The Affordable Care Act was a healthcare reform introduced in March 2010, widely known as Obamacare or PPACA (U.S. Centers for Medicare & Medicaid Services, 2018). The law has three significant objectives (U.S. Centers for Medicare & Medicaid Services, 2018):
- Make affordable health insurance accessible to all people. It offers subsidies for households earning between 100% and 400% of the federal poverty level, which lowers their costs.
- It also expands the Medicaid program to cover all adults with income less than 138% of the federal poverty level.
- It supports innovative medical care delivery methods that minimize healthcare costs
Stuart Butler of Heritage Foundation first formulated the policy proposal in 1989 and called it “Assuring Affordable Healthcare for all Americans” (Roy, 2012). The plan mandated that all households obtain adequate insurance, considering healthcare protection as a fundamental responsibility of the government (Roy, 2012). The proposal was the first published individual mandate in the context of private-sector health systems. It subsequently underwent revisions four years later after its introduction.
The idea centered on an individual health insurance mandate later emerged in two bills enforced by Republican lawmakers in 1993 (Individual health care insurance mandate has roots two decades long, 2012). Senators such as Orrin Hatch and Charles Grassley supported the bill even though they opposed Obamacare (Individual health care insurance mandate has roots two decades long, 2012). The mandate proposed in 1989 preceded Obamacare and Romneycare and employed a model in which the policies financed individual insurance purchases through vouchers (Roy, 2012). When American politician Mitt Romney first attempted to design a health plan, he sought the Heritage Foundation’s help. He introduced Romneycare, which contained an individual mandate and an employer mandate (Roy, 2012). However, Romney turned down the employer mandate which was later overruled by 80% of Democrats (Roy, 2012).
In 2006, Massachusetts implemented a health reform legislation to provide universal access to health insurance coverage. However, the policymakers sought to limit the law’s scope and further postponed vital actions regarding payment reform and quality of care (Roosevelt et al., 2013). Jansson (2014) notes that policies always do not emerge suddenly but goes through a developmental process. Policy advocates try to decide the wrong and right through a detailed analysis. Also, policy advocates present problems to legislated decision-makers, which could be found in the Heritage foundation showing its policy to Romney.
During the 2008 presidential campaign, Obama claimed that he is against the mandate that required all Americans to buy health care insurance (Individual health care insurance mandate has roots two decades long, 2012). He claimed in an interview that while Hillary Clinton wanted everyone to buy healthcare, he does not wish to introduce a mandate that forces them to do so. He believed that most Americans could not afford it, and he wanted to lower the cost (Individual health care insurance mandate has roots two decades long, 2012). Thus, the Obama Administration adopted many elements from the 2006 Massachusetts health reform law and sped up the legislation by tackling problems associated with quality of care, access, cost, and payment.
The Obama Administration adopted a practical inside into the issues at hand and realized that it must make tradeoffs within the law for receiving support from stakeholders (Roosevelt et al., 2013). Jansson (2014) claims that policy advocates often stand on the shoulders of different reformers. Likewise, the Affordable Care Act was built on the foundations of the Massachusetts health reform law.
Patterns of Participation
Policy initiators often work with other people in formulating social reforms. Some individuals are bystanders who do not have any role in policy deliberations, whereas others remain as policy responders because they seek to modify the initiators’ policy proposals (Jansson, 2014). Some of them are blockers because they block or modify bids (Jansson, 2014). Jansson (2014) asserts that these groups are not fixed because people often change groups during policy deliberations. Initiators often attract people from other groups, and opposers try to attract others to their position (Jansson, 2014). On March 23, 2010, the Democratic majorities passed the Patient Protection and Affordable Care Act (ACA). However, the policy lacked Republican votes, whereas 34 out of 253 Democrats voted no (Dalen et al., 2015). According to John Boehner, the bill would “destroy the best healthcare delivery system in the world” (as cited in Dalen et al., 2015, p. 4). However, this statement is still far-fetched because the U.S. healthcare system is not the best in the world.
The U.S. healthcare does not concentrate on providing healthcare access to everyone, which has resulted in increasing infant and maternal mortality (Dalen et al., 2015). Around 18% of U.S. citizens lacked health insurance in 2013, preventing them from accessing primary and preventive care. Uninsured citizens suffer from annual mortality of about 25 to 40% more than individuals with health insurance (Dalen et al., 2015). Even though the United States spends a significant amount of its budget on healthcare, it does not have the best healthcare system. Dalen et al. (2015) point out that around 45% of Americans opposed the ACA’s passing. Their opposition’s primary reason is that they do not trust the federal government, with polls showing that Republicans are highly distrustful of the government compared to Democrats (Dalen et al., 2015).
Issues could arise during different levels of the policy deliberations. Some of them could lead to disagreement, whereas some involve minimal conflict. Jansson (2014) claims that the level of friction often depends on the participants’ actions and rhetoric. In the high conflict, people employ emotion-laden language and used filibusters to establish their position’s validity (Jansson, 2014). The lack of conflicts signals consensual deliberations (Jansson, 2014). Passing the ACA was incredibly challenging because almost all Republicans opposed the bill.
In 2008, Senator Max Baucus of Montana, the finance committee chairman, released a White Paper that anticipated the legislative process. The White Paper focused on issues concerning health insurance and the high cost of healthcare. In 2009, the number of uninsured individuals in America had risen to 50.7 million (Jost & McDonough, 2020). From its very start in the 1930s, U.S. health insurance was mostly job-related. Most uninsured individuals came from low-income families as their employees refused them health insurance and even offered insurance at high prices. Also, low-income and seasonal workers did not receive coverage (Jost & McDonough, 2020). Baucus noted that Medicare had overpaid for many services. Also, he points out that America lacked primary care providers and mental health professionals (Jost & McDonough, 2020).
Policy deliberations could last a long time because policies often have to go through different subcommittees and floor debates before the elected officials take them up for approval (Jansson, 2014). Policy initiatives also take years for their implementation because policymakers and supporters work continuously to educate others regarding the benefits of enforcing the initiatives. Some issues could be sped up, especially when government heads prioritize them on their agendas (Jansson, 2014). Some policies could go through several years of deliberations until new executives would take it to push them forward (Jansson, 2014). On November 12, 2008, Baucus presented his health reform in a white paper. The passage of the ACA went through two significant periods. The first one was during 2009 when health reform received widespread support from stakeholders (Jost & McDonough, 2020). Senate and House Minority Leaders Mitch McConnell and John Boehner opposed the health reform (Jost & McDonough, 2020). However, Obama’s popularity managed to overpower the Republican opposition. In the same year, Republicans established the Tea Party movement against the democratic plans (Jost & McDonough, 2020). Thus, the ACA went through a long developmental process.
The Democrats had tried to gain support from stakeholders who had rejected the Clinton health reform process. The health insurance industry had initially engaging reform discussions, but by 2009 it declined the policy. Key organizations such as the American Medical Association (AMA) and the American Hospital Association opposed the bill (Jost & McDonough, 2020). However, the drug industry engaged in a deal with the Obama administration and pledged public support for the legislation along with 80 billion in 10-year financial concessions for financing the law (Jost & McDonough, 2020). The industry had put forward specific commitments, such as the legislation must not include issues rejected by the industry (Jost & McDonough, 2020). The insurance leaders opposed most of the ACA elements seeing that the bill would reduce $120 billion from Medicare advantage, which would adversely affect private insurance. Insurers vehemently opposed the bill and invested around $86.2 million for anti-AC advertising (Jost & McDonough, 2020). Republicans perceived that the ACA is a form of encroachment of the federal government into state insurance markets’ territories.
Some conservative activists claimed that the ACA created “death panels” and increased the federal deficit (Jost & McDonough, 2020). However, despite all the claims, the Republicans and Democrats unanimously agreed that the ACA raised taxes for high-income wage earners and insurance companies (Jost & McDonough, 2020). Thus, the final passage of the ACA did not even have a single Republican vote.
Issues addressed by the policy
Before ACA, a significant proportion of the American public did not have health insurance, making them vulnerable to healthcare disparities. The primary goal of the ACA was to increase the number of insured individuals. The law forbids private insurance from restricting access to health insurance through denial of coverage or charging high prices due to existing medical conditions (Roosevelt et al., 2013). Some of them included charging women higher premiums than men and terminating coverage for individuals who become sick (Roosevelt et al., 2013). In 2014, after the ACA’s passing, around 10 million Americans had gained health insurance (Dalen et al., 2015). Families with income less than 138% of the federal poverty level became eligible for Medicaid in 27 states (Dalen et al., 2015). The federal or state health insurance exchanges helped many residents with incomes from 138% to 400% of the FPL to obtain subsidized health insurance. The ACA also expanded parents’ health insurance to individuals from 19 to 26 (Dalen et al., 2015). Before, ACA, individuals with prior conditions were forced to pay exorbitant premiums to gain insurance at the same price as those without such conditions (Dalen et al., 2015). Thus the ACA drastically decreased the number of uninsured Americans from 18% in 2013 to 13.4% in 2014 (Dalen et al., 2015). Without ACA, a significant proportion of Americans would have found themselves exposed to healthcare disparities.
The Affordable Care Act
The ACA expands Medicaid and implements health insurance exchanges which would further widen the scope of insurance access. Around 13 million Americans would gain coverage due to the ACA (Andrews et al., 2013). The ACA places importance on integrated care models such as patient-centered medical homes, care organizations, improving care coordination, and making cost-effective healthcare (Andrews et al., 2013). The ACA had 952 pages which contained ten titles and 450 sections that presented different laws (Jost & McDonough, 2020). The four most significant rules of the ACA are Title I, Title II, Title III, and Title IX. Title I constitute the primary objective of ACA because it expands access to affordable and high-quality health insurance and care (Jost & McDonough, 2020). The ACA deems that insurers must include all enrollees and consider them one risk pool for determining rates (Jost & McDonough, 2020). The law also imposes a tax on uninsured individuals who can financially purchase coverage (Jost & McDonough, 2020). It set a companywide fine for larger organization employers who reject their employees from acquiring at this minimum coverage if even one of their employees enjoys ACA premium tax credits (Jost & McDonough, 2020). Title II expands Medicaid programs to 50 states and provides health insurance to any resident with a household income below 138% of the federal poverty line (Jost & McDonough, 2020). Title III improves low-income subsidies for Medicare beneficiaries. Title IX introduces new taxes and payments that would finance the ACA and prevent increasing the federal deficit (Jost & McDonough, 2020). For this purpose, higher-income households, health insurers, tanning salons, and branded pharmaceuticals had to pay new taxes (Jost & McDonough, 2020). Before ACA, a significant proportion of Americans were unable to afford health insurance. Thus, the ACA introduced three vital health reform principles: financial risk protection, universal coverage, and affordability (Orzag & Rekhi, 2020). The ACA resulted in decreasing the number of uninsured Americans. Americans who earned $36,000 in annual household income received insurance (Borelli et al., 2016). The policy also improved the lives of racial and ethnic minorities. ACA requires marketplace plans to offer a plain language SBC so that it enables consumers to compare programs. The bill also requires navigators to help consumers enroll in projects and provide education to increase awareness about the Marketplace. As per figures from 2013 and 2014, assistant programs had assisted around 10.6 million people (Borelli et al., 2016).
Effective advocacy groups are responsible for shaping public officials’ agendas and putting pressure on them to consider solutions or problems (Jansson, 2014). They also engage in research to address specific social needs and publicize stories to convey social issues (Jansson, 2014). Currently, state Medicaid programs and ACA provide many services to vulnerable populations, including low-income families, people with disabilities, and pregnant women. Bachman (2017) notes that social works care management skills could help Medicaid employees to acquire healthcare coverage, encourage patient engagement in care, and create community-based service links. In this regard, for social workers to contribute to healthcare reforms, social work education should focus on enhancing leadership skills in interdisciplinary practice associated with prevention and population health (Bachman, 2017).
There are three advocacy levels: policy-sensitive practice, policy-related practice, and policy advocacy (Jansson, 2014). In this regard, professionals must prioritize their clients’ needs. Social workers and other professionals must work toward protecting clients and enhancing their well-being. Therefore, social workers must make professional recommendations to help the client with their economic and social aspects. Social workers must engage in liaison and advocacy work for clients so that they could improve their lives. The policy-sensitive practice is the level where professionals must consider their clients’ economic and social realities by deriving them from societal policies (Jansson, 2014). Andrews et al. (2013) claim that social workers understand that every individual in society is a part of a network that correlates with health choices and healthcare.
Consequently, social workers can comprehend the association between health, employment, education, and other social structures that help restore and maintain health. In this regard, social workers know patients’ requirements and what they need from multiple systems after discharge. They also play a significant role in ensuring that patients have understood their discharge instructions and have adequate resources to follow these instructions (Andrews et al., 2013). ACA has introduced a Navigator program that would assist consumers in enrolling in health insurance. The program has provided specific duties that social workers must carry out. Some of them include conducting public education activities, raising awareness about health plans, giving reference to consumer assistance programs, and distributing impartial information about plan enrolment (Andrews et al., 2013). Even though this program is categorized as consumer assistance, it has a close association with social work practice.
In this regard, social workers must help clients acquire skills to overcome certain challenging circumstances and find resources to manage their issues in the future (Jansson, 2014). Jansson (2014) claims that social workers must empower clients and provide them survival skills (Jansson, 2014). Social workers could use case advocacy services that involve mediation and conflict management (Jansson, 2014). This level is called policy-related services in which social workers engage in micro-advocacy, such as helping clients obtain second opinions (Jansson, 2014). Due to the evidence-based nature of social work, social workers play a significant role in understanding the various nuances of mental health and physical health and their interactions to devise plans grounded within the knowledge they have garnered. Andrews et al. (2013) claim that evidence-based social work practice helps ensure that disease prevention and care management recommendations are understood. Patients and families could follow adequate instructions in the case of illness.
Social workers move toward policy advocacy when they go beyond direct service or policy-sensitive practice. Some of the activities at this level include developing and working in coalitions, lobbying, using their power to push social reforms, conducting policy-related research, and introducing policy proposals (Jansson, 2014). In the context of ACA, social work is a profession that concentrates on individuals who are not covered by health insurance. Even after introducing ACA, around 29 million Americans will still lack health insurance (Andrews et al., 2013). Historically, social workers played a significant role in providing assistance and rallying support for vulnerable populations. Thus, social workers can work with communities and public institutions and focus on disadvantaged groups ignored by the health reform.
Social workers play a significant role in policy advocacy and ensuring the expansion of ACA so that it covers underprivileged groups. Social workers have an in-depth understanding of the patients’ environmental context and knowledge regarding evidence-based practice so that they could assume the role of patient navigators and care coordinators (Andrews et al., 2013). Therefore, the social work profession must adopt multilevel advocacy strategies that could influence state and national decisions regarding implementing key ACA provisions. In this regard, social workers could help implement policy analysis, identify critical state-level decision points, and conduct research relevant to the ACA. Andrews et al. (2013) claim that practice-based research networks could help assess how social workers could function effectively in interprofessional healthcare teams and settings. While ACA has introduced new healthcare models, social workers must focus on achieving good health outcomes and bringing down healthcare costs. Andrews et al. (2015) claim that the design and implementation of research studies that focus on decreasing healthcare costs and improving healthcare models should prioritize social work research.
Theoretical Framework and Style of Policy Practice
There are different approaches in policy practice. The policy advocates often employ an electoral style when they want a specific individual to be elected to office or when they require contesting a ballot initiative (Jansson, 2014). The primary goal is to include progressive candidates for defeating less progressive candidates or defeating or enacting a ballot initiative (Jansson, 2014). Policy advocates often work alongside campaign organizations and political parties, and they must possess adequate skills to discuss the issues with voters and campaign staff (Jansson, 2014). A legislative advocacy policy style attempts to secure the implementation of specific legislation. For this purpose, policy advocates work alongside community-based organizations and advocacy groups to convince legislators to adopt particular measures or defeat a measure (Jansson, 2014). The level of conflict can differ according to the specific action. In this style, policy advocates must-have the skills to analyze a policy and develop relevant strategies adequately. They must also work with coalitions and possess appropriate knowledge of the legislative process and lobbying (Jansson, 2014).
Social workers have long acknowledged the importance of healthcare, and they have rallied support for an equitable healthcare system. During the 1990s, the National Association of Social Workers (NASW) refused to support Clinton’s Health Security Act (Yingling, 2020). They perceived that the Act had a market-based reform despite its focus on universal coverage. The social work organization was able to look toward how the Act would protect health insurance companies and maintained a profit-oriented approach (Yingling, 2020).
In the case of analytic style, policy advocates should use data for developing policy proposals and evaluate how existing policies have made a change in society (Jansson, 2014). For this purpose, they work with think tanks and government agencies. They must have adequate skills in conducting research and making recommendations (Jansson, 2014). Despite the revolutionary reform introduced by the ACA, it had many inadequacies. Obama and other Democrats did not want to interfere with the functional parts that they only introduced a minimally invasive reform (Jost & McDonough, 2020). They feared that the healthcare reform would meet a fate similar to the Clinton health reform. Thus, the ACA failed to implement any new public health insurance program but primarily relied on expanding Medicaid. The ACA does not include federal price regulation, and also it does not provide the federal government any control for negotiating drug prices (Jost & McDonough, 2020). Even though the ACA had given significant authority to the federal government, it still favors state over federal regulation, which shows the policy preferences of Democratic senators who had drafted the Act (Jost & McDonough, 2020). It also did not address the premium tax credits that were not available to around 12 million undocumented immigrants (Jost & McDonough, 2020). Thus, policy advocates must employ an analytic style to develop new policy proposals and improve the existing policy.
Policy advocates employ a troubleshooting style for enhancing initiatives or evaluating them using an “eye to improve their quality” (Jansson, 2014, p. 82). In this case, policy advocates must work alongside planning groups and coordinate their activities with government officials, funders, and consultants (Jansson, 2014). Compared to other styles, troubleshooting involves less conflict because policy advocates focus on problem-solving and improving a particular program. Policy advocates engaging in troubleshooting style should have adequate skills to assess a specific plan and identify its flaw. To determine the weaknesses within ACA, policy advocates must research within the healthcare services and work alongside healthcare professionals.
Policy advocacy is a professional intervention that seeks to enhance the well-being of the public. Social workers who work with clients have a primary professional duty to reform policies that aggravate their clients’ issues. Policies often go through different developmental stages. They are not enforced within the span of a single day but rather go through years and years of deliberations. They majorly focus on vulnerable populations, and the policies seek to improve their lives and conditions. Jansson (2014) asserts that if social workers ignore the reforms that policies require, they potentially ignore their clients’ ecosystems. Therefore, it becomes unethical to refrain from engaging in policy advocacy and overlook improvements that specific policies need. Social workers must persuade policymakers to enforce social reforms and elect progressive candidates to the office (Jansson, 2014).
Policy advocacy is a developmental process. Policy advocates must use analytic, political, interactional, and ethical skills to avoid challenges. In the context of ACA, social workers have long understood its shortcomings. Although the policy prevented discrimination of pre-existing conditions and expanded Medicaid, it still failed to achieve universal coverage, resulting in rendering millions of people underinsured (Yingling, 2020). Social workers must use their analytical skills to understand the shortcomings of the reform and how it still did not provide comprehensive protection to disenfranchised communities. Therefore, social workers could understand how the reform reinforces the conventional system where big corporations still profit from the disenfranchised’s sufferings.
Role of Social Workers
Jansson (2014) delineates four rationales for policy advocacy. The first is the ethical rationale which deems that social workers must concentrate on the clients’ well-being and must overcome the narrow definition of professional practice. For this purpose, social workers should engage in policy advocacy and activities associated with social justice and addressing inequalities within society.
The second rationale is the analytic rationale for policy advocacy. In this regard, social workers analyze evidence-based research and put forward reforms and services to help the vulnerable population (Jansson, 2014). After closely analyzing evidence-based research and formulating plans to improve the underprivileged’s lives, social workers rally support policies and funding. The United States’ political system is fraught with inadequacies and inequalities that often favor the rich and disfavors the poor. It has gone through a series of social imbalances such as lack of funding for childcare, tax deductions for the affluent Americans, and health insurance with employment instead of making health insurance available to all (Jansson, 2014). Unlike other countries, Americans have primarily improved their social and economic environment, but its policies have plunged 20% of American children into poverty (Jansson, 2014). A series of environmental factors such as unemployment, health expenditures, and academic track contribute to exacerbating these inequalities.
Social work is a profession that is mostly evidence-based and uses rigorous research derived from the community and professional spheres. In the ACA’s context, social workers play a significant role in understanding how mental health and physical health have a close correlation. The expansion of the insurance coverage also covers Mental Health Parity and Addiction Equity Act. Before 2008, only large employers could access this plan. After the ACA, around 13 million people will gain coverage for behavioral health services. In this regard, social workers need to establish a relationship with state Medicaid agencies and health information exchanges (HIEs) (Andrews et al., 2013). Social workers should also update themselves regarding the critical policy decisions that would encompass social work.
Jansson (2014) claims that the policy choices that rallies for fairness and social justice in America still face significant challenges because the political system favors the rich rather than the poor. Influential public and private institutions often want to maintain the status quo or even reject social reforms for sustaining their power and economic prosperity. In this context, social workers must engage in policy practice because they can derive “distinctive viewpoints into the policy-making process” (Jansson, 2014). Therefore, policy advocacy’s political rationale is a significant social work component because its essential purpose is to enhance the underprivileged and vulnerable populations’ quality-of-life.
The electoral rationale for policy advocacy is also an integral component because political parties can often create bias in the system by appointing people of their preferences in top positions, often determining a policy’s implementation. Jansson (2014) points out that even when the ballot system is introduced initially to help the public overcome corrupt politics, it often results in implementing special interests and conservatives’ policies rather than protecting the general public’s welfare. In this regard, social workers must engage in political campaigns for pushing social reforms (Jansson, 2014). By integrating the NASW code of ethics, social workers should uphold their principles and professional standards by involving themselves in political arenas for pushing forward healthcare reforms that address the inadequacies presented by current reforms (Read the Code of Ethics, n.d.). Social workers must address the gap in affordable coverage options that affects individuals with different healthcare conditions. Borelli et al. (2016) claim that the ACA focused on only individuals who earned less than 138% of the FPL. As a result, the premium and cost-sharing subsidies are only available to those who make 100 to 400% of the FPL (Borelli et al., 2016). For instance, non-expansion states deem that non-disabled individuals who have dependent children and earn about $2400 per year would be ineligible for Medicaid programs (Borelli et al., 2016).
Adults who lack children are also ineligible for Medicaid in non-expansion states (Borelli et al., 2016). Ironically, individuals who earn less than 100% of the FPL do not have access to affordable healthcare coverage because their income is low for qualifying for marketplace subsidies and Medicaid eligibility (Borelli et al., 2016). According to Borelli et al. (2016), this disadvantage puts individuals with diabetes at risk. People with diabetes face significant health disparity in terms of Medicaid coverage. Also, African Americans represent only 20% of Medicaid enrollees because a substantial proportion of African-American people live in non-expansion states (Borelli et al., 2016). Thus, social workers must expand Medicaid programs to all American states to cover African Americans and other ethnic minorities.
Borelli et al. (2016) point out that family coverage often has a higher price than self-only coverage, which excludes low to moderate-income families from buying health insurance in the marketplaces. Using an analytic approach, social workers must focus on addressing these inequalities and inadequacies. In this regard, they could coordinate their efforts with health professionals and other research networks to help them advance research and identify the policy design’s inadequate elements. Andrews et al. (2015) argue that social workers should coordinate with insurers in the managed care sphere to retain a significant ACA implementation role. In this way, they could introduce specific measures to address rising healthcare costs and work alongside stakeholders to teach cost-effective strategies to improve healthcare access and quality. As a result, social workers must address this gap because it significantly affects disenfranchised communities and families.
There are eight stages of tasks for implementing policy advocacy. In decisions regarding what is right and wrong, policy advocates and practitioners must employ ethical analysis for deciding if policies are ethically sound and effective in addressing social issues (Jansson, 2014). Social workers must also know how to navigate policy and advocacy systems and understand where they must introduce changes. Practitioners engage in agenda-setting tasks to assess if the context for a particular policy is favorable (Jansson, 2014). In this process, they formulate specific strategies for introducing reforms on the policymakers’ agendas (Jansson, 2014). Problem analyzing task is when practitioners evaluate problems and their causes and gather more details to resolve them. Later, in the proposal writing task, practitioners formulate solutions to solve problems (Jansson, 2014). Later, in the policy enacting task, practitioners attempt to approve and implement their policies. For this purpose, they must seek various resources and employ innovative strategies (Jansson, 2014). In the context of the COVID-19 pandemic, the functions of social workers have managed to expand. Yingling (2020) argues that the pandemic is a unique moment in history where social work organizations could push their advocacy toward introducing a single-payer healthcare system. As the NASW Code of Ethics, healthcare is a fundamental human right (Yingling, 2020).
Perceiving healthcare in the context of social justice makes it evident that social work must introduce comprehensive reforms for supporting reform campaigns. During the pandemic, the number of employer-sponsored health insurance has managed to decrease drastically. Around 43.4% of adults were inadequately insured during the initial phase of 2020, which leaves individuals exposed to high healthcare costs that can later transform into medical debt (Collins et al., 2020). Social workers must come together to implement strategies that could lead to changes within the system. They must form alliances with organizations such as Physicians for a National Health Program and National Nurses United that advocate for a single-payer system (Yingling, 2020). While the ACA has expanded access to health insurance, the tax credits phase out higher middle incomes (Jost & McDonough, 2020). Although the law’s scope far exceeded any other reforms, it refused to address significant problems. Social workers can make advocacy recommendations by communicating and interacting with healthcare professionals and policymakers and introducing the ACA’s successful reforms. Also, Andrews et al. (2015) claim that researchers must develop new models for improving health that benefits social workers, which contrasts with attempts to fit social workers into existing healthcare models.
Social workers must move toward interventions in real-world settings for testing diverse populations and improving effectiveness regarding agenda-setting tasks. For this purpose, they could collaborate with managed care organizations and companies making electronic health records, which would provide quality data and a timely manner (Andrews & Browne, 2015). They must also concentrate on interdisciplinary research to adequately analyze results derived by scholars from other professions (Andrews & Browne, 2015). In essence, social workers must work alongside policymakers, health professionals, and insurers to address the ACA’s many inadequacies for improving healthcare access. It is also integral for social workers to facilitate the opportunity for such coordination to elevate and expand their roles in the social work arena for improving the quality-of-life of disadvantaged individuals.
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