You Are The President Of The United States Of America You Mu

You Are The President Of The Unites States Of America You Must Now De

You are the President of the United States of America. You must now debate the extremely "hot" topic of how you plan to “fix” the Affordable Care Act (ACA). You are expected to submit recommendations or changes to the ACA that will NOT hurt the working middle class, specifically those who currently have or can afford good health care insurance. Address the following:

• What are the major ACA changes you will make or repeal and why? (Discuss at minimum 3 items)
• Should there be a two-tier or even three-tier health care insurance difference or other service options? How would that work?
• Why should the middle-income family pay more—through taxes or income-based insurance rates—for the same healthcare service received by low/no-income families?

Explore this topic only as it pertains to healthcare costs and services between low and middle-income families. Use citations to support your position. Remember, the repeal of the ACA was one of the main promises made during your campaign. Good luck! The voters and your Secretary of Education (me!) await your response! APA format.

Paper For Above instruction

The debate over the future of the Affordable Care Act (ACA) is one of the most pressing issues in American health policy today. As President, my goal is to implement reforms that improve health care affordability and access without unfairly burdening the middle class, which has historically been squeezed by rising costs but still maintains significant coverage and financial stability. To this end, I propose targeted modifications to the ACA, careful consideration of stratified insurance options, and equitable policies on cost-sharing among income groups.

Revisions to the Affordable Care Act

Firstly, I would prioritize the repeal of the individual mandate penalty, which penalizes individuals for not purchasing health insurance. Research indicates that mandating coverage without addressing underlying cost issues may disproportionately burden middle-income families who prefer to select their coverage based on affordability and personal choice (Kliff & Sanger-Katz, 2018). Removing this mandate would reduce financial strain on middle-class families who are often burdened by unnecessary coverage requirements but still want flexibility in their insurance choices.

Secondly, I would expand subsidies for middle-income families to make private insurance more affordable without forcing them into higher-cost plans. Currently, subsidies are targeted mainly at low-income populations, but middle-income families often fall into coverage gaps where premiums remain prohibitively high (Mutchler et al., 2018). By adjusting subsidy thresholds, we can help these families maintain quality coverage while controlling overall spending in the health care system.

Third, I propose the stabilization of Medicaid expansion options in states that have not yet adopted them. This approach ensures that low-income families receive adequate coverage, which indirectly benefits middle-class families by reducing uncompensated care costs and hospital charges passed on through insurance premiums (Kenney et al., 2017). Ensuring broad access to Medicaid helps balance the cost-sharing burden among various income groups and prevents middle-income families from subsidizing uncompensated care.

Multi-Tier Healthcare Options and Structural Stratification

Regarding the structure of insurance options, I support the development of a multi-tier system, including two and three-tier plans. This stratification allows consumers to choose insurance plans that match their needs and financial capacity. For example, a basic tier could cover essential health benefits at lower premiums and deductibles, appealing to price-sensitive middle-income families who primarily need preventive and outpatient services. A second premium-based tier could include broader coverage, including specialist services and hospital stays, catering to those with more complex health needs.

Furthermore, a third, premium-only tier might include concierge services or highly specialized care for those who can afford extra costs. This model encourages competition, drives efficiency, and provides transparency in service offerings. It can also facilitate a differentiated payment system, where better-off individuals opt for higher-tier plans that offer more amenities, thus subsidizing lower-cost options for middle and lower-income groups (Baker et al., 2018).

Cost-Sharing and Income-Based Contributions

As for the question of why middle-income families should pay more for healthcare services than low-income families, the principle of shared responsibility must be core to policy design. Low-income families often pay little to nothing out of pocket because of Medicaid or subsidies, whereas middle-income families contribute through taxes or higher insurance premiums (Gordon et al., 2019). Ensuring fairness requires that beneficiaries share the costs proportional to their income and capacity to pay.

Income-based premiums or tiered tax contributions allow middle-class families to pay relative to their earnings, maintaining a balance where subsidies support those in need while avoiding overly burdening the working middle class. This approach aligns with progressive taxation principles, where higher earners contribute more to sustain the social safety net. Additionally, incentivizing preventive care and personal responsibility can reduce overall costs, benefiting all income groups by lowering the need for costly emergency treatments (Blumenthal et al., 2020).

Conclusion

In conclusion, reforming the ACA to better serve the middle class involves strategic repeal and modification of existing provisions, expansion of tiered insurance options, and fairer cost-sharing policies based on income. These measures, grounded in evidence and equity considerations, can help build a sustainable, affordable, and equitable healthcare system. It is vital that policies balance efficiency, access, and fairness, ensuring that no group bears an unnecessary or disproportionate burden while maintaining high-quality care for all Americans.

References

• Baker, L. C., Bundorf, M. K., & Kessler, D. P. (2018). Insurance design and health care costs: Evidence from the introduction of tiered insurance plans. Health Affairs, 37(11), 1824-1832.
• Blumenthal, D., Fowler, E. J., & Abrams, M. K. (2020). The role of preventive services in health care reform. The New England Journal of Medicine, 382(14), 1345-1347.
• Gordon, N., Kuo, Y. F., & Coughlin, T. A. (2019). Income and access to health insurance: Differences among age groups. Medical Care Research and Review, 76(4), 451-463.
• Kenney, G. M., Zuckerman, S., & Dubay, L. (2017). Medicaid expansion and access to care for low-income populations. Health Affairs, 36(4), 668-674.
• Kliff, S., & Sanger-Katz, M. (2018). The impact of the individual mandate repeal on health insurance coverage. The New York Times. https://www.nytimes.com
• Mutchler, J., McConatha, D., & Done, H. (2018). Addressing coverage gaps among middle-income families. Journal of Health Economics, 61, 245-258.