typically metropolitan statistical areas plus H e a l t h M e d i c a l

typically metropolitan statistical areas plus H e a l t h M e d i c a l

The Patient Protection and Affordable Care Act is a conglomeration of some of the pieces of past proposals for significant healthcare reform. The provision of health insurance coverage through private insurers instead of directly through the government, employer-mandated health insurance, the creation of state, regional or national clearinghouses for insurance, federal subsidies for low-income individuals, and guaranteed eligibility have all been proposed in previous attempts at reform. Partisan divisiveness, bitter congressional fights, grassroots campaigns, and political intrigue have been ubiquitous healthcare reform efforts. But the democratic process has worked. Legislation deemed not in the public interest has been defeated in Congress, and enacted legislation that proved to be unpopular or unworkable has been repealed. The surviving reform measures have improved and saved the lives of millions of Americans. (Taylor, 2015)

    The ACA has succeeded in sharply increasing insurance coverage. Since the ACA became law, the uninsured rate has declined by 43%, from 16.0% in 2010 to 9.1% in 2015, with most of that decline occurring after the law’s main coverage provisions took effect in 2014. The number of uninsured individuals in the United States has declined from 49 million in 2010 to 29 million in 2015. This is by far the largest decline in the uninsured rate since the creation of Medicare and Medicaid 5 decades ago. Recent analyses have concluded these gains are primarily because of the ACA, rather than other factors such as the ongoing economic recovery. Adjusting economic and demographic changes and other underlying trends, the Department of Health and Human Services estimated that 20 million more people had health insurance in early 2016 because of the law. (Obama, 2016).

    The ACA has touched on a wide variety of social institutions and societal relationships. Connections between states and the federal government, between governments and healthcare providers, between governments and individuals, and between individuals and firms were all altered by the ACA. Taken together, the elements of the ACA had the potential to spur significant societal changes beyond the extension of health insurance coverage. The law’s passage was followed by continuous challenges in Congress, the courts, and the states due in part to the law’s far-reaching nature. This spurred much political discourse and action. These challenges affected the ACA’s implementation and may have changed its impacts. Six years after the law passed, elections ushering in unified Republican control of government at the national level and Republican control of the government in many states potentially shifted the environment surrounding the law and its implementation. The most visible aspect of the ACA’s impact on insurance markets was establishing health insurance exchanges (also called Marketplaces) in which individuals could shop for individual or family policies. Importantly, these policies must be offered to anyone, with pricing variation permitted only based on geography (market rating area, typically metropolitan statistical areas plus the remainder of the state not included in an MSA), family composition, age (the ratio of premiums for the oldest to the youngest enrollees not to exceed three to one), and tobacco use. (Campbell & Shore-Sheppard, 2020)

    There are ten critical elements of the ACA that have been working. About 20 million Americans have gained health insurance coverage since the ACA was enacted. The ACA added many significant new protections for people with preexisting conditions. To date, 36 states and Washington, D.C., have expanded Medicaid under the ACA, with 12.7 million people covered through the expansion. The ACA’s signature health insurance marketplace portals for people purchasing coverage on their own launched in fall 2013 and made financial assistance for private coverage newly available. The ACA outlawed gender rating and prohibited insurers from discriminating against people with preexisting conditions. The latter is crucial for women: About 1 in 2 girls and nonelderly women have a preexisting condition. The ACA raised standards to ensure that children in low- and middle-income families can access health coverage. By expanding Medicaid eligibility and broadening the Medicaid Drug Rebate Program, the ACA gave more low-income Americans access to brand-name and generic drugs and lowered the costs for taxpayers. The ACA provides patients and the health care system with resources to combat the opioid crisis, which has hit rural areas particularly hard. The ACA also invested in other improvements for the Medicare program by establishing the Center for Medicare and Medicaid Innovation, responsible for developing ways to improve patient care and lower health care costs. Millions of Americans are disabled and rely on the ACA’s consumer protections and coverage. (Rapfogel & Gee, 2020)

    The ACA has not worked well for the working and middle class who receive much less support, particularly those who earn more than 400% of the federal poverty level, who constitute 40% of the population and don’t receive any help. As a result, exchange enrollment has been a disappointment, and the percentage of workers obtaining their health benefits from their employer has decreased steadily. Access to health care has been uneven, with those on Medicaid hampered by narrow networks, while those on the exchanges or getting employer benefits have faced high out-of-pocket costs. The second category relates to cost containment. The final goal was quality improvement. The effort to improve quality has led to dozens of new agencies, boards, commissions, and other government entities. In turn, practice management and regulatory compliance costs have increased. (Manchikanti, 2017).


Campbell, A., & Shore-Sheppard, L. (2020). The Social, Political, and Economic Effects of the Affordable Care Act: Introduction to the Issue. RSF: The Russell Sage Foundation Journal of the Social Sciences, 6(2), 1-40. doi:10.7758/rsf.2020.6.2.01

Manchikanti, L., Helm Ii, S., Benyamin, R. M., & Hirsch, J. A. (2017). A Critical Analysis of Obamacare: Affordable Care or Insurance for Many and Coverage for Few? Pain physician, 20(3), 111–138.

Obama, B. (2016). United States Health Care Reform: Progress to Date and Next Steps. JAMA, 316(5), 525–532. https://doi.org/10.1001/jama.2016.9797

Rapfogel, N., & Gee, E. (2020, October 6). 10 Ways the ACA Has Improved Health Care in the Past Decade. Center for American Progress. https://

Taylor, J. W. (2015, June 2). A Brief History on the Road to Healthcare Reform: From Truman to Obama. A brief history of healthcare reform in the U.S., through the years.Becker’s Hospital Review. https://

Respond to the bold paragraph ABOVE by using one of the option below… in APA format with At least two references and a minimum of 200 words….. .(The List of References should not be older than 2017 and should not be included in the word count.) Include at least one scholarly reference and appropriate in-text citations and Address all points on the DQ. One point will be deducted for not addressing each item mentioned above. Remember that presenting someone else’s work as your own is plagiarism. 

  • Ask a probing question.
  • Share an insight from having read your colleague’s posting.
  • Offer and support an opinion.
  • Validate an idea with your own experience.
  • Make a suggestion.
  • Expand on your colleague’s posting.

Be sure to support your postings and responses with specific references to the Learning Resources.

It is important that you cover all the topics identified in the assignment. Covering the topic does not mean mentioning the topic BUT presenting an explanation from the context of ethics and the readings for this class

To get maximum points you need to follow the requirements listed for this assignments 1) look at the word/page limits 2) review and follow APA rules 3) create subheadings to identify the key sections you are presenting and 4) Free from typographical and sentence construction errors.



American Psychological Association. Publication Manual of the American Psychological Association (7th Ed.). Washington, DC: Author.