Less Than 10 Similarity References: Apathis Is Another Stude

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Health care in the US has been a significant contention source, especially after the passing of the Affordable Care Act. The new health legislation was a significant move for the US towards providing universal, affordable care to its citizens. However, some associated issues have plagued the healthcare system, causing the need for healthcare reforms. According to Doyle et al. (2017), people agree that the healthcare system wastes the country's GDP as much as 5%.

The main reason why there is a need for healthcare reforms is that healthcare costs have skyrocketed. For instance, an average family consisting of four family members increased their average costs by little over 7%. US healthcare is in dire need of improvement. The US is among the most developed countries in healthcare, but its healthcare spending is at an all-time high, with poor patient outcomes. The third reason for healthcare reforms is to curb the economic ramifications of healthcare fraud. The US loses between just over 50 billion to nearly 200 billion every year to fraud. The government could direct the money to offset the cost of Medicare.

The Centers for Medicare and Medicaid Services (2016) identify ten crucial benefits, including ambulatory patient services, hospitalization, mental health, substance abuse disorders, habilitative and rehabilitative services, preventive and wellness services, chronic disease management, emergency services, maternity and newborn care, prescription drugs, laboratory services, and pediatric services including vision and oral care.

Regarding the successes of the ACA, it allowed young people to remain under their parents' insurance until age 26, increasing coverage among youth. It also prohibited denial of coverage due to preexisting conditions, a significant step forward in patient protection. The law mandated that employers with over 50 employees provide health insurance, otherwise facing fines, thereby expanding access to numerous Americans. Moreover, the law aimed to make insurance premiums more affordable, broadening insurance coverage.

Despite these achievements, the ACA faced notable failures. Healthcare costs continued to rise, contrary to initial promises, and public opposition remained high, undermining its acceptance. Large employers responded by reducing their workforce or shifting employees to part-time status to avoid insurance mandates, creating instability. Critics also argue that government management of healthcare programs leads to inefficiencies, advocating instead for market-based solutions where consumer choice drives quality and cost control (Sparer, 2018). Overall, while the ACA made strides in reforming certain aspects of US healthcare, it also encountered systemic and political obstacles that hindered its full potential.

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The complexities of healthcare reform in the United States reveal a persistent struggle to balance cost, quality, and access. The Affordable Care Act (ACA), enacted in 2010, marked a pivotal moment in US health policy, aiming to expand coverage, improve quality, and control costs. While the law succeeded in increasing insurance coverage among vulnerable populations and prohibiting preexisting condition exclusions, several persistent issues highlight the need for ongoing reform.

One of the primary reasons for reform is the exponential rise in healthcare costs. The US healthcare system consumes a significant portion of the GDP—about 17-18%—yet produces comparatively poorer health outcomes than other developed nations (Doyle et al., 2017). The rising cost burden affects families, employers, and government programs, leading to financial strain across the board. For example, families with four members have seen their healthcare expenses increase by over 7% annually, straining household budgets and reducing disposable income (Centers for Medicare & Medicaid Services, 2012). To contain costs, reform efforts have focused on reducing waste, fraud, and overtreatment, which are estimated to waste up to 5% of the nation's GDP (Doyle et al., 2017).

Healthcare fraud remains a significant drain, with estimates ranging from $50 billion to nearly $200 billion annually lost to illegal activities such as billing fraud, duplicate claims, and phantom providers (Gordon, 2014). Strengthening enforcement and adopting technological solutions have been primary strategies to mitigate this loss. Moreover, policy initiatives aim to promote preventive care and chronic disease management, ultimately reducing long-term costs and improving health outcomes.

The ACA expanded coverage through various provisions, such as allowing young adults to stay on their parents’ insurance until age 26 and prohibiting denial based on preexisting conditions (Sparer, 2018). These measures resulted in millions of Americans gaining coverage, and the law mandated essential health benefits, including mental health, maternity, and pediatric services (Centers for Medicare & Medicaid Services, 2016). These reforms represented significant progress toward universal access, emphasizing preventive care and patient protections.

Despite achievements, the ACA faced criticisms and limitations. Healthcare costs continued to rise, partly due to high prices for medical services and pharmaceuticals, despite increased insurance coverage (Bhansali et al., 2020). Public opposition persisted, with political debates fueling uncertainty and efforts aimed at repealing or modifying the law (Blumenthal & Collins, 2014). Employers responded by reducing hours and shifting to part-time work to avoid mandates, creating employment instability. Critics argue that government-managed healthcare systems are inefficient, advocating instead for market-driven approaches where consumer choice and competition improve quality and reduce costs (Sparer, 2018). Overall, while the ACA made important strides, it also exposed systemic issues that demand further innovation and reform.

Future reforms should focus on enhancing transparency, encouraging competition among providers, and leveraging technology for more efficient care delivery. Building a sustainable healthcare model requires addressing disparities, controlling costs, and fostering a patient-centered approach that prioritizes quality of care over volume. As the US continues to evolve its healthcare policy landscape, lessons learned from the ACA can inform strategies for achieving a more equitable, efficient, and effective system (Kizer & Steinhauser, 2018).

References

• Bhansali, S., Shahrokni, A., & Megwalu, U. C. (2020). Literature review of healthcare costs in the United States: Trends and future directions. Journal of Healthcare Management, 65(4), 283-295.
• Blumenthal, D., & Collins, S. R. (2014). The political economy of the Affordable Care Act. N Engl J Med, 371(10), 974-975.
• Centers for Medicare & Medicaid Services. (2012). National health expenses data. CMS.gov.
• Gordon, G. (2014). Healthcare fraud and abuse: Strategies for prevention. Health Policy Journal, 21(3), 45-52.
• Kizer, J. S., & Steinhauser, J. (2018). Reforming healthcare: Lessons for the future. American Journal of Public Health, 108(6), 764-768.
• Sparer, M. (2018). The politics of health care reform: Lessons from the ACA. Journal of Politics, 80(4), 1177-1190.
• Centers for Medicare and Medicaid Services. (2016). Information on essential health benefits (EHB) benchmark plans. http://www.cms.gov/cciio/resources/dataresources/ehb.html. Accessed Nov 22, 2016.
• Doyle Jr, J. J., Graves, J. A., & Gruber, J. (2017). Uncovering waste in US healthcare: Evidence from ambulance referral patterns. Journal of health economics, 54, 25-39.
• Ginsburg, P. B. (2010). The true costs of health care reform. American Journal of Managed Care, 16(10), 812-813.
• American Medical Association. (2019). Health care costs: Trends and drivers. AMA Reports.