Ways to Improve the Affordable Care Act Essay

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Current Status of Health Care in the United States

Health care in the United States is in a state of legislative flux. The Affordable Care Act was passed in order to reduce the number of uninsured people in the country, as well as start to contain the runaway growth in health care costs through a number of measures that essential brought more of health care under stronger government influence. The ACA was mostly successful, both in terms of cost containment (Weiner,) and bringing down the number of uninsured Americans (Mangan, 2017).

However, there were some challenges with the ACA. The first is that the individual mandate was unpopular in some circles, as people were faced with a choice of paying a penalty if they did not purchase health care insurance, which was viewed as a forced expenditure. The individual mandate faced legal challenges and the ethics of this provision were debated (Gostin, 2010). Another issue with the ACA was the government-set structure of the plans, which created issues for insurers and in some markets there were few if any options for health care coverage at different points in time, as insurers simply did not see those markets as profitable within the scope of the plans (Mangan, 2017). A third issue might be identified in the structure of the ACA, which gives states considerable power over the implementation of the Act, so that its outcomes are different in different states. This led many Republican-run states to drop certain aspects, such as refusing to take money for Medicaid expansion (Healthcare.gov, 2017).

The current federal government is also determined seemingly to undermine the ACA, if not outright repeal it. This create the condition of uncertainty for insurers, patients and health care providers alike, which benefits pretty much nobody. Any health care reform would ideally be aimed at identifying issues with the current regime and addressing those with targeted action, rather than ill-conceived, politically-motivated repeal campaigns with no plausible substitute for the ACA.

Review of a Portion of the ACA

The section of the Act reviewed covers the definition of ACA-compliant plans. Within the ACA, there are health insurance plan exchanges. This structure basically creates a marketplace where insurance providers provide plans according to standardized templates. They then market these plans, competing on both price and service. The marketplaces are a means of fostering greater competition in the health care insurance market. This occurs because the plans are standardized, which makes them easier for the insurance companies to administer, but also easier for consumers to understand.

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The information asymmetry between consumers who need health care coverage, the insurance companies, and the health care providers themselves, has been identified as one of the critical issues driving health care costs higher – consumers are price-takers and that allows for them to be exploited. The creation of the exchanges seeks to remove some of that information asymmetry by having insurance companies compete with standardized plans.

The ACA lays out the types of plans and how they are structured. There are four categories of health care plans – bronze, silver, gold, and platinum. These plans are based on the deductible percentage – with a platinum plan you pay 10%, down to 60% for a bronze plan. The idea is that people want to have different structures depending on their health care needs. Within this, there are some high degrees of variance of course. Each local market will have its own exchange; these are set up by state and the degree of competition within each market will vary. Areas with higher populations and greater density of health care providers will likely see a more competitive exchange, for example. It is worth knowing that there are provisions within the ACA to help offset some of the cost of these plans, for people who qualify on the basis of income.

These plan categories are intended to offer a baseline level of coverage for people, and at the same time give people the option of what they want to pay. There are some issues with this structure, however. First of all, there is the individual mandate, which of course means that people have to pay for at least the bronze plan. Relatively healthy individuals are thus faced with buying at least a bronze plan, which can run into the hundreds of dollars per month. Prior to the ACA, there were some plans on offer in most markets that had lower levels of coverage than mandated by the ACA. Such non-compliant plans were essentially eliminated with the ACA in favor of more expensive plans, thus increasing the cost of health care coverage for some individuals. Further, healthy people who might otherwise not have had health care coverage at all are faced with payment for at least a bronze plan.

The other issue one notices with the structure of these plans is that they by no means offer….....

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