TheAffordable Care Act – ACAA public policy that expressed shared responsibility successfully changed health insurance in the United States.  A reform that covered the entire insurance market eliminated a major discriminatory practice of excluding pre-existing condition.  These statements confirm the effective implementation of the Affordable Care Act of 2010 (ACA) or the Patient Protection and Affordable Care Act (PPACA) or simply Obamacare as it ensures coverage for all Americans through tax credits that make insurance affordable for everyone.  The ACA reforms the health insurance industry and the American health care system as a whole and provides Americans more rights and protections as it expands access to affordable quality health care to millions of uninsured.Before the implementation of the ACA thehealth care system is very difficult for many Americans to participate inbecause health insurance is very expensive. Those who live in poverty qualify for free healthcare paid by thegovernment or the Medicaid; and those who are older than 65 obtain Medicare inwhich the government subsidizes for its premiums.  However, there are still many unqualifiedincluding the self-employed, those persons who are not able to obtain healthinsurance through their jobs, and minors (Willis, 2017), hence they have nomeans of paying for healthcare. Most frequently are the instances in whichinsurance was even denied to people with medical conditions thus, without anyinsurance to pay for treatments.The UninsuredIt has been a misconception that the uninsured are those who do not have jobs are those who just do not want insurance.  The majority of these uninsured were working families who cannot afford or do not have access to health insurance.  The primary reasons for Americans being uninsured are cost and job loss with poor working families as the most likely to be uninsured.  In America, “the uninsured are more likely to die than those with insurance; are less likely to have a usual source of care outside of the emergency room; often go without screenings and preventive care; often delay or go without needed medical care; and pay more for medical care” (Obamacare Facts, 2017).AffordableCare Act (ACA): Definition The Patient Protection and Affordable Care Act (PPACA) is most commonly known as the Affordable Care Act or ACA is a health reform legislation signed into law by President Barack Obama in March 2010 (ObamaCare Facts, 2016) which puts in place comprehensive health insurance reforms to provide Americans with better health security such as: expanded coverage; holding insurance companies accountable; lower health care costs; guaranteed more choice; and enhanced quality of care for all Americans. The ACA’s major provisions include the following descriptions: Eligibility                                                                                9.   Dual eligibleFinancing                                                                               10.   Provider paymentsInformation Technology Systems and Data                          11.  Program transparencyCoordination with Affordable Insurance Exchanges             12.   Program integrityBenefits                                                                                  13. PreventionCommunity-based long term services and supports               Quality of care and delivery systemsChildren’s Health Insurance Program (CHIP)The ACA was signedinto law on March 23, 2010 and upheld by a Supreme Court ruling on June 28,2012.  “The ACA was signed into law toaddress the national health care crisis and to make insurance moreaffordable and available for the 44 million uninsured people. This lawrequires all Americans to have health insurance by 2014 or pay a per month feefor each month without minimum essential coverage” (ObamaCare Facts, 2016).  This shared responsibility provision is referredto as a tax and not a mandate and is introduced as a new way to purchaseinsurance.  The ACA allows thepossibility of being able to purchase insurance through state health insurancemarketplaces that provides buyers with cost assistance and be able to compareplans.  As the ACA requires that allAmericans purchase a private health care plan, and getan exemption or pay a tax penalty on their federal income taxes,the law also implements new benefits, rights and protections leadingto better quality and more affordable health insurance. “The ACA refers totwo separate pieces of legislation of  the (PPACA) (P.L. 111-148) and the HealthCare and Education Reconciliation Act of 2010 (P.L. 111-152); and both of theselaws expand Medicaid coverage to millions of low-income Americans and makesnumerous improvements to both Medicaid and the Children’s Health InsuranceProgram (CHIP)” (Medicaid, 2016).The ACA improves the health care industry including the minimum standards of what health insurance must cover.  The 44 million Americans who are currently without health insurance are projected to be covered under this health care law and be included among the recipients of better preventive care, women’s health services, and better care for seniors and expanded coverage of the poorest people in America.  ACA’s provisions protect consumers by holding the insurance companies liable as they can “no longer deny individuals for pre-existing conditions or being able to drop their coverage for being sick, free preventive treatments, and the elimination of discrimination, and annual and lifetime limits on essential health benefits; and that all plans sold on off the insurance exchange include ten essential benefits and have a minimum actuarial value” (ObamaCare Facts, 2016).     Why has ACA been soopposed?The ACA boasts ofits capability to save low to middle-income families and small businessesbillions of dollars by providing reduced costs and reduced premiums to millionsof Americans through marketplace subsidies.  “The ACA was passed by a Democratic Congressand signed into law by a Democratic president in 2010 with the consistentopposition from Republican congressmen, governors, and Republican candidates”(Dalen et al., 2015).  The opposition to a government role in health care is based on the fact that that the large majority of American citizens do not trust the American government, particularly Republicans who are much less trusting of the federal government and much less supportive of a government role in health care than Democrats. Those in the opposition generally ignore the most important goal of the ACA which is to improve the health of Americans by increasing the number covered by health insurance.  “People have lost the doctors and health plans they valued, many are being forced to pay penalties for not buying ObamaCare’s expensive mandated insurance, others are finding they must pay back subsidies they received last year; many workers have lost jobs and hours because businesses couldn’t afford to provide ObamaCare’s expensive benefits or pay thousands of dollars in penalties” (Turner, 2015).  It is significant to note that with just on the first year of ACA’s implementation is a recorded more than 10 million citizens who have gained health insurance.  “The percentage of Americans without health insurance decreased from 18% in July 2013 to 13.4% in June 2014. In addition, the ACA has eliminated many of the negative features of private insurance such as the denial of coverage for those with prior conditions” (Dalen et al., 2015). TotalCosts of the Affordable Care ActThe CongressionalBudget Office (CBO) has presented its estimates on the ACA’s costs and impacton insurance coverage with the “total net cost of the insurance coverageprovisions of the law to be over $1 trillion after 10 years from 2016 through2025. This gross cost includes spending on subsidies for insurance from theexchanges, tax credits to small businesses and expanded Medicaid coverage (Fatcheck,2015).  The insurance-related provisionsimplies that “6 in 10 Americans can get covered for $100 or less onthe Health Insurance Marketplace, with the average plan costingjust $82 after Premium Tax Credits in 2014.  This trend of low costs for those withcost assistance has generally continued each year due to the way premiums arecapped based on income” (ObamaCare Facts, 2016).  The CBO stated that gross amount that will bespent in the following 10 years is for insurance subsidies from exchanges andrelated spending and revenues, for Medicaid and CHIP, and for tax credits forsmall employers. The ACA does not sell health insurance, but creates a marketplace for Americans to buy regulated and subsidized private insurance.  “Most Americans have to either: obtain health insurance known as minimum essential coverage and maintain it throughout the year, or pay a shared responsibility fee for every month they go without coverage.  Many qualify for lower costs on monthly premiums and out-of-pocket costs via cost assistance subsidies through the marketplace” (ObamaCare Facts, 2016).  Cost assistance is based on income and includes “Premium Tax Credits, which lower monthly premiums, and Cost Sharing Reduction subsidies, which lower out-of-pocket costs like co-pays, coinsurance, deductibles, and out-of-pocket maximums.  However, those who have access to affordable employer-sponsored insurance won’t be eligible for subsidies” (ObamaCare Facts, 2016).  Impact of ACAon Small BusinessesThe ACA mandates anemployer to provide full-time employees with comprehensive health insurance.  The enforcement of this mandate was initiatedon 2015 for employers with more than 99 full-time employees.  Employers with 50 to 99 full-time workers beganto comply on 2016. Businesses with less than 50 employees will not be sanctionedwith penalties.  Employers are also prohibitedto place burdensome amount of premiums on some employees as payment based on apercentage of their wage income (Herrick, 2014).   Much of the burdenof complying with the ACA falls on small businesses as it affects howbusinesses operate such as the hiring of employees, employee compensation, and growth.The ACA provides small employers a temporary health insurance tax credit asthey are able to employ moderately-paid workers. The credit is only availablefor six years for those businesses that have 25 or lesser employees with averagewage of less than $50,000.00 (Herrick, 2014).  Small businesses obtain group health coveragefrom insurers with cost-increasing regulations, and must renew annually theircoverage compared to large corporations, thus it is to self-insure by payingthe medical bills of their employees and hiring insurers to manage healthbenefits (Herrick, 2014).  Healthbenefits are included in the significant expenses for employers as asubstantial portion of the total compensation of workers. The CBO evaluationindicates that the required coverage for an individual will cost $5,800 or morein 2016 which is equivalent to an additional $3 per hour of minimum healthwage. Family coverage is estimated to cost more than twice that amount asillustrated by the cost of employee health benefits at $2.70 per hour which is,according to the Bureau of Labor Statistics, 8.5 percent of the privateindustry worker’s total compensation (Herrick, 2014).   What arethe Health Insurance Exchanges?The ACA’s HealthInsurance Exchanges is also called the Health Insurance Marketplace, and was openedon October 1, 2013.  “Exchanges are State,Federal or join-run depending on your State” (ObamaCAre Facts, 2016).   TheACA health insurance exchanges or ObamaCare exchanges are online marketplacesfor health insurance where Americans can obtain coverage from competing privatehealth care providers. “Shoppers can use a price calculator to see if theyqualify for cost assistance subsidies (as well as Medicaid and CHIP)and see side-by-side comparisons of qualified health plans ensuring the bestdeal for them and their family.  Thehealth insurance marketplaces (also known as exchanges) are estimated toprovide up to 29 million people with affordable health insurance by 2019”(ObamaCAre Facts, 2016).   Marketplaces going into open enrolment 2015offers enrolling in a new plan, change plans, verify cost assistance, enrollin Medicaid and CHIP, and to apply for cost assistance which caninclude premium subsidies and out-of-pocket subsidies depending on income.  Onemust obtain or maintain minimum essential coverage (all marketplaceplans are minimum essential coverage), or qualify for an exemption,during open enrolment to avoid owing the per month fee for nothaving coverage.  In the individual andfamily market open enrolment is the only time you can switch plans or buya new plan, this is true whether you use the marketplaces or shop outside ofthe marketplaces.  Missing out on openenrolment renders one unable to buy a major medical health plan thatcounts as minimum essential coverage unless the person qualifiesfor a special enrolment period” (ObanaCare Facts, 2016).  One must have coverage by the end of eachyear’s open enrolment to avoid the per month fee for not having healthinsurance for that year (ObamaCAre Facts, 2016).  Impact on Medicaidand MedicareThe benefits of Medicare are demonstrated in the decreased cost of prescription drugs and the elimination of co-pays for preventive services. The following are the effects of ACA on Medicare:ACA protects one’sMedicare coverage. One need not replace hisor her Medicare coverage with Marketplace coverage as Medicare is not part ofthe Health Insurance Marketplace established by the health care law, thus ACAmaintains the current and same benefits and security with an obtained Medicare,whether through Original Medicare or a Medicare Advantage Plan. ACA provides morepreventive services, for less making Medicare cover specific preventiveservices – mammograms or colonoscopies, without charging aperson for the Part B coinsurance or deductible. ACA can save money onbrand-name drugs and even provide a 55% discount in the purchase of PartD-covered brand-name prescription drugs. Doctors get more supportwith new initiatives to support care coordination and get additionalresources to make sure that the patients’ treatments are consistent. “The health care law ensures theprotection of Medicare for years to come. The life of the Medicare Trustfund will be extended to at least 2029—a 12-year extension due to reductions inwaste, fraud and abuse, and Medicare costs, which will provide you with futuresavings on your premiums and coinsurance” (Medicare, 2016). ThePros and Cons of the ACAThe pros and cons of the ACA reflect the complex nature of the new health care law.  The ACA contains many benefits for low and middle income families and businesses, but it also contains some obstacles for high earners, larger firms that do not insure their employees, and certain sectors of the healthcare industry.  The ACA regulates private insurance to ensure an individual more rights and protections despite much opposition which explain the need to illustrate ACA’s pros and cons just as provided in the ObamaCare Facts online source:Pros:Uninsuredpeople have access to affordable, high-quality health insurance throughMedicaid expansion, their employers, and the Health Insurance Marketplace.Uninsured Americans canget free or low cost health insurance, and some can get help onout-of-pocket costs using their state’s Health Insurance Marketplace.More private coverageoptions with all major medical coverage options providing minimumessential coverage. Provides cost-curbingmeasures. Smallbusinesses with less than 25 full-time equivalent employees canget tax credits for up to 50% of their employees’ health insurancepremium costs. Medicare has improved forseniors by measures that eliminate the donut hole, keep rates down, cut wastefulspending and fraud, and expand free preventive services. The ACA remains a freemarket and allows our $3 trillion dollar healthcare industry to thrive.(ObamaCare Facts, 2016)Cons:To get the money to helpinsure all these people, there are new taxes that may affect an individualdirectly are the individual mandate and the employer mandate.All Americans who canafford health insurance have to obtain health coverage, getan exemption, or pay a fee which creates an extra complicationwith regards to filing taxes. Some folks who just barely missthe Federal Poverty Level limit of 400% are hit the hardest as theydon’t qualify for assistance. Those who do get cost assistance will need toadjust tax credits on the 8962 – Premium Tax Credit form.More options mean morecomplicated shopping for coverage. Keeping a private health insurancesystem means that shopping for health insurance can be confusing, andconsumers risk over-buying or under-buying. Coverage options also, bynature, create a tiered healthcare system where more money equates to a betterquality of care. However, in that respect, nothing has changed.Insurance companies mustcover sick people, and this increases the cost of everyone’s insurance. Mostpeople must obtain coverage or pay a per-month fee. Some people were benefitingfrom being in a low-risk group than men in good health with no pre-existingconditions, who were not responsible for anyone but themselves, and who remainedhealthy had low insurance costs. Medicaid expanded usingFederal and State funding. Not all States have to expand Medicaid.   Employee health benefits can be expensive.Lower wage workers may end up getting better value through the marketplace, buthaving employer-sponsored coverage means that they can’t get cost assistance. (ObamaCareFacts, 2016)The ACA Health Insurance exchangescontinue to prove its effectiveness in reducing the number of uninsured as theyprovide the essential information for people to make an informed selectionabout which plan is best for their needs.  The ACA has brought about major improvementsin how health coverage is purchased, but also in lowering cost and increasingquality outcomes.  The ACA has establisheduniversal coverage and shared responsibility as well as set federal standardsfor health insurers offering products in both the individual and small-groupmarkets and employer-sponsored health benefit plans.  There may be the technical challenges in the establishmentof the law  because “the question of whether the law falls withinCongress’ constitutional powers rests on whether the courts come to viewthe legislation as regulating our economic approach to the purchase of healthcare (because we all use care, the issue becomes how to pay for it), or instead(as the law’s opponents argue) as a law that forces individuals, as passivenon-economic actors, to buy a product they do not want” (Rosenbaum, 2011).  The ACA has set anarray of federal standards for insurers that sell products in both theindividual and group health insurance markets, as well as for self-insuredgroup health benefit plans sponsored by employers.  The ACA has proven its worth in: “improvinghealth-care quality, efficiency, and accountability, making primary health caremore accessible to medically underserved populations, improving the public’shealth and training health professionals, and providing long-term care”(Rosenbaum, 2011).  “The ACA istransformational and has faced the great task of implementation with opportunitiesfor major advances in public health policy and practice are simplyunparalleled. The Act represents a singular opportunity not only to transformcoverage and care, but also to rethink the basic mission of public health in anation with universal coverage (Rosenbaum, 2011).  The ACA has brought significant changes whichinclude among others the following:Lowered spending postingthe slowest growth rate in healthcare expenditure after 1960 and brought hugereduction in uninsured rates as it provides access and increasesaffordability.  The June 2016 UrbanInstitute report on total coverage and costs stated that the long-term projectionsof spending are found to be $2.6 trillion less. Spending projected by 2020should ideally be 13% less, while the rate of uninsured has fallen to 9.1% in2015.Increase in enrollment:auto-renewals, renewals, and new enrollments in the Obamacare Health Exchangeplans at the end of 2014. Enrollment- Federal andState Health Insurance Marketplace: With the open enrollment at end of 2015, around11.7 million Americans were enrolled in the Federal and State Health InsuranceMarketplaces. Only Medicaid and CHIP had covered 10.8% and 5.7 million youths lessthan 26 years were able to stay on their parents’ health insurance coverage.Millions of others were covered under the expanded coverage provided byemployers under Obamacare and with private players who worked out of themarketplace. Around $11.5 billion wassaved by 8.2 million senior citizens since 2010 in their prescription drugs.That means about $1047 for each beneficiary. ACA has helped in savingmore than $19.2 billion that America incurred through fraud activities. This amountis around $10 million more than what was found five years back in 2010.$12 billion savings inhealth care costs (Bhattacharya, 2016).AffordableCare Act of 2010: To Reform or to RepealHealthCare ReformBefore the ACA wassigned into law, there were growing numbers of uninsured people as well as personaldebt and bankruptcy due to medical costs. Health care costs continue to increase that only result in the ever-growingprofit for the health care corporations.  There was a growing nationaldebt and deficit reflecting a US health care system that has been outof control for many years that it was referred to as unsustainable trendsin healthcare or the health care crisis. However, despite the notable impact of the ACA the real healthcarereform still needs to be in place and dramatically change the current broken modelthat is unaffordable and is not consumer-centered.Transformingtoward a serious healthcare reform must entail coverage on accountability,transparency, cost and quality. Policy makers must set the essentialfundamentals for a market-based and patient-centric system to ensure that all Americansget a fair treatment by health care providers. Reforms must be continuous to help make health insurance more affordableto lower and middle income Americans and small business employers. “Althoughthe ACA has reduced the number of uninsured by about 3 percentagepoints from 2013 to 2014, the primary source of new coverage is Medicaid, whichprovides more restricted access to care than most private insurance. as the ACAis showing increasing signs of instability” (Antos et al., 2015).  A new health program for low-income Americansis currently needed and wherein it pays primary care physicians a minimumamount a month to see each patient, whether they are healthy or sick, and thatit would give Medicaid patients what they really need: first-class primary carephysicians to manage their chronic cardiovascular and metabolic conditions. Expansionsof state and local clinic systems can be helpful considering the current healthcare trends.TheQuest to Repeal the ACAAmerica’s Obamacare ensures that everyone has access to medical treatment, but the current dilemma it faces is abolishment.  The following are noteworthy facts about ACA that are also being currently viewed by the present administration as contributors to the need for abolishing the act:  Obamacare ensures thatevery American legally acquires health insurance through legislation. There arealso government subsidies available to make the insurance more affordable forindividuals.Obamacare also makes it alegal requirement for companies to provide healthcare if they have more than 50full-time employees. A government website wasmade available so everyone requiring health insurance was able to comparerates, sign up and learn about public subsidies.The Obamacare law monitorshealth insurance companies to ensure everyone’s coverage as well as flag themdown if they deny anyone cover (Willis, 2017).President Donald Trump aims to repeal and replace theACA through Congress despite its increasing appeal with its rule on prohibitinginsurers from denying coverage for pre-existing conditions.  Obamacare is at its highest popularity levelstoday despite facing the challenge of a replacement as proposed by Trump whichconsists of “a series of reforms that follow free market principles such asallowing the sale of health insurance across state lines and requiring pricetransparency from doctors and hospitals” (Willis, 2017).  With the work to repeal and replace the ACA inplace, more Americans are expressing their views favoring Obamacare.  A “reduction of 22% in the rate of uninsuredever since ACA has been introduced indicates that more families are assured thateach member will be cared for because they have health coverage” (Bhattacharya,2016).  Repealing the ACA is not anoption now for most Americans as they see that repairing the law will bringbetter results.  Supporters of repealingthe ACA have yet to come up with a meaningful and better alternative approachto healthcare reform.  “The Republicanleadership has backed a plan to repeal many parts of Obamacare while replacingothers, such as income-based subsidies to help Americans afford insurance.Those would be replaced by tax credits based on a person’s age” (Willis, 2017).ACAis ProgressThe ACA has succeeded in significantlyincreasing insurance coverage as it recorded the largest decline in theuninsured rate since the creation of Medicare and Medicaid.   The ACA’s major coverage provisions that havecontributed to significant positive transitions include:comprehensive reforms inthe health insurance market combined with financial assistance for low- andmoderate-income individuals to purchase coverage;generous federal supportfor states that expand their Medicaid programs to cover more low-income adults;andand improvements inexisting insurance coverage (Obama, 2016).Thus, the aforementioned provisions have alsocontributed to the following outcome:States that decided toexpand their Medicaid programs saw larger reductions in their uninsured.  Greater insurancecoverage appears to have been achieved without negative effects on the labormarket, despite widespread predictions that the law would be a “job killer.”Private-sector employment has increased in every month since the ACA becamelaw, and rigorous comparisons of Medicaid expansion and no expansion statesshow no negative effects on employment in expansion states.The law has also greatlyimproved health insurance coverage for people who already had it. Coverage offered on the individual market or to small businessesmust now include a core set of health care services, including maternity careand treatment for mental health and substance use disorders, services that weresometimes not covered at all previously (Obama, 2016).ConclusionThe ACA has truly progressed tobecome the most important health care legislation enforced in the United Statessince the conception of Medicare and Medicaid in 1965.  More Americans continue to be served by ACA’scomprehensive reforms through improved accessibility, affordability, andquality of health care.  However, suchprogress must not impede major opportunities for greater improvements on thehealth care system. Americans want high quality health care from theirhealth care system and that is its capability to provide the greatest benefits.  Freedom of choice, affordability andshared responsibility are features that are expected from a reformed healthcaresystem that will give more advantage to more people. Efforts to reform the U.S.health care system must consider the language of human rights, thus access toquality health care must be perceived as a right, and not just an option orprivilege.  The ACA and health carereform embody greater moral gravity in ensuring that everyone deserves accessto basic health care.  Many still claimof the ACA as defective, but the ACA proves that the government can be innovativethrough its ability to respond to the ever-changing health care environment. References:Antos, J., Capretta, J. and Wilensky, G. (2015). JAMA Forum: Replacing the Affordable Bhattacharya, A. (2016). Performance of Obamacare in the Last 5 Years. True Coverage Insurance Marketplace. Retrieved July 9, 2017 from https://truecoverage.com/blog/performance-of-obamacare-in-last-5-years/ Care Act and Other Suggested Reforms. Retrieved July9, 2017 from             https://newsatjama.jama.com/2015/12/21/jama-forum-replacing-the-affordable-care-act-    and-other-suggested-reforms/Dalen, J. E., Waterbrook, K., andAlpert J. S. (2015). Why do so many Americans oppose the      Affordable Care Act? American Journal ofMedicine Vol.128 No.8, pp.:807-10. doi:   10.1016/j.amjmed.2015.01.032.Fatcheck (2015). Conflating costs of the ACA. Retrieved July 9, 2017 from http://www.factcheck.org/2015/02/conflating-costs-of-the-aca/Medicaid (2016). Affordable Care Act. Retrieved July 9, 2017 from https://www.medicaid.gov/affordablecareact/affordable-care-act.htmlObama, B. (2016). United States Health Care ReformProgress to Date and Next Steps. The JAMA Network. Retrieved July 9, 2017 from http://jamanetwork.com/journals/jama/fullarticle/2533698ObamaCare Facts (2016). ObamaCare Health Summary. Retrieved July 9, 2017 from http://obamacarefacts.com/obamahealthcare-summary/Rosenbaum, S. (2011). The Patient Protection and Affordable Care Act: Implications for Public Health Policy and Practice. Public Health Report Vol.126 No.1, pp.130–135. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001814/https://www.ncbi.nlm.nih.gov/            pmc/articles/PMC3001814/Turner, G. M. (2015). For Many Americans, Opposition To ObamaCare Has Become Personal. Forbes. Retrieved July 9, 2017 from http://www.forbes.com/sites/gracemarieturner/2015/03/23/for-many-americans-opposition-to-obamacare-has-become-personal/#367135b23226Willis, A. (2017). What is Obamacare and why does Trump want to repeal it? Metro News.          Retrieved July 9, 2017 from http://metro.co.uk/2017/05/05/what-is-obamacare-and-why-does-trump-want-to-repeal-it-6617385/#ixzz4mLLqj8TPGet Help With Your EssayIf you need assistance with writing your essay, our professional essay writing service is here to help!Find out more