Health policy combines action, plans and decisions to achieve certain health care improvements. The goals of the health care policies are referred by the World Health organization as a vision for the future, building consensus, informing people and outlining the priorities for the short and medium term. Many historical policies have been implemented in the United States, but still the health care expenses are rising from year to year and had in the last year 2015 reached 17.5% of GDP (United States Census Bureau, n.d.).
The paper will examine one of the most important health policies Medicaid. The social health care program has been developed for individuals and families with limited resources and with low income that cannot afford to pay for the health care. Poverty has been always associated with bigger health risks and inability to access health care. Inside the Medicaid the Patient Protection and Affordable Care Act – PPACA will be examined, known also by the name “Obamacare”. The policy provides the health care delivery and includes the mandatory and optional service states must provide. In 2016 the most important health policy to focus on will be the resolving of the future of the PPACA.
The Affordable Care Act expands the coverage, holds insurance companies accountable, lowers the health care costs, provides more choice and enhances the quality of health care for citizens. The act expands the Medicaid coverage to millions of low income families and individuals inside the Medicaid and CHIP – Children’s Health Insurance Program. The law was enacted at the beginning of the year 2010 in order to increase access to the health insurance. Premium costs for the healthcare are reduced by providing hundreds of billions of dollars in tax relief (Medicaid.gov, n.d.). The predictions are that the act will cut if fully implemented, the number of uninsured citizens by more than half. The Congressional Budget Office reported that the health insurance coverage will result in 94% of the population insured, where 31 million people will get insurance, 15 million beneficiaries would be enrolled in Medicaid, but still 14millions are expected to stay without the coverage (Rosenbaum 2011). There were many disagreements and protests because of the policy, because the law enacted all tax payers, but not all individuals are legally included in coverage guarantee of health coverage. Through these six years many argument against and for have been raised.
The current politics of issue are regarding the effects of the implementation in some states brought in this period of time. According to the Census Bureau, 13.3% Americans were uninsured in the 2015, among those also high percent of uninsured children. Many are still living in the medically underserved geographic locations with no health facilities or clinics. The changes at number of uninsured have drastically felt in comparison to the year 2010 prior the acceptance of act in comparison of the year 2015 (United States Census Bureau, n.d.). However, there are still debates about the effectiveness of the health policy in implementation and in the coming elections this year the debate that has been so polarized will be further seen. The reasons for disagreements have also led in the past to many protests. The Kaiser Family Foundation poll reported that in 2015 the majority of the Americans still believe the law should be further debated. The population is still not decided whether the Obamacare is success or a failure. The public opinion poll conducted through the times of 2009 to 2015 has shown that between this time periods the opposing side was bigger than the side in favor (Kaiser Family Foundation poll, 2015). With the Supreme Court ruling that the Affordable Care Act and expansion of Medicaid is optional for states the predicted improvements did not reach every state in the country.
Provision of healthcare to low-income individuals is being implemented in some states and has been discharged in others. With the court ruling that the extinction of insurance policy is not mandatory many of its goals have been put into question. Policy making has come into law, even though there are still fierce debates about it and the possible invocation. Many propositions about improvement of the healthcare system in the country did not pass the Congress and there are still two major opposing sides, one that agree with the Obamacare and other that do not.
With the current and the past health care system the social injustice upon various vulnerable groups has been carried out. Many health issues have roots in social injustice. The social context of the PPACA can be seen thorough the statistics of provision of health care insurance among the vulnerable groups. The provision of coverage has been expanded to the low-income individuals with incomes below or at 138 percent of poverty for individuals under the age of 65, parents, children, pregnant woman and adults without dependent children. The expansion was designed to address the uninsured among the low-income and limited access to employer coverage. With an option to implement the Medicaid expansion has limited options to providing those in need the health coverage. The coverage gap has evolved with some state deciding not to implement the Medicaid and in it the people are in fair or poor health, and have affected the racial and ethnic groups differently. The poor and American blacks are the most vulnerable. The complex health policy needs cooperation and efforts on federal and the state level (Damico & Garfield, 2016).
Ethical context of the PPACA could be looked through the lens of human rights. In the United States the healthcare is not regarded as a right, but as a privilege and just an option. Why should the health insurance be dependable on wealth and working status? It would be ethical to allow everyone the access to the health insurance regardless of gender, race, ethnicity and wealth. Equality is not achieved with the current health care system. If the health care system works with the ethical standards, it includes quality, freedom of choice, affordable services and sharing of the costs for the health care benefits (American College of Emergency Physicians, 2011). The health policy surrounding the PPACA is in accordance with the ethic since it tries to provide the health insurance to all citizens by increasing the affordability and availability. Should the right to be healthy be an option or should it be guaranteed for all?
Historical roots of the PPACA go back to the President Roosevelt, who took the first indicative in promotion of health insurance for workers in 1912. Many actors and organizations that promoted the health insurance were created afterwards. At the time of the great depression the health care and medical costs were increasing and resulted in poverty. After the World War II, President Truman enabled some kind of right to health care. Further on, in 1960 the President Lyndon amended the Social Security act and the Medicare and Medicaid were included. In 2003 improvement were seen on the Medicare Prescription Drugs. Many Congresses rejections were seen in the past, but the Presidents Obama in 2010 addressed the health care reform and achieved to pass the PPACA through (Maniam, Black, and Leavell, 2013).
Financial and economic context are also important. The Centers for Medicare and Medicaid Services has reported (2012) that the PPACA will resolve in lowering the Medicare costs by $200 billion for taxpayers through the 2016 and nearly $60 billion for beneficiaries and traditional Medicare. Health care reform will reduce the Medicare costs with reforming: payments to private insurers, reforming the provider payments, with improved productivity, improving the patient safety through the Partnership for Patients, downsizing of fraud and abuse in the Medicare system and get durable medical equipment, expended benefits will lower the payments for hospitals, readmission reduction and adjustment to premium subsidies (The Centers for Medicare and Medicaid Services). There were also arguments about the financial cost to the business and rising finical cost as expenditures of GDP.
Under the Theoretical underpinning of the policy PPACA the different legislations and perceiving’s can be built on different theories. Health behavior theory predicts that health choices and principles are the impact of the global health standards, ideals and multiple aspects of health education and improvement. Self-efficient theory believes that some might positively use the PPACA health insurance provision, but at the same time some may be free-rides on the benefits they receive and could care even less for their healthcare because it is paid through the taxpayers’ funds. Iron triangle theory can be used in measuring the progress and outcomes of the PPACA with the dimension of costs, access and quality. Social cognitive theory can also play a part in explaining the PPACA development. Observation of behavior and seeing its outcomes is the main purpose of the cognitive theory. People learn by observing other people and the environment in which individual person grows up contributes to the behavior towards the health care insurance. The public opinion can be explained with the help of the cognitive theory (Sridhar, 2014).
Stakeholders of interest in the PPACA are various, from consumers, providers, health plans groups and purchasers. For the consumers the policy in majority represents a more secure and affordable health insurance coverage provides quality and access. The provider benefits to more patients enrolled in the health care system and benefit plans, with standardization cost sharing benefits and finical initiatives. The health plan benefits with expended market. The purchasers focus on improving and maintain the health status, more healthy people and fewer costs that would result in the absence. The PPACA includes also other stakeholders: medical profession, hospitals, medical equipment dealers, pharmaceutical manufacturers, insurance companies, uninsured, patients, consumers, labor unions, and leaders of drug companies, health care providers and various governmental agencies.
A nursing policy/ position statement regarding the PPACA exists. The American Nurses Association supports the reform and stated that the reform of the health care system in the country is needed. The ANA’s position is that health care is a basic human right for all people and that PPACA should do more since it does not involves the immigrants that are one of the most vulnerable groups in the country (The American Nurses Association, n.d.).
Policy options and solutions can result in no change, partial change or radical change regarding the PPACA. If there will be no changes the policy will not reach all that need health insurance. The gap will widen and further cause inequality among different races and especially among the low-income individuals. With no change the state will further have the option to implement the extension of Medicaid or not. With partial change in favor we could see great improvement in reducing the rate of uninsured in the United States or in a partial change with reducing the negative side effect that can result in even bigger provision of health care. There is also a possibility of revoking already accepted extensions of Medicaid in the states that have already implemented Obamacare which would bring us back to the situation prior to the year 2010. There is always a possibility of a radical change that can be imposed from the Republicans, which could result in undermining the health policy and creating a new one. Based on the debates there is no single policy available where the majority would agree about and that could lead to the repeating of the history and years of Congress rejections of various health care policies.
Resolving the future of the PPACA will be the majority health policy concern in the year 2016. In the coming elections the democratic and republican views are going to be confronted. Republicans are supporting the flexibility to design and execute health programs. Demonization of Obamacare is predicted with pointing out the federal law is forcing the people to get health insurance even if they do not want it. Democrats, on the other side promotion of the act will be seen by pointing out the group that benefited the most. Pushing for expansion of the coverage and benefits on the bias of the PPACA by the Democratic Party is going to be seen. Views of both political parties differ about the health care policy. The republicans want to replace and repeal the act and on the other side the democrats’ candidates’ extoll the achievements of the act. The debate has been about the replace concept. The building of the consensus can prove difficult.
The theoretical underpinnings of the policy options/solutions differ based on the chosen theory. With the help of the Iron triangle and doing a cost-benefit analysis based on the progress and outcomes of the PPACA including all costs, access and quality of the health care system can be carried out. The examination of the policy in states that have already implemented it and extended the Medicaid policy should be made. It would help to show objective analysis on which both sides could form a consensus. The pros and cons would be shown and the possibility to improve policy with the cooperation of both sides. The action can be better preformed with knowing the shortcomings and advantages. Taking the health behavior theory in mind the looking outside of the country is necessary. The comparison with other healthcare systems in other countries could be made. If the global health standards have an effect on the principles and health choices the studying of the disadvantages and advantages of foreign health systems would be wise. By knowing what the main worries of self-efficient theory is, the policy should be rearranged in order to prevent free-riders and exploitations of a system that is meant for vulnerable groups. Through the culture, learning and observation of behavior, the changes can be made based on the social cognitive theory. If the two major party opinions are completely divided so will be the division among the citizens. The public opinion is the result of state representatives, media and reporting.
The health advocacy with promotion of health care and rights of a patient can help to reach the desired goals of provision of healthcare for all citizens. Aspects and leadership requirements and professionalism are desired in every possible solution or change. The holistic approach instead of the fragmented with coordination is the right principle.
Each option or solution provides an opportunity or need for inter professional collaboration. If no change or extreme change are implemented this means that only one side is reaching its objectives. All three changes in order to serve the society must be made with the cooperation of the various professionals that can make objective arguments that can lead further to common solutions. The common ground needs to be found with professional collaboration.
With every possible change there are pros and cons. If there will be no changes in the healthcare expenditure, the costs will further grow since not all of the states will be included in the health care policy. And the healthcare won’t be available for everyone that cannot afford it. The costs put into the implementation of the PPACA were big, but can result in reduction of spending in the future. With the radical change and the introduction of new policies a lot of financial damage would be done. The solution is to develop the policy further and work on the roots that are already made. With the cooperation and clear cost-benefit analysis effectiveness and efficiency in the area of health care insurance can be made. The consensus should be built on mutual respect on both sides, with adjustments that would even improve our health care system that needs to be changed since the expenditures are growing but do not result in overall improved public health. The differences should be put aside and the solutions should start from the common ground. Consensus builds and collaborative issue solving should include various different parties and actors that are important in PPACA to develop a mutual solution. Many problems among society regarding the PPACA act have shown in these four years. Only diversification of actors involved in issue resolving can bring results that will be acceptable for all. All should be involved from government actors, actor from both political parties, business representatives and other actor mentioned above. First, they should present their problems in order to identify the disagreements, then the participant identification must be carried out, so that all actors will have the legal and legitimate representative. The process is then designed by defining the problem and making an analysis on which the problem solution can be based. Such a complex healthcare policy needs time and experts from various fields to find the solution acceptable for the majority.
American College of Emergency Physicians. (2011). Ethics of health care reform: Issues in emergency- medicine- An information paper. Retrieved from www.acep.org/Content.aspx?id=80871
Centers for Medicare and Medicaid Services. (2012). The Affordable Care Act: Lowering Medicare costs by improving care efforts will save over $200 billion for taxpayers through 2016, nearly $60 billion for beneficiaries in traditional Medicare. Retrieved from http://www.cms.gov/apps/files/aca-savings-report-2012.pdf
Damico, Anthony, Garfield, Rachel. (2016). The Covarage Gap Uninsured Poor Adults in States that Do Not Expand Medicaid – An Update. Retrieved from: http://kff.org/health-reform/issue-brief/the-coverage-gap-uninsured-poor-adults-in- states-that-do-not-expand-medicaid-an-update/
Kaiser Family Foundation. (2015). Kaiser Health Trackinh Poll: June 2015. Retrieved from http://kff.org/health-costs/poll-finding/kaiser-health-tracking-poll-june-2015/
Maniam, Balasundram, Laurie Black, and Hadley Leavell. (2013). The Financial and Economic Effects of the Patient Protection and Affordable Care Act (PPACA). Journal of the Academy of Business & Economics. Retrieved from https://www.researchgate.net/publication/284242581_THE_FINANCIAL_AND_ECO NOMIC_EFFECTS_OF_THE_PATIENT_PROTECTION_AND_AFFORDABLE_C ARE_ACT_PPACA
Medicaid.gov.(N.d.). Affordable Care Act. Retrieved from https://www.medicaid.gov/affordablecareact/affordable-care-act.html
Rosenbaum, Sara. (2011). The Patient Protection and Affordable Care Act: Implications for Public Health Policy and Practice. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001814/
Sridhar, Srinivasnon Divya. (2014). Health IT as a Tool for Prevention in Public Health Policies. United States: Taylor & Francis Group.
The American Nurses Association. PPACA. Retrieved from http://nursingworld.org/search.aspx?SearchPhrase=PPACA
United States Census Bureau. (N.d.). Retrieved from http://www.census.gov/
World Health Organization. (N.d). Health policy. Retrieved from http://www.who.int/topics/health_policy/en/