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Ashton Irvin

Professor Padgett

ENGL 102

4 April 2017

Patient Protection and Affordable Care Act

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. Now that Obama is out of office and Trump is president, the law is no longer under

protection (Oberlander). According to the authors of Expected and Unexpected Consequences of

the Affordable Care Act, no matter your position, the ACA is a reality. 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 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
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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.

Another paragraph on the positives

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
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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). Premiums are to rise by an average of 25% in 2017. This increase was predicted at

the start of the law, and government subsides to help pay for insurance will also increase. But

those who should be covered by the Medicaid expansion aren't eligible for those subsidies.

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

citizens to have health insurance. A major problem that Obamacare faces is that many insurance

companies are backing out because of a lack Americans signing up. This causes insurance costs

to increase for everyone, ad this causes another decrease in participation (Why is Obamacare so

Controversial?). 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. This has caused

some Americans to just pay the fine for not having healthcare because they 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 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
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health care. This means that when the ACA was created, it was designed with a flawed

assumption (Rudnicki).

What we should include in a new reform in order to put some of the healthcare debate

over the Affordable Care Act to rest. Keep pre-existing condition and more coverage. Make

states participate in Medicaid, work towards improving the health of individuals rather than

health insurance. Find out a way to increase access and quality of care for a cheaper price

because right now only two can be achieved. Increased access to quality of care means increased

costs, and decreased costs mean a lack of access or quality. 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.

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. 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.

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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.

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.

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.