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Public Health Legislation 2
The Patient protection and Affordable Care Act (ACA) health care legislation has been very
instrumental in bringing reforms to improve the quality, affordability, and equality of health care.
This act became law on March 23, 2010 and began implementation on January 1, 2014. The new
law brought a myriad of changes, imposing new responsibilities on the employer and individual,
health insurance firms, the existing Medicaid health systems, as well as inclusion of financially
marginalized groups such children and the elderly. However, along the way were several
intermediate steps and unforeseen challenges that came along. This paper seeks to illuminate the
impact and progress of the ACA in regards to the health sector, its legal framework, economic
and social sectors. This review is informed by data obtained from multi sector stakeholders,
public data agencies and public research findings (Barak Obama, 2017).
The ACA public health policy came to being through amendments, extensions, and revisions of
the pre-existing federal laws such as the Medicaid and Medicare to establish a new legal
framework that was all-inclusive and spanning from birth to death (Rosenbaum, 2017). Prior to
this, the health care legal framework favored the employed leaving out a vastly large section of
the population that was uninsured to pay directly for medical care. In a bid to promote universal
health, this act sought to reduce the gap of the uninsured population of the United States of
The ACA constitutes ten legislative parts, which collectively aim to achieve the following
objectives. The first aim being to achieve universal health coverage via shared responsibility
between the government, employers, and the individual citizen. The next target was to improve
the quality, access, and affordability of health care for the American people. The third objective
sought to increase healthcare efficiency and reduce wastage of resources to ensure accountability
among the major stakeholders. A fourth aim was to boost primary and preventive health care
Public Health Legislation 3
access to promote longer life and avoid unnecessary hospital visits trough better preventive
intervention. The fifth objective was to invest more research into the healthcare system through
formation of committees and bodies that would offer continuous support on how best to tackle
challenges and implement policies such as individual subscriptions and price regulation
(Rosenbaum, 2017).
Since its enactment into law, the ACA has seen the uninsured rates decrease from 16 percent in
2010 to 9 percent in 2016. Healthcare payment systems are also increasingly shifting from the
traditional Medicare format to newer payment methods such as Accountable care organizations
(ACOs) and bundled (Piper, 2017) payment system. This has seen slow but sustainable growth in
the enrollment of citizens benefiting from the ACA. Despite of this progress, there remains great
An individual’s wellbeing can be viewed as a liability or an asset. Since health care has monetary
value attached to it, one’s health status it trickles down to the economy and the federal budget.
The productivity of the human resource is also determined by their well-being. It was thus
deemed imperative by the ACA that health insurance reforms be rolled out for children in
schools, adults who work, and the retired and elderly to manage associate costs better.
The largest decline in the number of uninsured individuals since the recession of 2007 has been
witnessed with the implementation of the ACA. The department of Health and Human services
points at 20 million new subscribers to the ACA in 2016 alone. However, the lawmakers had
underestimate the sheer magnitude of the task ahead when creating this act. The states suffered
huge drawbacks due to the slow pace of decision making in regards to resolving arising issues
Public Health Legislation 4
with the adoption of the ACA. However, the federal government could not impose the changes
directly onto its member states. Some were seen to adopt innovative strategies to implement the
new healthcare law by making their own preliminary decisions and joining the dots to bring the
act to life to the best of their abilities. Each facet of this new law required serious bureaucratic
procedures ranging from financial assistance for the moderate-income people, federal state
support for expansion of Medicare and Medicaid, to improving existing insurance policy
frameworks, and everything in between. All in all positive reforms such as reduced insurance
premiums and inclusion of child cover to 26 years has seen the number of the uninsured
population decrease significantly, implying better healthcare for more people (Barak Obama,
2017).
The law adjusted premium rates for Medicare and Medicaid insurance firms to align with the
actual cost they incurred. In effect, this new regulation saw a decrease in insurance premiums
paid for healthcare. The law went a step further to address the issues of fraud in the healthcare
industry. The law introduced checks to the registration of private healthcare firms and introduced
stiffer penalties for those found guilty of fraudulently charging the exchequer. In addition, the
law introduced a value based system where a criteria for evaluating the financial value of service
was agreed upon for those who paid upfront for treatment. These checks worked together to
By introducing alternative payment methods, the ACA has increased flexibility for many of US
citizens. Bundled payment system for instance covers all services provided during a clinical visit.
The law mandated the Centre for Medicare and Medicaid Innovation (CMMI) to spearhead the
testing and implementation of alternative payments to suit different capacities of the legal US
Public Health Legislation 5
residents. These amendments were made in a view of broadening the scope of payments beyond
individual services or entries, to accommodate the entire service offered during a clinic session
(Rosenbaum, 2017).
Streamlining the healthcare insurance premium rates has seen lower deductions from the gross
salary remitted to many employees. The broadening of the premium collection avenues has seen
to it that better services are offered at lower cost for the individual subscriber. These
Out-of-pocket Spending
The quality of medical care has improved with the introduction of the ACA with the rate of
hospital acquire conditions such as infections, misdiagnosis and wrong prescriptions. The
Agency for Healthcare Research and Quality estimates that these reductions prevented 87000
deaths in a period of four years. Medical patient readmission rates after 30 days were also seen to
decrease sharply from 19% in 2010 to 17% in 2015 (Barak Obama, 2017).
There exists insufficient data on how prescription drug use, cost, and coverage has changed since
the introduction of the ACA law. Some experts predict a future rise in prescription drug use,
while other are not showing too much excitement over changes in current trends. One thing that
remains clear is that new dynamic policies have been adopted by the ACA concerning the
pharmaceutical industry. The ACA introduced prescription drug benefits as one of its
transformative agendas, which covers both small markets and individuals who contribute to the
care. Prior to the act, medical policies purchases excluded drug benefits. As such, one had to pay
Public Health Legislation 6
for drugs separately and mostly out of the pocket. The law mandated member states to provide
prescription drugs to their clients who were under the Medicaid program. 23 percent of adults
(19 – 64 years old) failed to consume prescribed drugs citing cost concerns. However, the plans
may differ according to the package purchased. The ACA provides plans formulated differently
for the same prescription drugs. This criterion has the potential to affect patients suffering from
The Republican administration has set out publicly its intent to repeal the Affordable Care Act
and introduce a second alternative. Such a change is likely to bear significant impact on access to
healthcare for the entire public sphere. A repeal of the ACA would roll back on all previously
gains that were achieved and may see the uninsured population rates return to previous levels.
Some propose a change on the basis of the existing ACA framework and work on the demerits of
The republicans have tabled different proposals to adopt as new healthcare plans mostly pegging
their debates on the financial implications brought about by ACA care plan including subsidies
and so forth. One scenario proposes the elimination of subsidies while retaining reduction in
premium contributions to healthcare providers. Healthcare providers had accepted the payment
reductions in exchange for higher member enrollment rates to compensate for the reduced funds.
It is such consequences that the republicans fail to consider in their quest to repealing the ACA
law. The burden of uncompensated care will remains unresolved as with other implications of
References
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5069435/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5343718/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4627524/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4031738/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001814/#B19