?).

There will also be an increase in government subsidies, but those who have health coverage

under Medicaid, will not be able to benefit from these subsidies (Why is Obamacare so

Controversial?). According to Pew Research, seventy-six percent of people disapprove of the law

because they believe it is too expensive (Motel). This raises the question of whether or not the

Affordable Care Act is actually affordable. Pew Research also says that the number one reason

that people disapprove of this healthcare law is because it has too much government involvement

(Motel). This goes into the fact that it is required for all United States citizens to have health

insurance. If people do not sign up for health insurance, they are fined, so it is clear to see why

this is an issue to many Americans.

 Irvin 4

Monthly Pre-Existing Condition Insurance Plan Enrollment: SC, NC, GA

6000
5000
4000

Number of People 3000

2000
1000
0
Enrolled through November 1, 2011

Enrolled Through

SC GA NC

(Data obtained from https://data.cms.gov/Health/Monthly-Pre-Existing-Condition-Insurance-

Plan-Enro/dpuq-z7nj)

In order to expand and achieve universal coverage, the health care act requires all US

citizens to have health insurance. This goes back to Obamas plan to have a uniform healthcare

where people pay the same and get the same coverage. This sounds like a great plan until people

are having to pay more for coverage that they do not necessarily need. In some cases, Americans

cannot afford Obamacare because the aid that is available is not substantial enough to buy it.
 Irvin 5

This has caused some Americans to just pay the fine for not having healthcare because the fines

are too small to convince them to enroll (Why is Obamacare so Controversial?). For some, not

being on Obamacare is better for them because they can choose the coverage they want or need

for cheaper. This leads to another major problem because many insurance companies are backing

out of Obamacare because of a lack of Americans signing up. This causes insurance costs to

increase for everyone which then causes another decrease in participation, and this is due to a

lack of appeal from the healthcare act (Why is Obamacare so Controversial?). When Obama first

brought up the act, many people only looked at the positives because it was said that the goal

was to increase healthcare coverage across the United States. As you can see from the chart

above, there was an increase of enrollment early on, but enrollment began to decrease by 2013.

Many people began to see the negative aspects of the Affordable Care Act because although it

increases the coverage a person receives, it means that people are paying for coverage that they

do not necessarily need.

In order to shrink the division amongst those that approve and those that do not approve,

our government needs to find a way to incorporate the positive aspects of the ACA while fixing

the negative aspects that Americans have problems with. Some of the biggest reasons that people

support this law is because it expands health coverage to the uninsured, and it assures coverage

for people with pre-existing conditions (Motel). This is one aspect of the healthcare act that

needs to be carried into the next healthcare reform. A contradictory position on the ACA has to

do with Medicaid. In order to increase approval, we need to keep the part where qualifications

for Medicaid increase, but we need to require states to issue this. This may only directly affect

one group of people, but it will be one step closer to helping solve this problem. In a new,

reformed healthcare act, we need to make sure that people are paying for the coverage that they
 Irvin 6

actually need instead of just giving people coverage for everything. This could be improved if we

started with a framework for health, rather than health insurance (Rudnicki). This means that if

we are able to give people only the coverage they need at an affordable price, we will be able to

improve the health of individuals rather than make them pay for coverage they do not need. The

triple aim goal was a good thought process, but it is the most expensive option and assumed

that if everyone has health insurance, then they also have health care. This means that when the

ACA was created, it was designed with a flawed assumption (Rudnicki). We need to target health

care places and officials and make quality universal rather than price because if quality is the

same, then the price will eventually become universal. Ultimately, the goal of the new reform

needs to target individuals needs to help improve their health, and from here we need to figure

out a way to make quality healthcare more accessible.

Opposition vs Approval of the Affordable Care Act

50%
40%
30%
20%
10%
0%
percentage of people

public opinion
 Irvin 7

(Data obtained from http://www.people-press.org/2014/05/05/views-of-the-affordable-care-act-

and-its-future/)

By creating a new healthcare act or policy that fixes the flaws and implements the

positive effects of the Affordable Care Act, we will be able to work towards resolving this debate

on healthcare. The United States has witnessed a major shift in healthcare over the past few

years, and this is going to continue to change whether we reform the act or not. As seen in the

chart above, more people strongly oppose the healthcare act than they approve it. Overall, there

are more people who look at the act as being more negative than it is positive. Personally, I

benefit from Obamacare because most other insurances do not accept me because of preexisting

conditions. However, my parents end up paying three hundred dollars a month for my insurance

when they only end up paying around four hundred dollars a month for them and my brother. A

reformed health care act needs to include patient protection from pre-existing conditions and

increased coverage while making states implement Medicaid and decreasing the cost of plans so

that more people will be able to afford to sign up. We will never be able to completely resolve

this problem because the debate has occurred for a very long time, but a new, reformed act will

be able to alleviate the problem.

Ashton,

You deserve much kudos for taking on a complex and difficult topic. You clearly have done lots

of reading and the research youve compiled here is great. It seems to me that your thesis is

largely like youre taking the current temperature (or use a hammy medical metaphor) of the
 Irvin 8

ACA. I dont think anyone needs persuading that the law isnt perfect and that certain aspects

need amending. What I would like is to get a clearer sense of who your audience is and what you

want to persuade them of. Is it people who want to repeal and replace? if so, that would really

guide the direction of your argument. And I think thats where my biggest concern is: there

doesnt seem to be a guiding compass for this paper aside from saying there are problems with

the current law. Maybe you want to persuade folks who want to toss the whole law out to slow

down and reconsider. Im not sure. But in revision picture your audience and write for that

audience. Otherwise, good work here.

 Irvin 9

Works Cited

Gottlieb, Scott. "Do You Win Or Lose Under Obamacare? What You Must Know To See How

You'll Fare." Forbes. Forbes Magazine, 20 Nov. 2013. Web. 22 Feb. 2017.

Hader, Richard. "Affordable Care Act...Ready, Set, Go!." Nursing Management, vol. 43, no. 8,

Aug. 2012, p. 6. EBSCOhost, doi:10.1097/01.NUMA.0000418130.27878.24.

Motel, Seth. "Chapter 2: Views of the Affordable Care Act and Its Future." Pew Research Center

for the People and the Press. N.p., 04 May 2014. Web. 10 Apr. 2017.

Oberlander, Jonathan. "The End of Obamacare." New England Journal of Medicine, vol. 376, no.

1, 05 Jan. 2017, pp. 1-3. EBSCOhost, doi:10.1056/NEJMp1614438.

Pollack, Craig Evan, et al. "A View from the Front Line - Physicians' Perspectives on ACA

Repeal." New England Journal of Medicine, vol. 376, no. 6, 09 Feb. 2017, pp. e8.1-e8.3.

EBSCOhost, doi:10.1056/NEJMp1700144.

Rudnicki, Marek, et al. "Expected and Unexpected Consequences of the Affordable Care Act:

The Impact on Patients and Surgeons-Pro and Con Arguments." Journal of

Gastrointestinal Surgery, vol. 20, no. 2, Feb. 2016, pp. 351-360. EBSCOhost,

doi:10.1007/s11605-015-3032-8.
 Irvin 10

Shin, Peter and Marsha Regenstein. "After the Affordable Care Act: Health Reform and the

Safety Net." Journal of Law, Medicine & Ethics, vol. 44, no. 4, Winter2016, pp. 585-588.

EBSCOhost, doi:10.1177/1073110516684801.

"Why Is Obamacare so Controversial?" BBC News. BBC, 11 Nov. 2016. Web. 27 Feb. 2017.