The Effectiveness of the Obamacare Policy in Administering Quality Healthcare - Coursework Example

The Effectiveness of the Obamacare Policy in Administering Quality Healthcare to All Citizens of the United States of America

Introduction

A while before the Patient Protection and Affordable Care Act became law; health insurance was considered to be a medical aspect for the rich, with the poor and more vulnerable to diseases being left more desperate and struggling to afford healthcare (Grabowski, Huckfeldt, Sood, Escarce, and Newhouse, 2012). There was no peace of mind when it came to medical insurance coverage which provided extreme panic, increased anxiety and dread among the financially unstable and people of color in the United States of America. There was a possibility of discriminating about 129 million Americans based on their pre-existing conditions such as diabetes, cancer, cardiovascular diseases as well as other funny complications such pregnancy and acne. A population of 129 million people lacking insurance coverage implied that typically one in every two individuals could not afford to comfortably manage a serious disease or condition citing the extremely high expenses associated with such conditions (Levine, 2015). For other Americans, suffering from a certain disease was considered bad enough to scrap their names from the existing insurance coverage plans, making them unable to cater for the financial expenditures of certain diseases. Losing jobs in those years was also a potential cause for being eliminated from an insurance coverage plan, increasing the tension of ever obtaining the best quality of care in US healthcare facilities. As a matter of fact, every household was just a single job loss or a single case of suffering from a disease away from experiencing the effects of the worst insurance system. The situation was terrifying as evidenced by some of the newspaper headlines of the days such as the Washington Post sometime in 2009 which confirmed the declaration of acne and pregnancy among the conditions that could disqualify an individual from a medical insurance plan (Fontenot, 2015). The USA Today in 2007 had also brought the situation to light with the revelation that some ailing patients had been left holding their catheter bags since the revocation of the health care policies. Many more sources of information kept on citing the unaffordability of health care in the USA due to the poor medical insurance plans practiced in the country before the signing of the Patient Protection and Affordable Care Act, herein simply referred to as the ACA or Obamacare. The presence of the individual insurance market during these dark days exemplified the state of health insecurity despite putting in efforts in places of work for the employed citizens of the USA. Constant worry kept on attacking individuals that lacked insurance coverage due to financial instability and discrimination based on health status among other reasons. Amazingly, even individuals with existing insurance coverage found it quite challenging to obtain high-quality health care during times when more serious diseases befell them. The aim of this paper is to analyze the effectiveness of the Obamacare policy in administering quality healthcare to all citizens of the United States of America.

The Social Welfare Problem

Before the implementation of this social welfare policy, only slightly over three million citizens of the USA were beneficiaries of the Medicare prescription drugs coverage gap every year. This prescription gap was referred to as the doughnut hole a required individuals to generate funds enough to make 100% payments for prescription drugs. This scenario created an incident whereby patients skipped their doses; others shared medications while at the same time some patients opted to avoid taking the medications altogether citing the high costs incurred in acquiring such prescription medications. During the same dark years of the American health sector, individuals that benefited from the Original Medicare were required to cater for 20% of preventive services from their pockets while the insurance companies could charge any amount for such preventive services at their discretion (Butler & Murphy, 2014). During the first twelve months of Medicare insurance, the company only provided a one-time coverage for individuals seeking medical services. The private Medicare plans were not an exception in the mistreatment of patients seeking healthcare services since the private insurance companies required beneficiaries to pay higher for low-quality health services. Initially, the US Department of Health and Human Services responsible for the administration of Medicare as well as the Department of Justice made use of pay and chase as the methods to detect and prosecute fraudulent insurance companies. This method, however, is inefficient since its implication was that the Medicare insurance companies would recollect payments for fraudulent activities after paying the bills to the respective departments. It was rather unfortunate that the Medicare plans would collect the prescribed amount of money for services rendered irrespective of their quality. In fact, Medicare used to charge providers based on the quantity of care provided rather than the quality of care. The provisions for such Medicare providers failed to encourage or reward other healthcare providers that tried their best to coordinate patients or communicate with their patients about their care (Garber & Sox, 2010).

Lack of health insurance produces an estimated mortality of between 20 thousand and 45 thousand deaths in the USA every year. In fact, a study done in 2012 covering USA families indicated that about 130,000 citizens succumbed to death between 2005 and 2010 citing their lack of insurance or poor insurance plans (Grabowski et al., 2011). A simple breakdown of this figure indicates that three individuals perished every hour and the mortality affected all the states in America. Other studies have indicated higher or lower statistics of mortality resulting from lack of insurance in the USA. All in all, these studies affirm that increased lack of proper health insurance coverage results in increased mortality rates in the United States. Evidently, individuals lacking health care insurance coverage rarely get more advanced care than the one obtained from the emergency rooms (Weinick & Hasnain-Wynia, 2011). Furthermore, these individuals almost always go without screening and preventive care services, go without essential care and most of the time pay relatively higher to obtain healthcare services.

A study funded and performed by the Commonwealth Fund in 2008 about the probability of implementing the ACA found that 82% of Americans were tired of the old system of health insurance coverage and felt that system needed to be overhauled (Stutz & Baig, 2014). It was worrying for most Americans how it would be possible to survive in the country where healthcare was so unaffordable. The prices of healthcare services were so high such that about 50 million US citizens, converting into one out of every six individuals, were uninsured by 2010, just before the ACA was signed into law. Health insurance had become a budget-buster for most of the American families, making it unaffordable for many people to acquire such insurance. In fact, the cost of employer-sponsored family insurance coverage had gone to as high as $13,375 by 2009 according to a study done by the Kiser Family Foundation.

Economically, these poor health insurance policies of the past have laid a financial burden not only to the individuals but also to the American economy. The US has been spending excessively on health on both per capita basis and as a percent of the Gross Domestic Product when compared to any other country. According to a report produced by the Organization for Economic Co-operation and Development, the expenditure on health person went as high as $8,745. This value is more than double the per capita value spend by America's competitors at the global level that spends only $4,000 on health. Such countries include Australia, France, Germany, Japan, Canada and the United Kingdom (Reinhard, Kassner & Houser, 2011). Incidentally, about 18% of America’s GDP was spent on health before the implementation of the ACA, a value that was relatively high when compared to 9.1% spend by Australia on health, and 9.4% spend by the UK. Such high expenditures on health led to a situation whereby finances were drained into health issues while being diverted from other essential aspects such as education, transportation, and infrastructural developments.

Current Social Policy: ACA

A current social policy that addresses the lack of proper health insurance coverage among the financially unstable population of the USA is the Patient Protection and Affordable Care Act (ACA). Three values that this policy aimed to address include equality in healthcare service delivery, high-quality care and the delivery of affordable healthcare. This policy was made into law on March 23rd, 2010 and was instituted by the outgoing President of the USA, Barack Obama (Levine, 2015). This social policy was enacted with the aim of increasing health insurance coverage to Americans that lacked it before the reign of President Obama. By the time the bill was being enacted into law, about 47 million citizens of the USA were uninsured, creating a basis for the enactment of such a bill. The ACA mandated new approaches towards the reduction of medication costs as well as improving the quality of care provided by the American healthcare system.

Fifty years down the line, American health system had failed to put patients first in the provision of health care services. Most patients without insurance coverage could not afford to pay for a doctor's visit while people with existing insurance plans risked being denied medical attention when they needed it most. Important medical procedures such as checkups and screenings to many of the Americans appeared like luxurious services considering their extrapolated financial requirements (Kenney, Buettgens, Guyer, and Heberlein, 2011). The health system encouraged focusing on the quantity or amount of care that was offered by the system rather than the quality or effectiveness of care delivered.

The enactment of the ACA changed the health scenario in the USA by improving the accessibility, affordability and the quality of medical care given to patients after 2010. The enactment was accompanied by a strong enrollment of healthcare consumers in the Health Insurance Marketplace. In fact, about 10.2 million new applicants had paid their premiums through the Health Insurance Market and already had active insurance coverage by March 31, 2015. In about four decades, the USA observed the greatest reduction in the number of uninsured healthcare consumers in the country following the partial implementation of the ACA (Stimpson, Wilson & Su, 2013). Such a reduction was made possible due to the provision of the online Insurance Marketplace, the provision that young adults could continue clinging to the insurance plans of their parents till they reached 26 years of age and the expansion of Medicaid plans (Henry, 2015). Moreover, the implementation of the ACA has led to continued progress in fighting against health inequity, with the uninsured rates of adults declining by about 9.2 percent points. Vulnerable groups such as Latinos were not left behind in the implementation plan as the uninsured rates for this minority group reduced by about 12.3 percent points. Since 2013, the rate of insurance for women has continued to increase with a reduction of the uninsured going up to 7.7 percent points lower, resulting in about 7.7 million women being newly enrolled in an insurance plan (Regenstein & Rosenbaum, 2014). Women have also continued to benefit from health care preventive services coverage without having to use their out-of-pocket cash to pay for such services as it used to happen before the implementation of the social policy. It is no longer possible for health insurance companies to exercise discrimination based on gender in which being a woman was initially a preexisting condition (Belshé, 2011). The social policy has also led to the expansion of Medicaid in that more than 12.3 million people have been newly enrolled in Medicaid when compared to the overall enrollment before 2013.

The social policy and its implementation in 2010 led to a reduction in the uncompensated care in hospitals due to the Marketplace coverage and Medicaid expansion. The uncompensated hospital care costs were reduced to about $7.4 billion by 2014 when compared to the accrual figures that would have been estimated before 2014 (Levine, 2015). The Medicaid expansion accounted for about $5 billion of this cost which is approximately 68% of the said reduction (Naylor et al., 2012). Since the healthcare coverage is moving in a positive direction when compared to the situation in the past, it is important for the government to start focusing on the education of the public on the essence of such coverage. This education helps to minimize barriers that would eventually cause the population to live shorter and unhealthy lives (Fielding, Teutsch & Koh, 2012).

The affordability of care following the implementation of this social policy can be said to have improved when compared to the previous years before the enactment of the ACA. According to research done by Commonwealth Fund in 2014, few Americans experienced difficulties in paying for their health care services while fewer went without essential medication due to lack of adequate finances to facilitate treatment. The reduction of such cases in 2014 was the lowest since 2005 (Stimpson, Wilson & Su, 2013). The healthcare consumers have also been provided with the ability to make choices on which insurance plans to choose following the opening up of the online insurance marketplace. During the 2015 Open Enrollment, for instance, 25% more issuers of medical insurance coverage joined the marketplace, increasing the alternatives of insurance providers. As compared to the situation in 2014 whereby the consumers could only choose up to 30 insurance plans, the patients had an opportunity choose among 40 health plans on average (Hill, 2012). From research, an increase in the number of issuers is directly proportional to the affordability of the premiums. The growth of the health costs since the start of the implementation of the ACA has slowed sharply. In fact, researchers have termed the slow growth of the health costs since 2010 to present at the slowest rate in the last fifty years. Medicare, for example, paid $316 billion less by 2013 as compared to the probable cost it would have paid in the previous years. Between 2010 and 2014, the average premium for employer-based family coverage went up by only 3% nominally. For this type of coverage, the increase in premium was almost always registered in double digits as evidenced by research by the Kaiser Family Foundation.

Further, the ACA improved the quality of care through patient safety. It has been found that between 2011 and 2015, the rate of reduction of hospital acquired conditions has increased to about 17% with an estimated 50,000 lives being saved in addition to salvaging about $12 billion (Orentlicher, 2011). Following the ACA implementation, the rate of hospital re-admissions also fell to approximately 17.5% in 2013, a percentage that translated into about 150,000 fewer hospital readmissions between 2012 and 2013. The introduction of Accountable Care Organizations created a forum for working together to ensure that the patient was put at the center of healthcare provision, creating room for better health outcomes (Arcaya & Briggs, 2011). The health protection for consumers has increased considering that most individuals receive their health insurance through their employers without a possibility of being turned away due to preexisting conditions. Such insurance plans may not be dropped just because someone got sick and the coverage is exceeded to cater for transport services to the emergency room, prescriptions medications and preventive services (Levine, 2015).

Policy Analysis

Even after a single year of its operation, the ACA was reported to have largely succeeded in delivering President Obama’s core promises to the people of America. Nonetheless, the ACA policy faced some challenges that led to occurrences of various powerful conservative backlashes. Despite the backlashes witnessed during the implementation of this policy, it is still clear that the percentage of uninsured people has reduced by an average of 25% per year (Levine, 2015). As many people have enrolled in Medicaid as those that have enrolled in private insurance plans, ensuring that the low-income earners are not left out (Belmont et al., 2011). Under the ACA policy, the health insurance has been practically affordable since about 85% of those that enrolled for health insurance on the online platform during the first phase received federal subsidies that reduced the cost of their premiums.

One of the requirements of the Gilbert and Terrell (2002) model of social welfare policy analysis is that the policy's sources of finance are explained. It is important to highlight the sources of funding for the ACA policy so as to establish its sustainability shortly (Gilbert & Terrell, 2002). The government sourced for the funding of the ACA policy through cutting down its expenditure and creating provisions that could raise revenue for the health reform expected to perform exploits in providing quality and affordable health for American citizens. Using these two broad mechanisms of finance generation, the Democrats government was able to raise funds to expand the health insurance coverage for the more than 32 million people that were newly enrolled in the program. The cuts implied on the government expenditure amounted to about $741 billion that were used to finance the social health policy (Fielding, Teutsch & Koh, 2012). Such cuts were incurred in the way the government remunerated its doctors as well as hospitals that provided care to Medicaid and Medicare patients. Figure 1 shows the breakdown of the changes that occurred in the government’s payments so as to provide partial sources of revenue to finance the social policy.

Figure 1: Cuts in government expenses

Although the health law cuts into the federal government expenditure, it is not an adequate measure to source for all funds necessary for the implementation of the social policy on health issues. In the process of expanding insurance plans, this policy also creates an opportunity for increased collection of revenues. Some of the revenue also culminates from the collection of fines payable by those who fail to purchase insurance coverage amounting to about $55 billion in the course of about ten years (Mechanic, 2012). The government also collects finances amounting to about 111 billion dollars from an excise on Cadillac, the most expensive insurance plan. More money is obtained from less exciting parts of the social policy with the CBO expecting to achieve a $216 billion target saved from the positive consequences of expanding their insurance coverage including fewer reductions in uncompensated care. More funds are generated from relatively high-income earners who pay over $200,000 towards the implementation of the social policy by being charged 3.8% of their investment incomes in Medicare's hospital insurance. The breakdown of such income is illustrated in Figure 2.

Figure 2: Breakdown of revenue from less exciting portions of the ACA

Other smaller taxes also complement the sources of revenue to finance the health care policy including the 10% tax on indoor tanning which was expected to raise an approximated amount of three billion dollars. However, most of these taxes include such as the indoor tanning do not affect the small businesses so as to promote entrepreneurship and business creativity. Such taxes are levied on individuals who wish to venture into tanning and those that fail to buy health insurance or even bigger employers with more than 50 workers who deliberately fail offer coverage for their employees. These are just part of the sources of finance that were used to aid the success of the ACA policy.

The suitability of the ACA as a social policy can be gauged according to the Gilbert and Terrell (2002) framework model. The Gilbert and Terrell (G & T) framework propose that every welfare policy should consider providing alternatives for the targeted group of beneficiaries. In accomplishing the requirements of the G & T model, the ACA social policy on health provides an opportunity for healthcare consumers to purchase different premiums from the more than 40 premium options available in the competitive online insurance marketplace. The basis for social allocations of health care insurance is the possession of an American nationality without any bias based on color, financial stability, existing conditions or gender (Levine, 2015). As earlier said, the previous insurance coverage was biased on women in that this gender was considered to possess a preexisting condition, limiting the eligibility of women in the purchase of insurance plans. The ACA policy, however, addresses this limitation by providing an equitable platform for the purchase of any insurance plan irrespective of gender and pre-existing conditions. The type of social provision is health to all health consumers in the USA with the aim of increasing the affordability, accessibility, and quality of the social service (Stimpson, Wilson & Su, 2013). The strategy for the delivery of health insurance to the people of America as per the ACA policy was to create an online marketplace from which every individual would choose an insurance plan of their interest and suitability. The online platform provides an opportunity for all interested parties to acquire health insurance at a time of their convenience. The Individual Mandate was also instituted and conceptualized as a strategy for ensuring that all the suitable applicants benefited from lower costs of medication as well as highly accessible and quality healthcare.

The Individual Mandate is one area of controversy that keeps on slowing the implementation process of the Affordable Care Act. Some politicians kept on insisting on the lack of constitutionalism in charging fines to people who failed to purchase insurance plans as part of the strategy to ensure that as many people as possible gain health insurance coverage (Mechanic, 2012). The decision by the Supreme Court to overhaul the political judgments on the Individual Mandate opened an opportunity for the continued implantation of the policy citing its suitability in ensuring the provision of secure and high-quality healthcare in the system. Payment of such fines that are used to further increase the revenue for the implementation of the policy is a positive strategy for ensuring the success of the policy (Stimpson, Wilson & Su, 2013).

Conclusion and Recommendation

The poor, minority and women in the USA continued to suffer from healthcare disparities that could only be solved by the implementation of a social welfare policy. The Patient Protection and Affordable Care Act discussed in this project served a great deal in ensuring equity in the acquisition of health insurance by all citizens irrespective of their color, gender, and financial stability. Based on the various achievements the ACA has made in improving the quality, accessibility, and affordability of healthcare, it is important to maintain its continued implementation even after President Obama's reign comes to an end. However, this project recommends the diversion of more attention to targeting preventive measures to eliminate disease incidences rather than focusing more time and attention to the treatment of ailments. It would be cheaper to invest in preventive measures of disease when compared to investing lots of finances on treatment procedures as a way of maintaining longer lives and better health outcomes. Perhaps by so doing, the cost of purchasing insurance plans may keep on decreasing and eventually there may be no need to exert the forces of the Individual Mandate of citizens who fail to buy insurance plans.