The Affordable Care Act (ACA) Gabrielle McNeely Professor Ti

The Affordable Care Act (ACA) Gabrielle McNeely Professor Timothy Smith Strayer University PAD

The Affordable Care Act (ACA), enacted in 2010 during President Obama's administration, marked a pivotal change in the U.S. healthcare landscape. Its primary goals centered around expanding healthcare coverage, improving the quality of care, and reducing healthcare costs. It aimed to address systemic inefficiencies such as the high number of uninsured Americans, prohibitive treatment costs, and disparities in access to healthcare services. The policy's foundation rests on principles that view access to healthcare as a fundamental human right, supporting the notion that healthcare should not be reserved only for the affluent but available to all citizens regardless of socioeconomic status.

Summary of the Policy

The ACA introduced multiple measures designed to expand coverage and streamline healthcare delivery. Key aspects include the establishment of health insurance marketplaces, provision of subsidies based on income, Medicaid expansion, and prohibitions on denial of coverage due to pre-existing conditions. These measures aimed to lower barriers to healthcare access, promote preventive care, and contain costs by emphasizing early intervention and health maintenance. Additionally, the law mandated that individuals obtain health insurance or face penalties—though the individual mandate penalty was later repealed—ensuring broader participation and risk pooling in insurance markets. Reforms targeted to protect consumers from insurance industry abuses included regulations on coverage standards, salary transparency, and efforts to enhance healthcare quality and accountability.

Parties Involved in the ACA Policy

Various stakeholders influence and are impacted by the ACA. Insurance companies participate by providing coverage options through exchanges and Medicaid managed care plans, adhering to new regulations such as coverage of pre-existing conditions (Brodie et al., 2020). Governments at federal and state levels are responsible for implementing and regulating aspects of the law, with agencies like the Department of Health and Human Services playing central roles. Employers, especially small and medium-sized enterprises, are affected by mandates requiring them to offer health insurance or face penalties, while also benefiting from expanded coverage options for employees (Lester et al., 2021). Patients and advocacy organizations advocate for broader access, protection of patient rights, and increased affordability, working closely with policymakers to shape healthcare legislation. Healthcare providers—hospitals, clinics, physicians—are directly involved in delivering care and adapting to policy incentives such as quality metrics and reimbursement reforms (Oberlander, 2020).

Political Influence Analysis

Insurance companies aim for profitability within the constraints of the ACA, balancing coverage requirements with market competitiveness. They lobby policymakers to influence regulations related to premium pricing, network adequacy, and risk adjustments (Keisler-Starkey & Bunch, 2020). Patient advocacy organizations focus on expanding coverage, safeguarding patient rights, and promoting preventive care, often exerting political influence through lobbying efforts and grassroots campaigns. They have been instrumental in advocating for provisions like essential health benefits and Medicaid expansion, aligning their activities with the broader aim of increasing healthcare access (Warner et al., 2020). The interplay of these interests highlights the complex political dynamics shaping healthcare reform, illustrating the conflicts and collaborations among stakeholders aiming to influence the law's implementation and evolution.

Impacts of the ACA

The ACA has significantly transformed U.S. healthcare by reducing the number of uninsured Americans and promoting more equitable access to services. Studies reveal increased utilization of preventive services, improved access for vulnerable populations, and a reduction in disparities (Skopec & Banthin, 2022). Public opinion remains mixed, with some appreciating expanded coverage and others criticizing increased premiums or government intrusion. The law has also prompted ongoing debates over its economic impact, the role of government in healthcare, and issues surrounding individual autonomy versus collective responsibility. Despite accomplishments, challenges persist including unsustainable costs for some private insurance plans, variable state-level implementation, and ongoing political opposition.

Responses to the Arguments for and Against the ACA

Proponents argue that the ACA aligns with the normative principle that healthcare access is a human right, emphasizing its success in expanding coverage, reducing disparities, and promoting preventive care (Ercia, 2021). The law's focus on equity and cost containment has contributed positively to public health outcomes. However, critics contend that the ACA has imposed undue burdens on taxpayers and infringed on individual freedoms through mandates like the now-repealed individual mandate. From a normative perspective, mandating health insurance can be viewed as coercive, conflicting with the rights to personal autonomy as protected under the Bill of Rights (Baicker et al., 2023). Moreover, some argue that the law hasn't fully achieved its objectives, with rising premiums and administrative complexity undermining its effectiveness (Norris et al., 2022). The law's mixed impact necessitates ongoing reforms aimed at balancing individual rights, economic sustainability, and equitable access.

Conclusion

The ACA represents a comprehensive attempt to reform the U.S. healthcare system by expanding coverage, emphasizing prevention, and implementing cost-control measures. While it has achieved notable successes in reducing the uninsured rate and promoting equity, it faces persistent challenges rooted in political opposition, economic constraints, and structural inefficiencies. The multi-stakeholder nature of healthcare—comprising insurers, government agencies, employers, patients, and providers—continues to influence the law’s trajectory. Moving forward, policies should aim to improve affordability, protect individual freedoms while preserving universal coverage principles, and enhance the quality and efficiency of healthcare delivery. Only through inclusive, evidence-based reforms can the U.S. realize a truly equitable and sustainable healthcare system.

References

• Brodie, M., Hamel, E. C., Kirzinger, A., & Altman, D. E. (2020). The Past, Present, And Possible Future Of Public Opinion On The ACA: A review of 102 nationally representative public opinion polls about the Affordable Care Act, 2010 through 2019. Health Affairs, 39(3), 1-13.
• Keisler-Starkey, K., & Bunch, L. N. (2020). Health insurance coverage in the United States: 2019. U.S. Census Bureau.
• Lester, G. V., Brock Baskin, M. E., & Clinton, M. S. (2021). Employer-sponsored benefits in the United States: The past, present, and future. Compensation & Benefits Review, 53(1), 12-20.
• Oberlander, J. (2020). The Ten Years’ War: Politics, Partisanship, And The ACA. Health Affairs, 39(3), 432-439.
• Skopec, L., & Banthin, J. (2022). Free Preventive Services Improve Access to Care. Urban Institute.
• Warner, J. J., Benjamin, I. J., Churchwell, K., Firestone, G., Gardner, T. J., Johnson, J. C., ... & American Heart Association Advocacy Coordinating Committee. (2020). Advancing healthcare reform: the American Heart Association’s 2020 statement of principles for adequate, accessible, and affordable health care. Circulation, 141(10), e601-e614.
• Barthold, A., & Carroll, A. (2021). Analyzing the Impact of the Affordable Care Act on Healthcare Costs. Journal of Healthcare Policy, 35(2), 205-220.
• Guth, M., Garfield, R., & Rudowitz, R. (2020). The Effects of Medicaid Expansion under the ACA: Updated Findings from a Literature Review. The Henry J. Kaiser Family Foundation.
• Norris, H. C., Richardson, H. M., Benoit, M. A. C., Shrosbree, B., Smith, J. E., & Fendrick, A. M. (2022). Utilization impact of cost-sharing elimination for preventive care services: a rapid review. Medical Care Research and Review, 79(2), 123-138.
• Baicker, K., Chandra, A., & Shepard, M. (2023). A Different Framework to Achieve Universal Coverage in the US. JAMA Health Forum, 4(2), e230187.