Issues Paper

Issues Paper

The provision of affordable and high quality health care is an essential element for any government. It is imperative to have policies in place that facilitate the provision of affordable health insurance cover, which would in turn enhance access to health care. This paper analyzes the issue related to the Affordable Care Act (ACA) policy with considerations of local, state and national implications. The paper also analyzes how the healthcare policy impacts on economic, ethical, social, and political legal areas. Moreover, the paper identifies the stakeholders who will be impacted by the issue, the policy goals and objectives, as well as the policy options and alternatives.
1. Research and analyze a specific healthcare policy issue of choice with considerations of local, state, and national implications.
           The identified healthcare policy issue is that the ACA extends to the national government excessive control over the individual healthcare decisions and benefits resulting into to less freedom/autonomy for both individuals as well as companies. This is because Americans will be obliged to buy federally-designed health insurance cover, and businesses will be obliged to buy health insurance for their workers (Aboud, 2007). Healthcare is a massive and an expanding sector in the economy of the United States, and the portion of the total spending financed by the federal government is also expanding rapidly. In the next 10 years, roughly half of the entire healthcare expenditures will be due partly to the increasing healthcare programs. More federal government funding of healthcare, implies more government control, and this in turn connotes less individual freedom (World Health Organization, 2012). Healthcare entitlement initiatives or programs such as Medicaid and Medicare have expanded further than their initial estimates in both cost and enrollment, making the American people more reliant on the federal government for their healthcare like never before. Even within the private sector in the United States, the present tax treatment of health insurance perpetuates an old-fashioned model of coverage, which disheartens and discriminates against individuals buying and owning their own health coverage (Health Affairs, 2013).

Unfortunately, ratification of the Affordable Care Act (ACA)/Obamacare makes it much worse. This is because it essentially transforms the country’s healthcare system into a central, top-down national government system altering the relationship that exists between very many people and the sources of their care, hence creating more reliance on the national government for services and care delivery. For the very first time in the country’s history, it would requisite for all Americans to purchase federally-designed health care insurance, and clearly, this overall overextend by the federal government undermines the constitution (HealthCare Problems, 2012).

According the Kaiser Family Foundation (2012), the policy will affect states’ budgets in difference ways. First, state Medicaid expenditure on low-income individuals will increase mainly because of two reasons. The first reason is that the policy is expected to increase the enrollment among people who presently qualify but have not yet registered for Medicaid. Secondly, the policy requires Medicaid to cover every adult with income at/or below 133% of the federal poverty level (FPL).

  1. Research and analyze how the healthcare policy impacts social, economic, ethical, and political legal areas.

Social area –The policy has an impact on social areas in different ways. Families and individuals need to have more control of healthcare funds as well as decisions through both a market-based and a consumer-centered system. However, the policy limits this control and thus, some lawmakers are making some efforts to repeal this policy (Kaiser Health News, 2012).

Economic area – According to Public Agenda (2012), the policy aims at increasing health care coverage. However, this might actually raise the health care costs. This is primarily because a vast majority of people will receive preventative care and testing. Additional testing for instance, cholesterol tests and cancer screening will result in higher medical costs. Taxes would be increased on 1 million people who have yearly incomes of above $200,000 threshold, and on 4 million couples who file together with incomes above $250,000. They will be required to pay 2.35%, which is up from 1.45 percentage Medicare taxes on income exceeding the threshold (Public Agenda, 2012). Moreover, pharmaceutical corporations would pay an extra $84.8 billion in fees over the next 10 years, and this could increase the cost of drugs if they pass this additional cost onto the consumers. Manufacturers and importers of medical-device will be required to pay a 2.3% excise tax. This undoubtedly discourages such companies from employing new workers.

Moreover, between 4-6 million individuals stand to losing their company-sponsored healthcare plans. This is chiefly because many companies/businesses would find it much cheaper to pay the penalty and let their workers to buy their own insurance plans on the exchanges. In addition, other small companies could find that they might get a better health care plan through the state run exchanges (The Heritage Foundation, 2012).

 Ethical areas – There are several bioethical principles in nursing, some of them include autonomy, distributive justice, nonmaleficence and the Code of Nursing profession. The policy violates the autonomy or independence of the American people by obliging them to purchase health insurance cover or else a penalty would be imposed on them, or even a jail term. The individual mandate, a provision within the policy will force American citizens to purchase healthcare insurance that is approved by the government, whether they want it or not. A vast majority of young and healthy people who might rationally choose not to buy expensive government-sanctioned health insurance, would be forced to pay heavy fines or ultimately face jail time (Mason, Leavitt & Chaffee, 2012). Buying health insurance cover should be a personal decision and compelling people to do it is definitely unethical since that would be violating their autonomy. An innocent person may be thrown in prison simply for not purchasing the right health insurance and this clearly shows the Federal government’s violation of autonomy of its citizens. Distributive justice is a category of medical ethics inquiry that deals with how to distribute scarce medical resources over a broad population. The ACA policy makes distributive justice an official federal government role complete with the force of law. The bioethical principle of nonmaleficence asserts a requirement or obligation not to inflict harm intentionally (Hamric, Spross & Hanson, 2009). The policy upholds this bioethical principle through its various provisions.

Political and legal areas – The legislative action that has already happened is when the President signed the Affordable Care Act into law in 2010 with impacts at the national level, in order to strengthen and modernize health care (Kaiser Family Foundation, 2012). The legislation contains several provisions that have impacts on Americans in different ways, from employers to employees to ordinary citizens to insurance companies. The key provisions include the Individual Mandate and the Employer Mandate. The Individual Mandate demands that everyone should buy health insurance and a penalty for non-compliance is $695 per year per person or $2,085 per family. It also requires that insurers should provide health insurance coverage to individuals with pre-existing conditions. The impact is that the mandate infringes on civil liberties by obliging people to engage in commerce (HealthCare Problems, 2012).

The Employer Mandate provision of the legislation requires companies with at least 50 workers to offer insurance cover to their employees and if they do not, they pay a penalty of $2,000 per employee per year. Moreover, the employer also faces fines and increased taxes as a way of forcing the employer to obey the law (National Council for Community Behavioral Healthcare, 2012). The impact of this mandate is that it has created a barrier to job growth since it makes it more expensive for employers to hire more workers. With regard to the individual mandate, the Federal government says that it aims at increasing health insurance coverage to the American people and thus, increases access to health care. On the other hand, many American citizens hold the viewpoint that it is unconstitutional since it forces them to buy health insurance cover (Robert Wood Johnson Foundation, 2013).

Regarding the employer mandate, the government says that it aims to have every employee covered in order to improve their access to health care. On the other hand, employers have their complaints. In the United States, it is the small businesses that drive the economy. Business owners of small companies say that they cannot afford to pay insurance cover of their employees, and they if were forced to, their businesses might close down. With regard to the impact on legal arena, the Supreme Court ruled on the contentious individual mandate requiring Americans to obtain health insurance cover starting 2014, as constitutional. On the political arena, the court ruling favored democrats and the Obama administration in general since they had for a long time, tried to push the policy through Congress only to be frustrated by Republicans (U.S National Library of Medicine, 2012).

By requiring states to carry out federal policy, Obamacare or Affordable Care Act policy strikes at the core of American federalism. In addition, it is the first time whereby it is obligatory for American citizens, under the penalty of federal rule, to purchase a particular, government approved commercial product, that is, health insurance. Apparently, these federal overextends contravene the American constitution and undermines the country’s federalism. Given that most of the provisions in the policy do not go into effect until the year 2014, there is adequate time for the elect officials at all government levels not only to inform people on the policy’s harmful effects, and unlawful provisions, but also to put forth constitutionally suitable and consumer-centered reforms (The Heritage Foundation, 2012).

Issue statement: Providing universal high quality and affordable health care, and allowing competition and choice in the provision of health insurance coverage.
3. Identify stakeholders that the issue will affect
           The key stakeholders include the following: Federal government, employers, health insurance cover providers, the American citizens and health care providers. The Federal government is a stakeholder since it formulates and implements the policy that resulted to this issue, as it aims at increasing health insurance coverage to most Americans. Moreover, the government enforces punitive measures to those who fail to comply with the policy. Employers are also a major stakeholder and they range from small businesses to big companies. They are impacted since they must comply with the policy, which requires them to provide health insurance cover to their employees. Health insurance companies are also a stakeholder in this issue, since they provide health insurance coverage to company employees and the general population at large, and help to improve access to health care. Each and every American citizen is also a stakeholder in this issue. They are impacted by the issue in that it would be compulsory for them to purchase health insurance cover or face penalty/jail term. The final stakeholders are the healthcare providers, and include hospitals and other health facilities. They should brace themselves for an expected increase in customer numbers, since many who are currently low-income and uninsured, will most likely get health insurance cover and seek health care services when the new policy takes effect.

  1. Identify policy goals and objectives

The policy has several goals/objectives. The first objective is to expand health insurance coverage in order to reach as many uninsured people as possible. Most of the uninsured are typically low-income families and individuals who cannot afford the cost of health care insurance. The second objective is to hold insurance companies accountable by putting in place mechanisms that would prevent any discrimination or unprofessionalism among health insurance companies. Moreover, the mechanisms would also prevent health insurance companies from withdrawing coverage retroactively or denying coverage to individuals with pre-existing conditions. The third objective is to decrease health care costs and make healthcare more inexpensive and accessible particularly to the poor and low-income individuals and families. Fourth is to guarantee more choice for individuals and facilitate competition among health insurance companies. Facilitating and encouraging competition is essential in improving and enhancing health care quality universally. The last objective is to facilitate/ensure provision of high quality health care services. This is crucial since it would allow people to have access to the best possible care (Mason, Leavitt & Chaffee, 2012).

Generally, the policy is designed to lower the overall healthcare costs by making healthcare services available to everyone who presently cannot afford health insurance coverage particularly the poor and low-income individuals/families. These people most often use a health facility emergency room. For those who cannot afford coverage, the government would pay for them through several programs that would be established. Moreover, the policy aims at reducing the total number of uninsured individuals nationwide.
5. Consider policy options and alternatives

Senate: (2/13/2013) – Expanded & Improved Medicare for All Act (H.R.676) – This legislation establishes the Medicare for All Program in order to provide all Americans with the following: Free health care including primary care and prevention, dental services, mental health services, nutritional and dietary therapies, prescription drugs and long-term care (Congress, 2013).

Senate: (1/15/2013) – Public Option Deficit Reduction Act (H.R.261) – Amends ACA/Obamacare policy to necessitate the Secretary of Health and Human Services (HHS) to provide/offer a health benefits plan through Exchanges, which ensure competition, choice of affordable, high quality health insurance coverage all over the United States (C-SPAN, 2012).

With regard to evaluation of options, the following two evaluative criteria will be applied. First is relevance of the bill in relation to the issue, and secondly, the potential impact of the bill to the stakeholders. The first bill is Expanded & Improved Medicare for All Act (H.R.676) – This bill is relevant to the issue and its pros are: It seeks to provide free of charge healthcare services to people not only in the United States, but also those in the United States territories as well. Such services include primary care and prevention, long-term care, and nutritional and dietary therapies. The cons are: It is not clear on its actual implementation or execution. The second evaluative criteria is the potential negative impact of the bill to stakeholders. This bill does not have any unconstructive impact to its stakeholders. Rather, it is helpful to them since it establishes a Medicare that aims at providing free health services to the American people.

The other Bill currently being discussed is Public Option Deficit Reduction Act (H.R.261). In evaluating this Bill, it is relevant to the issue being discussed. This is primarily because of the following pros: It seeks to bring about competition, affordability and high-quality with regard to provision of health care insurance cover. Moreover, the bill will allow people to have a choice of the insurance cover they want. However, the con/limitation is that the bill still has some of the provisions of ACA, which have not been amended.

In comparing these two bills, the first one focuses primarily on providing free universal health care services, whilst the second Bill focuses on providing not only, affordable, but also high quality health care services for everyone in the United States. Moreover, unlike the first bill, the second bill has mechanisms that would allow/encourage competition with regard to health insurance coverage, and also would ensure consumers have a choice. Thus, it is the second bill that closely relates to the identified goals and objectives, and as such, it is the policy alternative.


Healthcare affordability is indispensable as far as enhancing health care is concerned especially with regard to the poor, vulnerable and low-income individuals in our societies. A vast majority of individuals are unable to access high quality health care just because their income cannot afford them to. Furthermore, they may find it expensive to purchase a comprehensive health insurance cover. As such, it is indispensable for a policy measure to be established that would help the vulnerable, low-income people to obtain affordable health insurance coverage from an insurance company of their choice, in order to improve or increase their access to healthcare. Objectives of such a policy should include such important things as expanding health insurance coverage, holding insurance companies accountable, guarantee more choice for people and encourage competition among health insurance providers, and ensure provision of high quality health care. As of now, Bill Public Option Deficit Reduction Act (H.R.261 is the most appropriate in dealing with this issue.




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