Research Paper: Public Health Service: A Renewed

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[. . .] S. Constitution thereby making it mandatory for individuals to purchase health insurance. The Individual Mandate provision of the PPACA (P.L. 111-148, PPACA) requires all Americans must purchase healthcare insurance policy from 2014 or face a federal penalty. The U.S. Supreme Court stroked down the individual mandate provisions stating that they violated the Commerce Clause. The court held that the Individual Mandate under the current provisions is unconstitutional. Another blow to the ACA provisions was that the Supreme Court stroked down the requirement for states to participate in Medicaid expansion or their Medicaid funds will be withheld by the Federal government. The Court held that the provision is an overreach by the Federal government. The Court held that the participation in the Medicaid expansion shall be voluntary. The striking down of the certain provisions of the ACA may impact the likely success of the act in bringing 94% Americans in the health insurance net. The Obama administration bragged about the likely success of the act without taking into consideration the potential legislative flaws that act could face. It also seems that a majority of the projections done by the CBO were based on the premise that every American over a certain age will have to purchase the insurance plan. Since the premise has been eliminated by the Court's ruling, bringing 94% of Americans into the healthcare system's network seems to be a daunting challenge for the Federal government.

Rago (2014) points out that the CBO admits the fact that a 'substantially large and considerably higher labor force will be subtracted due to the enforcement of the ACA. By 2024, around 2.5 million Americans will work less or not at all as a consequence of obtaining medical subsidies. Mr. Casey Mulligan, an economist by profession estimates that the ACA will make the economy contract by 3% by 2024. One of the most interesting and somewhat plausible criticisms on the ACA is that insurance subsidies are tied to income of an individual. The individual's right to obtain the subsidy will be absolved once he/she earns income higher than the eligibility threshold. Therefore, individuals will be encouraged to remain poorer in order to continue obtaining insurance subsidies. The ACA reform is too ambitious in transforming the healthcare insurance coverage, quality, efficiency, prevention and healthcare workforce (McDonough, 2012; p. 201). It touches too many reform agendas at once and leaves considerable room for writing definitions and rules that may take considerably longer to realize the promised results (McDonough, 2012). The ACA will be partly funded through federal borrowings that will increase the federal debt in the long-term. The U.S. Federal government is already heavily indebted, and an increase in debt is bound to impact the overall risk of the government. It seems that the benefits of the ACA are overpromised, and the administration made these promises on some initially over-simplistic premises. The first premise was that since individuals will be mandated to purchase insurance plans, the overall coverage will automatically increase to 94%. Secondly, all the states will be self-motivated to participate in the Medicaid plan otherwise they will risk losing the federal funding. Thus, any plausible person will not choose the latter option. However, with the Supreme Court striking down both the provision, the estimations developed on simplistic premises are getting challenged by expert economists like Mulligan. The CBO too of revising its initial estimates of the impact of ACA based on Mulligan's seminal work regarding marginal tax-rate. Further, it can also be assessed from the findings reported in Table 1 that the middle-income and the upper-income groups will be economically hard hit by the ACA provisions. It is yet premature to argue that if benefits of the legislation will outweigh the drawbacks. The opposite seems more plausible given the changes in the original legislation. The issues are still not at rest and researchers and economists are continuing their effort to highlight pros and cons of the legislation. Jacobs, et al. (2012) made a more appropriate observation regarding the ACA and the authors commented "almost every outcome remains possible: sudden reversal, protracted defeat, or long-term success" (p. 147).

5. Conclusion

The Patient Protection and Affordable Care Act (PPACA) that took effect from March 2010 is one of the most controversial public health topics currently under debate. The reform agenda under the ACA has attracted wide appreciation but a growing criticism as well. The ACA reforms of the U.S. healthcare system are aimed at increasing the quality of care and affordability of the healthcare insurance. The reform promises to increase the insurance coverage to 94% of the total U.S. population and reduce the healthcare cost for government and individuals. It seems that the ACA successfully addresses the key underlying challenges of the U.S. healthcare industry as identified by researchers i.e. taking measures to improve the quality of care and insurance coverage. A major flaw (that may impact the initial estimation related to the insurance coverage under ACA) was identified by the U.S. Supreme Court the court stroked down provision related to participation of states in the Medicaid program and the individual mandate provisions. Number of critiques argues that the legislation will induce the subtraction of substantially large and considerably higher labor force from the U.S. labor market. More than 2.5 million Americans may work less or not at all due to receiving ACA related insurance subsidies. The issue is not laid to rest until the impact of the ACA led reforms finally surface, either positive or negative.

References

Auerbach, D.I., & Kellermann, A.L. (2011). A decade of health care cost growth has wiped out real income gains for an average U.S. family. Health Affairs, 30(9), 1630-1636.

Emanuel, E., Tanden, N., Altman, S., Armstrong, S., Berwick, D., de Brantes, F., ... & Spiro, T. (2012). A systemic approach to containing health care spending. New England Journal of Medicine, 367(10), 949-954.

Haeder, S.F., & Weimer, D.L. (2013). You Can't Make Me Do It: State Implementation of Insurance Exchanges under the Affordable Care Act. Public Administration Review, 73(s1), S34-S47.

Howell, B., Williamson, S. & Wyatt, P.C. (n.d). Supreme Court Upholds PPACA. American Bar Health e-Source. Retrieved from: http://www.americanbar.org/newsletter/publications/aba_health_esource_home/aba_health_law_esource_0712_howell.html

Jacobs, L.R., & Skocpol, T. (2012). Health care reform and American politics: What everyone needs to know. Oxford University Press.

Johnson, P.A., & Fitzgerald, T. (2014). The Affordable Care Act and the Opportunity to Improve Prevention in Women: How to Make the Most of the Law. Clinical chemistry, 60(1), 138-140.

Koh, H.K., Berwick, D.M., Clancy, C.M., Baur, C., Brach, C., Harris, L.M., & Zerhusen, E.G. (2012). New federal policy initiatives to boost health literacy can help the nation move beyond the cycle of costly 'crisis care'. Health Affairs, 31(2), 434-443.

McDonough, J.E. (2012). The road ahead for the Affordable Care Act. New England Journal of Medicine, 367(3), 199-201.

Moonesar, I.A. (2013). U.S. Public Health Policy: A Current Briefing. Chartridge Books Oxford.

Rago, J. (2014, Feb). The Economist Who Exposed Obama-Care. The Wall Street Journal: Opinion. Retrieved from: http://online.wsj.com/news/articles/SB10001424052702304680904579367143880532248

Steber, M. (2013, Oct). Tax Law Changes in 2013 from the Affordable Care Act (ACA) That Affect Higher Income Earners. The Huffington Post. Retrieved from: http://www.huffingtonpost.com/mark-steber/tax-law-changes-in-2013-f_b_3873024.html

US GPO. (2010). The Patient Protection and Affordable Care… [END OF PREVIEW]

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