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Under Each Heading Following Information Should Be Included.

Under Each Heading Following Information Should Be Included in Paragraph Form. Make sure to cite your work using APA style 7th edition. Do not plagiarize. Include a reference page. The paper should be 4-5 pages (not including title and references). Label headings in bold. Include all information below: Legislative Intended Impact: Describe the policy/legislative action; who initiated the legislation; manifested and latent impacts. Public Expectations: concerns the public expects the policy to address; stakeholder values and whether respected; list ways public input was solicited. Affected Populations: identify specific populations impacted; list other stakeholders at micro, mezzo, and macro levels. Conclusion: summary of policy impact in addressing the social problem; specific policy advocacy efforts used to reduce the social problem; implications for social work practice.

Paper For Above Instructions

Legislative Intended Impact

The policy action examined is the expansion of health coverage under the Affordable Care Act (ACA), focusing especially on Medicaid expansion and the creation of health insurance marketplaces with subsidies. The intended impact, as articulated by policymakers, was to reduce the number of uninsured Americans, improve access to preventive and acute care, and lower financial barriers to care. The initiative was driven primarily by the executive and legislative branches of the U.S. government in the 2009–2010 period, with Democratic leadership steering passage through Congress. The manifested impacts include substantial gains in coverage, particularly among low-income populations, families, and individuals with preexisting conditions who previously faced affordability barriers. Latent impacts include increased demand for primary care services, shifts in hospital uncompensated care costs, and political polarization that continues to influence ongoing debates about funding, scope, and sustainability of subsidies and Medicaid expansion. These effects have varied by state, with expansion states generally experiencing larger reductions in uninsured rates and improvements in access to care than non-expansion states. Public health implications extend to improved access to preventive services, chronic disease management, and mental health care, though the sustainability of gains remains contingent on policy renewals and budgetary decisions (Kaiser Family Foundation, 2023; Oberlander, 2017).

In describing the policy action’s design, it is important to note that the ACA’s structure integrated automatic eligibility changes, income-based subsidies, and marketplace competition to influence consumer choices and insurer behavior. The policy sought to alter the upstream determinants of health by enabling continuous coverage, reducing financial strain during illness, and enabling more consistent utilization of preventive care. These goals align with social work’s emphasis on social justice, equity, and access to essential services, while also acknowledging the administrative and political complexities that shape policy implementation and outcomes (Blumenthal & Collins, 2014; Oberlander, 2017).

Policy administrators anticipated that improved access would translate into measurable reductions in delayed care, missed routine screenings, and financial hardship. They also expected that addressing coverage gaps would alleviate pressure on safety-net providers and reduce the reliance on emergency departments as the primary source of care for uninsured individuals. In practice, while coverage gains were concentrated among low-income populations and those in expansion states, there were uneven outcomes across regions, demographics, and employment sectors. These disparities illustrate both the policy’s potential to reduce social inequities and the need for targeted remedies to sustain gains over time (Kaiser Family Foundation, 2023; Sommers et al., 2015).

In sum, the legislative intended impact centers on expanding access to affordable health coverage, improving health service utilization, and reducing financial risk for vulnerable populations. The extent of achievement, however, has been mediated by state adoption decisions, political dynamics, and the capacity of health systems to absorb increased demand for services. For social work practitioners, understanding these dynamics is essential for advocating equitable access, coordinating care, and addressing barriers that persist even after coverage is obtained (Oberlander, 2017; Blumenthal & Collins, 2014).

Public Expectations

Public expectations surrounding the ACA’s implementation focused on several core issues: ensuring access to affordable health insurance, protecting individuals with preexisting conditions, expanding Medicaid where possible, and increasing access to preventive services without cost-sharing. The public anticipated that reform would reduce the number of uninsured and mitigate financial distress associated with medical care. Stakeholders—patients, healthcare providers, insurers, employers, and community organizations—held values related to equity, affordability, and quality of care; for many, these values were expected to be respected through transparent processes, meaningful public input, and continued improvements to affordability and coverage stability. Public input was solicited through formal hearings, stakeholder consultations, public comment periods on proposed rulemaking, and state-based open enrollment activities in health insurance marketplaces. Public sentiment generally supported expanded access and consumer protections, although views diverged regarding the best mechanisms to fund subsidies, expand Medicaid, and regulate marketplace competition (Kaiser Family Foundation, 2023; Oberlander, 2017).

As the policy unfolded, public expectations also included assurances that expansions would not undermine choice or quality and that protections such as keeping coverage for preexisting conditions would endure. Communities and advocacy organizations pressed for targeted outreach to hard-to-reach populations, including racial and ethnic minorities, rural residents, and low-income families, to ensure broad-based enrollment and utilization. The degree to which public input shaped policy adjustments varied by stage and jurisdiction, but the overarching aim of widening access remained central to reform narratives (Sommers et al., 2015; Centers for Medicare & Medicaid Services, 2020).

In practice, the public’s expectations about affordability, portability, and adequate provider networks were realized to varying extents. While subsidies and expanded eligibility delivered meaningful coverage gains for many, ongoing concerns about premium burdens, deductible levels, and regional provider shortages reminded policymakers and practitioners that access is multi-dimensional—encompassing not only eligibility but also affordability, availability, and acceptability of care (KFF, 2023; Census Bureau, 2019).

Affected Populations

Specific populations most affected by the ACA’s coverage expansions include low-income individuals and families, adults without dependent children in some states, and people with chronic illnesses or disabilities who gained greater financial protection and access. Pregnant women and children in Medicaid expansion programs benefited from improved access to preventive and prenatal services. Racial and ethnic minority groups experienced notable improvements in coverage rates, though disparities persisted in some regions, underscoring the ongoing need for equity-focused outreach and supports (Sommers et al., 2015; Kaiser Family Foundation, 2023).

Stakeholders at different levels experienced varied impacts. Micro-level effects centered on individuals and families: more predictable access to care, fewer medical debt incidents, and better management of chronic conditions. Mezzo-level effects involved healthcare organizations, primary care practices, safety-net hospitals, and community health centers, which faced shifts in patient volume, payer mix, and administrative requirements. Macro-level effects related to state governments, Medicaid programs, employers, and insurers included changes in budget allocations, policy design choices regarding expansion, and the broader economic implications of a more insured population (Oberlander, 2017; Blumenthal & Collins, 2014).

In analyzing affected populations, it is essential to recognize that some groups benefited more than others due to state decisions on expansion, local policy implementation, and socio-economic factors. Rural communities, for example, saw access improvements in some areas but continued to struggle with provider shortages and transportation barriers. Urban populations often benefited from better enrollment infrastructure but faced affordability concerns in high-cost markets. These variations illustrate the necessity of tailored advocacy and practice interventions across micro, mezzo, and macro levels to sustain gains and address residual inequities (KFF, 2023; Census Bureau, 2019).

Conclusion

Overall, the ACA’s coverage expansions and consumer protections represent a meaningful policy response to a long-standing social problem: the high rate of uninsured individuals and the barriers they face in obtaining timely, affordable health care. The policy helped reduce the uninsured rate, increase access to preventive services, and shift some costs away from uncompensated care for hospitals and safety-net providers. However, the magnitude of impact varied by state policy choices, economic conditions, and the availability of healthcare providers to meet demand. The public health benefits are clear in terms of greater access to care and improved financial protection, but persistent gaps remain in affordability, access to in-network providers, and coverage stability in non-expansion states (KFF, 2023; Oberlander, 2017; Sommers et al., 2015).

Specific policy advocacy efforts currently used to reduce the social problem include expanded enrollment assistance and navigator programs, targeted outreach to underserved communities, and legislative efforts to sustain subsidies and expand Medicaid where still eligible. Advocates emphasize simplifying the enrollment process, reducing administrative barriers, and ensuring that subsidies remain adequate to maintain affordability. These efforts are crucial for maintaining gains in coverage and for addressing disparities that persist in health outcomes (CMS, 2020; KFF, 2023).

Implications for social work practice are significant. Social workers play a critical role in helping clients understand eligibility requirements, navigate enrollment processes, and access benefits that address social determinants of health, such as housing stability, transportation, and food security. They also engage in policy advocacy to address systemic barriers, collaborate with community organizations to improve outreach and enrollment, and integrate policy knowledge into case planning and service delivery. By centering equity and client empowerment, social workers contribute to more effective, rights-based responses that align with social justice principles embedded in the profession (Blumenthal & Collins, 2014; Oberlander, 2017; American Public Health Association, 2019).

References

  • Kaiser Family Foundation. (2023). Summary of the Affordable Care Act. Retrieved from https://www.kff.org/health-reform/fact-sheet/summary-of-the-affordable-care-act/
  • Centers for Medicare & Medicaid Services. (2020). The Affordable Care Act: Marketplace overview. Retrieved from https://www.cms.gov/
  • Sommers, B. D., Gunja, M. Z., Finegold, K., & Musco, S. (2015). Changes in Self-Reported Insurance Coverage After the ACA. New England Journal of Medicine, 372(9), 854-862. Retrieved from https://www.nejm.org/doi/10.1056/NEJMsa1408459
  • Oberlander, J. (2017). The politics of health reform after the ACA. Health Affairs, 36(3), 420-424. Retrieved from https://www.healthaffairs.org/doi/10.1377/hlthaff.2016.1259
  • Blumenthal, D., & Collins, S. R. (2014). The ACA: What it has achieved and remaining challenges. JAMA, 312(23), 2390-2392. Retrieved from https://jamanetwork.com/
  • Kaiser Family Foundation. (2019). The impact of the ACA on coverage and costs. Retrieved from https://www.kff.org/
  • Census Bureau. (2019). Health Insurance Coverage in the United States: 2018. Retrieved from https://www.census.gov/library/publications/2019/demo/p60-267.html
  • Centers for Disease Control and Prevention. (2015). Health equity and the ACA: Opportunities and challenges. Retrieved from https://www.cdc.gov/
  • National Academy of Medicine. (2014). The ACA and the social determinants of health. Retrieved from https://nam.edu/
  • American Public Health Association. (2018). The ACA and public health: A policy overview. Retrieved from https://www.apha.org/

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