Affordable Care Act
PPA 601 Foundations of Public Administration
Timothy Smith
December 20, 2015

If an individual needs emergency medical care, the first place that most would seek treatment is through the emergency room at the closest hospital. Even if that individual does not have any medical insurance, they know that they can and will receive treatment if they go to the emergency room instead of going to the doctor’s office. The reason that individuals can count on this serves is because of the many women and men in Congress that have spent many hours making public policies around health care that showcase how providers will attend to their patients. Public policy is the way that the government maintains order and also how the government addresses the needs of its supporters through actions that are outlined by its constitution. That definition seems vague because public policy is not a concrete thing but rather it is a term that is used to describe a plethora of laws, mandates, or guidelines that are founded through a political process. There are many types of public policies because policies are put in place to address the needs of individuals and those policies are divided into different categories as they relate to society. For example, health policy includes not only insurance but also includes all policies that are related to the heath of a certain group. When the AIDS epidemic came about in the early 1980’s, governments from all over the world had to initiate new policies pertaining to how the disease would be handled. The government also had to initiate new policies pertaining to the steps they would take to educate the public. Along with policies pertaining to health, other important public policies are legal policies. Legal polices include the laws that are used to regulate what is considered a crime, how the crime will be punished and who will be accountable for handing out the punishment (Howlett et al 1995). There are multiple steps that need to be done in order to create a public policy.
In order for a public policy to be official the legislation has to go through five steps: The national agenda, formulation, adoption, implementation and evaluation. In terms of the national agenda, when a situation becomes a concern for a vast amount of individuals, that situation now becomes a part of the national agenda. The national agenda is the list of things that the American people want the government to address. An issue becomes part of the national agenda for many reasons. The first has to do with trends such as the rise in violent crime between the late eighties and the early nineties. Another reason is after a major event such as the September 11th attacks. After those attacks the American public commanded an increase in national security. Also the Exxon oil spill, the American public demanded for environmental protection. After issues get added to the national agenda, the public then begins to petition the government to take action. The next step is formulation. Public policy formulation regulates how the government will answer to the issues that are on the national agenda. Although, the public may be in agreement that a certain policy exists, the public might also strongly disagree about how to fix the issue. Officials of Congress, executive branch and interest groups could potentially all recommend solutions, which then could start an intense debate in Congress and in the media. The next step in creating a public policy is adoption. When the issues that are on the national agenda have been debated and proposals have been suggested, the government has to choose one of the policy solutions and then the government has to pass new laws to adopt the new policy. An example of this is when the president works with Congress to enact tax cuts. The next step in creating a public policy is implementation. After the policy goes through the adoption stage it is essential that is it implemented and now the federal agencies have to decide how to vary out the policy. The federal bureaucracy propagates the regulations that are passed by Congress into certain policy, depicting up the rules and procedures for putting the policy into practice. The last step in making a pubic policy is the evaluation stage. During the evaluation stage individuals begin to judge and evaluate the policy once it has been put into effect. Criticisms might come from the individuals whom the policy serves, bureaucrats who watch over the implementation and pundits and reporters who are concerned about the issue (Birkland, 2014). The purpose of this paper is to analyze the Affordable Care Act (Obama Care), describe the stakeholder and affected constituencies, describe the political institutions that are relevant to the policy, if the policy is faced by both the federal and state governments, how much the policy is costing Americans, discuss policies that address the issue, and to recommend a solution to the policy proposed.
The affordable Care Act is a long and difficult piece of legislation that has a main goal, which is to reform the healthcare system by providing American citizens with quality affordable health insurance and by restricting the growth in healthcare spending in the United States. The Affordable Care Act, also expands access to insurance coverage. The Affordable Care Act’s goal is to extend health insurance coverage to over thirty million uninsured Americans by expanding both private and public insurance. The Affordable Care Act requires employers to cover their workers or pay penalties; it provides tax credits to certain small companies that cover employee health insurance. This policy also requires the state to create insurance exchanges to help citizens and small business buy insurance. The Affordable Care Act also improves health quality and system performance. The Affordable Care Act includes many provisions such as: research studies on the effectiveness of certain treatments, demonstration projects to reduce errors related to medicine, investments in health information technology, options for states to help people that have Medicaid enroll when thet have multiple chronic conditions and improvements in coordination between Medicare and Medicaid individuals who qualify for both. The Affordable Care Act also increases consumer insurance programs such as: eliminating monetary limits on insurance coverage, stopping insurance plans from excluding insurance for children that have preexisting conditions, stopping insurance plans from cancelling coverage and establishing the share of premiums that is devoted to medical services (Selbin et al, 2013). There are still adjustments that should be made to this public policy.
Even though with the Affordable Care Act millions of people that do not have insurance will get access to affordable high quality insurance. However, in order to get the money to help insure those millions of people, there are new taxes, mostly on high earners and also on the healthcare industry. The taxes that affect individuals directly are the individual mandate and the employer mandate. The individual mandate claims that all of the Americans who can afford health insurance have to enroll in health insurance, get an exemption or pay a fee. This creates a huge complication in terms of filing taxes. Some individuals who barely miss the Federal Poverty Limit of four hundred percent are affected the hardest because they do not quality for assistance. With the Affordable Care Act, there are now more coverage options and all of the main medical coverage options have to deliver minimum essential coverage. The concern with this is that more options mean that it is harder to look for coverage. Shopping for health insurance can be risky because of over buying or under buying. Another concern with the Affordable Care Act is that now insurance companies have to cover sick individuals. This means that the cost of everyone’s insurances increases. In order to make sure that people do not just purchase insurance coverage when they need it, most individuals have to get coverage or pay a monthly fee. Another drawback is that coverage can only be gotten during the yearly open enrollment period (Thompson, 2014). Along with the many concerns of the Affordable Care Act, there are also stakeholder and constituencies that are affected.
The four major stakeholders in the Affordable Care Act are consumers, employers, states and healthcare providers. In terms of the consumers, the majority of American healthcare consumers, about fifty five percent who obtain medical coverage through their employer and thirty two percent through a government program, may not be aware of as many major changes in medical insurance coverage. The Congressional budget estimates that the amount of uninsured people that are not elderly, will decrease substantially from fifty five million in 2013 to twenty nine million in 2017 and based on these predictions, consumers may see increased publicity and marketing of health insurance that is targeted towards the younger adult population. In terms of the employer stakeholders, both the employers and the employees could benefit from more apparent competition among insurance providers when the open enrollment period begins. However, the for the employers, a section of the Affordable Care Act states that organizations with greater than fifty employees have to offer insurance only to the ones that work more than thirty hours per wee. This provision may persuade the larger companies to change the employee timetables, which gives smaller companies an advantage because they have a workforce that is less than fifty employees. In terms of the states, in many cases, the states can choose for themselves whether to endorse specific provision of the Affordable Care Act. For example, establishing state program health insurance exchanges in time for the annual open enrollment. IN March 2013, twenty-four states and the District of Columbia agreed to establish a state run or a combination of state and federal health insurance exchanges, the remaining twenty-six states agreed to operate federal exchanges. Also the states had the authority to decide on whether to accept of refuse federal finds for expanding and improving Medicaid programs. In terms of the healthcare provider stakeholders, providers are expected to integrate and make an effort to provide higher quality and low cost healthcare. To persuade providers to do this, bundle payment programs became effective January 2013. Also, in an effort to upsurge access to primary care and preventative health programs, physicians that provide primary care are reimbursed one hundred percent of Medicare payment rates. The physicians also will receive a ten percent bonus payment on top of the Medicare reimbursement (Cheng et. al, 2013). There were many political institutions involved in the Affordable Care Act.
The political institutions of reporting the news (media), drafting the policy (Congress), and representing the State (the President) were all essential towards passing the Affordable Care Act. The media had a large impact on passing this act. There were multiple polls in the media that registered concerns for reform while also causing other individuals to ponder their own losses, instead of pondering their gains, from the bill. The media does its job to exert a grand influence on the policy process because it is easily accessible in many people’s homes, the media is very simple to understand even for the uneducated and the medial also does not have statutory rules for printing misleading headlines and possible serious debates on key components. The other political institution that played a role was Congress. Congressional committees reserved most of the power in passing health legislations. For Obama, the hurdle was the Senate Finance Committee and that is why Obama made a chose to have the Finance Committee lead debated on the bills and made it possible for the legislation to create the legislation. This placed the power into the hands of the Democratic Chairman of the Committee (Rigby et. al, 2014). The Affordable Care Act has concerns that both the state and the federal governments have to face.
Medicaid expanded to cover over fifteen million people who fall below the poverty line. As a result of the expansion, Medicaid had to use Federal and State funding. However, not all states have to expand Medicaid. The states that choose not to expand Medicaid leave five million of the nation’s poorest individuals without coverage options. The children health insurance program has expanded to cover up to nine million children. That program also uses Federal and State funding. The States that provide Medicaid receive one hundred percent federal funding for the very first year and then receive ninety percent funding the years following (Zhu et. al. 2014). However, the Affordable Care Act is costing Americans a lot of money.
The cost of the Affordable Care Act is estimated to be about 1.207 trillion dollars by the year 2025. The annual provisions to the Affordable Care Act will cost the federal government forty-one billion dollars in 2014 and 1.487 billion dollars over the 2015-2024 period. The gross cost for Medicaid, the children’s health insurance, the exchanges and tax credits for small employers will be approximately 2.004 billion dollars. There will also be receipts of 517 billion dollars from penalties on certain uninsured individuals and specific employers, high premium insurance plans and increases in tax revenues. The Affordable Care Act will cost taxpayers one hundred forty two billion dollars.
A proposed policy of the Affordable Care Act is section 1557, which is the nondiscrimination rule. This rule was proposed to advance health equality and to reduce inequalities in health care. This policy will assist some individuals that have been the most susceptible to discrimination and will also aid to provide populations the same access to health care and also health coverage. This rule synchronizes protections provided by existing, established civil rights laws. The basic requirement of this policy is that consumers cannot be exempt from health services or health coverage. Consumers can also not be discriminated against because of their race, color, origin, sex, age or disability. Another proposed rule for the Affordable Care Act is the patient protection rule. This rule would set parameters and provisions that relate to adjusting risk, reinsurance and risk programs. The rule would also set parameters for cost sharing reductions, set the standards for the open enrollment period and guaranteed renewability (Thompson, 2012). Some other policy issues are lack of flexibility, lack of explicit instructions, outdated solutions, overwhelming cost to the states and the uncertainty of federal government fulfilling its portion of costs and restrictions on state insurance. The solution to fix the lack of flexibility would be to decrease the states chance to coordinate welfare assistance programs. This will hopefully eliminate silos across programs and integrate wherever possible. Flexibility gives the state the ability to learn better ways to coordinate and administer the welfare assistance programs. For the lack of timely and explicit instructions the solution would be to provide new general rules that allow automated extension deadlines if the federal government cannot provide timely advise. This would allow states to seek waivers for timelines in the law that are not realistic. The solution for the outdated solutions would be to allow the state to get out of any provision that imposes an outdated solution. The solution for the overwhelming cost would be to place a cap on the impact to the states and also give automated suspension of requirements if the cap is reached. Another solution would be to have the federal government pay for one hundred percent of the cost, or to provide 90/10 funding always for mandated federal government changes. The solution to the uncertainty of the federal government would be to provide a trigger mechanism to roll back mandates if the federal government is not able to fulfill its end of the arrangement. The solution for the restriction on state run insurance would be to provide more flexibility to states to create alternative insurance exchanges designed to interact with the healthcare insurance market. This way the coverage can be seamless when moving between the government assistance programs and private coverage (Affordable Care Act). The purpose of this paper is to analyze the Affordable Care Act (Obama Care), describe the stakeholder and affected constituencies, describe the political institutions that are relevant to the policy, if the policy is faced by both the federal and state governments, how much the policy is costing Americans, discuss policies that address the issue, and to recommend a solution to the policy proposed. The Affordable Care Act made it possible for tens of millions of people that did not have insurance, get access to high-quality affordable health insurance through the Medicaid expansion and the employers. There were some issues surrounding this policy. For example, this policy increased some individual’s taxes and there were issues at the state and federal level.

References
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Zhu, L., & Johansen, M. S. (2014). The refusal of 24 states to expand Medicaid under Obamacare will maintain their high levels of inequality in healthcare coverage. LSE American Politics and Policy.