Examining The Individual Mandate In The Patient Protection ✓ Solved

Examining the Individual Mandate in the Patient Protection ACA

The Affordable Care Act (ACA) requires all US citizens and legal residents to obtain qualifying health coverage. Explain the Individual Mandate included in the Patient Protection and ACA including the tax penalties that will be imposed if a person or a family does not obtain qualifying health coverage. Analyze the eligibility criteria for exemptions and subsidies to obtain coverage. Explain one policy change or enhancement you would recommend if you were required to ensure the success of the Individual Mandate included in the Patient Protection and ACA and justify the intended outcome.

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The Affordable Care Act (ACA) represents a fundamental change in the U.S. healthcare system, primarily through its Individual Mandate, which mandates that all U.S. citizens and legal residents obtain qualifying health coverage. This mandate was introduced as a mechanism to reduce the number of uninsured individuals in the United States and to promote a more equitable healthcare system. Noncompliance with the Individual Mandate can result in significant tax penalties, compelling individuals to secure health insurance or face financial consequences.

The Individual Mandate was initially enforced with financial penalties designed to encourage compliance but faced various changes over the years. Originally, individuals without health coverage were subjected to a tax penalty based on the greater of a flat dollar amount or a percentage of their income. For example, in 2016, the penalty was calculated as $695 for adults and $347.50 for children, up to a maximum of $2,085 per family, or 2.5% of household income above the filing threshold, whichever was greater (HealthCare.gov, n.d.; Jost, 2017). However, starting in 2019, the federal tax penalty for not having health insurance was effectively eliminated, leading to discussions about the future viability of the Individual Mandate.

In analyzing the eligibility criteria for exemptions and subsidies, it is vital to understand how these components allow certain populations to bypass the mandate or receive financial assistance in securing coverage. Exemptions can be granted based on specific conditions such as religious objections, coverage gaps, and certain hardships that make obtaining health insurance a challenge. Individuals eligible for Medicaid and CHIP (Children's Health Insurance Program) are also exempt from the mandate, as these programs provide coverage alternatives (HealthCare.gov, n.d.). Furthermore, subsidies are available to assist households that fall below a certain income threshold, thus making healthcare more affordable. These subsidies lower the costs of monthly premiums and out-of-pocket expenses related to healthcare.

To enhance the success of the Individual Mandate within the ACA, I propose implementing an automation system that simplifies the application process for subsidies and exemptions. Many eligible individuals fail to enroll in health coverage due to confusion around the procedure and paperwork required to apply for financial assistance. By leveraging technology, prospective enrollees could have access to a user-friendly online platform that quickly assesses their eligibility for subsidies and exemptions based on their financial information and personal circumstances. This digital solution would not only streamline the enrollment process but also provide tailored recommendations on the health plans that best fit the users' needs and budgets. Enhancing awareness campaigns alongside this system can ensure that marginalized populations are informed of their options and support availabilities for navigating the ACA (Koduah, 2014).

The intended outcome of recommending this policy change is to increase compliance with the Individual Mandate through improved accessibility and understanding around health coverage options. By reducing barriers to access, it is anticipated that more individuals and families will enroll in health insurance, fostering community health benefits across the nation, reducing the burden of uncompensated care on healthcare systems, and ultimately leading to a more efficient and inclusive healthcare market. Furthermore, as individuals gain health coverage, overall public health indicators should improve, thanks to increased access to preventive care services and disease management resources.

In conclusion, the Individual Mandate has been a pivotal aspect of the ACA, shaping the healthcare landscape in the U.S. However, its effectiveness is closely tied to the accessibility of health coverage and public understanding of the options available to them. By implementing systems that support clear communication and simplified processes for obtaining coverage, we can work towards a more effective Individual Mandate that ultimately serves the intended purpose of improving healthcare access for all citizens.

References

  • HealthCare.gov. (n.d.). The fee for not having health insurance. Retrieved from https://www.healthcare.gov/fees/
  • Jost, T. (2017, August 21). The IRS Is Still Enforcing The Individual Mandate, Despite What Many Taxpayers Believe. Retrieved from https://www.healthaffairs.org/do/10.1377/hblog20170821.061628/full/
  • Koduah, A. (2014, November 28). The role of policy actors and contextual factors in policy agenda setting and formulation: maternal fee exemption policies in Ghana over four and a half decades. BioMed Central. Retrieved from https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-014-0904-5
  • U.S. Congress. (n.d.). Health. Retrieved from https://www.congress.gov/
  • Kaiser Family Foundation. (2018). Key Facts About the Uninsured Population. Retrieved from https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/
  • National Conference of State Legislatures. (2020). The Affordable Care Act: A Brief Summary. Retrieved from https://www.ncsl.org/research/health/the-affordable-care-act-a-brief-summary.aspx
  • Centers for Disease Control and Prevention. (2021). Health Insurance Coverage. Retrieved from https://www.cdc.gov/nchs/pressroom/sosmap/health_insurance/
  • Institute of Medicine. (2014). Essential Health Benefits: Balancing Coverage and Costs. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK248036/
  • American Action Forum. (2019). The Future of the Individual Mandate: Impact of Repeal and New Constructions. Retrieved from https://www.americanactionforum.org/research/the-future-of-the-individual-mandate/
  • Frean, M., Gruber, J., & Sommers, B. D. (2017). Premiums and Participation in the ACA Health Insurance Exchanges. New England Journal of Medicine, 376(23), 2325-2331. doi:10.1056/NEJMsa1604870

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