More People Insured Under ACA Chapter

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Public Policy the Affordable Care Act


There are two gaps in particular that the Affordable Care Act was meant to address. The first gap in particular that was meant to be addressed is to provide affordable healthcare for those that could not afford it. The other main gap was to not be able to find insurance (or affordable insurance) that did not come with lack of coverage for preexisting conditions. For many, they were unable to find care to address chronic conditions (Beroino, 2014) (Zarocostas, 2010). What is clear is that the Affordable Care Act has had a demonstrable impact on the amount of uninsured people in the United States. To use Gallup's data, the uninsured rate in the first quarter of 2009 (about a year before the Affordable Care Act was passed) was about 15.4%. That number rose slowly through the beginning of 2014 as the provisions of the Affordable Care Act were implemented. The number peaked out at 18.0% just before January of 2014. However, the number has shot downward since then. It fell to 17.1 in January 2014, then 15.6% in March 2014, then 13.4% in July and then down to 12.9% in late 2014. The number, per the latest 1Q2015 numbers, now sits at 11.9%. That is a cut of more than seven percent in less than two years. Many people had the perception that only the jobless and those that did not want insurance did not have insurance. However, most people that did not have insurance were working and wanted it but could not afford it. Even so, only about seventy percent of people out there thought it was "important" to have it. As such, perceptions and public education have been issues as well (ObamaCare Facts, 2015).Get full Download Microsoft Word File access
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The swells of people that enrolled via the Affordable Care Act and thus drove down the numbers of insured are undeniable. For example, the prior Gallup poll showed that there was a giant drop in the uninsured in 2014. This can be attributed in part to the fact that eight million people that signed up during open enrollment in 2014. These are the same people that wanted to sign up for insurance before but could not do so due to pre-existing conditions and/or because they could not afford the insurance in question. Of course, part of the Affordable Care Act was that insurance policies could not deny or spike the prices on people that had preexisting conditions such as diabetes or heart disease, just to name two.


Finally, the Affordable Care Act was and is necessary and it will serve as a vehicle to improve the outcomes and futures of those that make use of the program as compared to those that do not. For example, the dependent coverage provision of the Affordable Care Act will improve the health-related outcomes of adults (Barbaresco, Courtemanche & Qi, 2015). Further, there are even college courses and curricula that are modeled and shaped on the idea of creating patient-centered outcomes (Hoerger, 2015). Indeed, there have been studies with disorders or diseases like prostate cancer that show a clear correlation between having insurance (regardless of where it comes from) and the outcomes for the patient. Given that, the aim of the Affordable Care Act to increase the amount people covered is a very important priority and improves the aggregate outcomes of patients (Mahal et al., 2014).

To drill down a bit on why insurance status is so important, an exploration of what was found in the Mahal et al. study will be conducted. The background of the study is that the Affordable Care Act ostensibly intends to expand health insurance coverage for roughly thirty million previously uninsured Americans. To help evaluate the impact of the Affordable Care Act on the treatment and patient outcomes related to prostate care, the study examined the associations between insurance coverage and prostate cancer outcomes among men that were less than sixty-five years old and were thus not eligible to enroll in Medicare. The sample size of the study was quite large. Indeed, there was an assessment of more than 85,203 men younger than sixty-five that were diagnosed with prostate cancer between 2007 and 2010. There was a multivariable logistic regression framework that modeled the association between insurance status and stage at presentation. Among men with the high-risk disease, the associations between insurance status and receipt of what is known as "definitive therapy" revealed that prostate cancer-specific mortality (PCSM) and all-cause mortality were determined using the multi-variable logic. Fine and Gray competing-risks and Cox regression models were used (Mahal et al., 2014).

The results reflected that uninsured patients were more likely than not to be non-white and come from regions that were rural in nature and characteristics. Further, they were also more likely to be of lower educational attainment and household income as compared to the median of the United States. Insured men were more likely to receive "definitive treatment" and had decreased PCSM and all-cause mortality rates as compared to those that had compromised or no insurance at all. Couple this with the lower amount of uninsured people as mentioned before in the gaps section, it is not remotely unreasonable to presume that people who are insured will live longer and better due to the Affordable Care Act as compared to what would happen if the ACA was not passed into law. Indeed, the county would seem to be in better shape medically and ethically now that the law has been passed (Mahal et al., 2014).

Differences in health and life outcomes can be seen in disorders and diseases other than prostate cancer, of course. One study looked at insurance mandates in a post-Affordable Care Act landscape as it relates to women with diabetes that were having children. This was combined with the idea of having mandated insurance for those women so that they would have a higher level of care for themselves and their fetuses/infants as they developed and were eventually born. The high-level results of the study found a few interesting things. First, even among educated women (who typically have higher likelihood of being insured and having better insurance in general) saw a reduction in the problem of low birth rate and also saw less instances of having births that were premature in nature. That being said, the gains were concentrated among older women and were noticeably larger for African-Americans. This could be explained by the fact that older women are more prone to have birth complications like low birth rate and premature birth and the African-American blip could be explained by that race of women typically having lower insured rates and/or going to the doctor less in general. Regardless, this study would seem to lend credence to the idea that people with insurance have better outcomes. Since the Affordable Care Act has been addressing that, the outcomes for women who are having children while having diabetes will be better than those that are left languishing with paltry or no health insurance at all. Diabetes in particular is something that would help the Affordable Care Act get a lot of "bang for the buck" considering that the amount of women at childbearing age and that also have diabetes has doubled between 1980 and 2009. The statistics in the broader population are no different (Grecu & Spector, 2015).

A different study that related to diabetes used a tool and method known as a "value-based insurance design program." This study was also published after the Affordable Care Act was passed, about three years to be precise. One major pitfall of diabetes treatments and outcomes that the program was meant to address was "cost-related non-adherence." In other words, the program was meant to make sure that copays and other expenses were not the reason that people did not get proper diabetes-related care. A resounding majority of the people in the study attested that they were better able to take care of their diabetes, with 89% affirming that to be the case (Elliott, et al., 2013).

One thing that is not covered a lot in papers like these is the idea of what employers can do to wield the Affordable Care Act and wellness programs to help employees find their own better healthcare outcomes. This subject was covered in a 2013 treatise by Willingham. Employers are finally getting the message that wellness programs are the right thing to do and they are becoming a non-option for any large base of employees that use health insurance. Indeed, many gaps in healthcare are being addressed through the 70% or so of employers that use the aforementioned wellness programs. They typically include incentives for doing (or not doing) things that improve health such as using pedometers, stopping smoking, losing weight and so forth. Employees can benefit from a health standpoint as well as a pocketbook standpoint as they typically pay less for their healthcare insurance if they meet certain metrics. Both the ACA and HIPAA have… [END OF PREVIEW] . . . READ MORE

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How to Cite "More People Insured Under ACA" Chapter in a Bibliography:

APA Style

More People Insured Under ACA.  (2015, May 31).  Retrieved December 4, 2020, from

MLA Format

"More People Insured Under ACA."  31 May 2015.  Web.  4 December 2020. <>.

Chicago Style

"More People Insured Under ACA."  May 31, 2015.  Accessed December 4, 2020.