Healthcare is undeniably one of the most fundamental necessities indispensable to the maintenance of a person’s healthy physical state. While excellent healthcare services are available in the United States, its access is surprisingly impenetrable for the majority of the population. Besides its continued soaring costs, the distribution of healthcare services is mainly executed through health insurance coverage. According to a study commissioned by the consumer health advocacy group Families USA, one out of three Americans less than 65 years old was uninsured at some point during 2007 and 2008. That amounts to about 86.7 million Americans. Consequently, on March 23, 2010, the Patient Protection and Affordable Care Act (Public Law 111 – 148) was enacted as America’s new healthcare reform law. The purpose of this investigation is to analyze the importance of the Affordable Care Act’s New Rules on preventive care.
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Universal health coverage considerations started in 1933 during the great depression with President Theodore Roosevelt. After World War II, President Harry Truman had also tried and so does President Lyndon Johnson. In 1974, President Richard Nixon health care reform was rejected as well. President Jimmy Carter’s health reform efforts were disenchanted. In 1993, the Clintons’ health care bill was not enacted. President George Bush did not even make an attempt. In 2007, Representative John Conyers Jr. introduced to Congress the United States national Health Care Act bill and Senator Ron Wyden introduced the Healthy American Act (S. 334) in the Senate; all to no avail. For all these times, the health care system was still inaccessible. However, while campaigning for the presidency, Barack Obama made health care his first priority.
Socio-cultural environment
It is known that African Americans and Hispanics make up the two largest ethnic groups in the United States. The American Public Health Association (APHA) to state: “Communities across the country are struggling with widespread disparities in all aspects of health care. This is a problem that is generating more and more attention, not only in the field of public health, but also in the health-care delivery system.” The American Cancer Society to emit: “In analyses by race and ethnicity, African-American men and women have 40% and 20% higher death rates from all cancers combined compared with White men and women, respectively.” Ethnic minorities such as Native Americans and Asian Americans are also victims of the health delivery inequalities in this country. All of these issues indicated the need for a reformation of the health care system.
When it comes to ethical issues influencing the Patient Protection and Affordable Care Act, a large amount of researches reveals disproportion in the health care delivery system. Kaiser Commission on Medicaid and the uninsured documented that “these inequalities are caused by income disparities that result in lack of health insurance and other barriers to receiving services.” And according to the Drug benefit Trends, uninsured Americans are less likely to receive preventive services in health care. In the Journal of American Medical Association (JAMA), the Council on Ethical and Judicial Affairs reports ” Recent studies have suggested that even when blacks gain access to the health care system, they are less likely than whites to receive certain surgical or other therapies.” The concept of medical underwriting is also a weighted ethical issue. In most states in the U.S., millions of consumers have been denied health insurance purchases due pre-existing conditions, which labels them as “uninsurable” (Harrington & Estes 2008).
“When health insurance developed in the United States in the 1930s, it covered hospital and later major medical bills, not preventive services. Insurance also had nothing to do with public health. And when Medicare was enacted in 1965, it too made no provision for preventive and public-health services” (Star 2010). And because of lack of preventive care, “chronic diseases, such as heart disease, cancer, and diabetes, are responsible for 7 of 10 deaths among Americans each year and account for 75 percent of the nation’s health spending” (healthyamericans.org reported). It is surprising to see how health care costs escalated for the past 10 years. In 2005, two trillions of dollars were spent on health care in the United States and it is expected to double five years from now (Harrington & Estes 2008). The reason behind this over-inflation in health care costs is the non-regulation of this industry. Based on these issues, it is clear that the health care system needed a fix.
Political environment
The health care reform debate in the United States has been a political issue for many years. It focused on increasing coverage, decreasing the cost and social burden of healthcare, insurance reform, and the philosophy of its provision, funding, and government involvement (Harrington & Estes 2008). In addition, lobbyists and several interest groups (doctors associations, drug and insurance companies) totally impede the establishment of a universal healthcare program in this country. President Clinton and his wife came close to fix the broken healthcare system but were denied the opportunity. In 2007 presidential candidate Hilary Clinton, during the primary election, campaigned on universal healthcare, but lost the primary election. At the same time, Barack Obama made health care reform one of his first priorities. As he got elected, he had to keep his promise by extending health care services to millions of Americans.
History of the Law
According to the Library of Congress-Thomas, on September 17, 2009, Representative Charles Rangel introduced in the House the “Service Members Home Ownership Tax Act of 2009” (H.R. 3590), which encompasses affordable health care for all Americans. The bill received consideration by the Ways and Means’ committee and passed the House in October 2009. Later, in December 2009, it passed the Senate as the “Patient Protection and Affordable Care Act” with a major amendment: “Health Care Education and reconciliation act of 2010.” On March 21, 2010 the House agreed to the Senate amendment. And on March 23, 2010 the bill was signed into law by President Barack Obama. The law gives birth to an interesting policy: “The Affordable Care Act’s New Rules on Preventive Care.”
Supporting Stakeholders
It is evident that the “Patient Protection and Affordable Care Act (Public Law 111 – 148)” has countless supporting stakeholders. The Obama’s administration is actually the most obvious one as the president campaigned on health care reform, and made it the first priority in his agenda. Before signing it into law, he worked hard to propel the Bill forward by holding conferences with all congressional members together in order to convince them to vote for the bill. He even took executive orders to reassure a few democrats in the House that public funding for abortion was not part of the bill. He also held town hall meetings all over the country concerning the importance of this bill.
The majority of the democrats in congress were devoted toward the passage of this bill. The House had to adopt the Senate version of the Bill for the sake of compromise. While in recess, each democratic Congressman held a series of town hall meetings in their districts to earn the trust of the voters concerning this bill.
The most obvious supporting stakeholders were the beneficiaries of this healthcare reform: the uninsured, the working class who purchases health care plans through their employers, the Medicare and Medicaid recipients. Countless citizens wrote letters to their district Congressmen and demanded that s/he vote in favor of the health care reform bill. In addition, more than 350 organizations, representing millions of Americans, have indicated their support for the health care reform legislation.
Opposing Stakeholders
As far opposing stakeholders of the new health care law, several instances can be counted. One apparent opponent is the Republican Party. Even though the republican congressmen had their own propositions inserted in the heath care legislation, none of them voted in its favor. They voiced their discontent for the passing of the bill and vowed to repeal it whenever possible. Another violent opposing stakeholder of the bill is the Tea Party movement. During the summer recess, the Tea Party movement organized protests and many conservative groups and individuals targeted democratic town hall meetings to voice their opposition to the proposed reform bills. They went so far as to threaten the lives of several democratic congressmen who voted for the bill.
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The insurance companies also lined up in the ranks of the opposing stakeholders. Before the passage of the health care legislation, they lobbied Congress extensively to dispose of the bill; however, the majority of the democrats in Congress saw this reform as a lifetime opportunity and would not get deviated from their way, except a few. As a result, those companies start protesting by increasing premiums, copayments, and deductibles. Some of them now cease to offer health plans for children altogether.
The drug companies, employers, and several U.S. states are also identified as ardent opposing stakeholders of the health care reform. Several states, like Florida, filed law suits to prevent the application of the new health care reform in those states. They believe the cost of Medicaid will be too enormous for the states to carry.
Evaluation
The “Patient Protection and Affordable Care Act” appears to be one-of-the-kind legislation. This law is advantageous for all consumers in general, whether it is Medicare recipients, Medicaid recipients, CHIP recipients, employees, and uninsured. There is now enhancement in every aspect of healthcare delivery. Provisions include prohibiting denial of coverage based on pre-existing medical conditions, expanding Medicaid eligibility, subsidizing insurance premiums, providing incentives for businesses to provide health care benefits, establishing health insurance exchanges, and support for medical research.
This legislation will extend health services to millions of Americans and allow seniors to pay for their prescriptions with ease while children can remain on their parents’ health plans until the age of 26. Many more interesting features are seen in the provisions for preventive care: preventable chronic diseases such as heart disease, cancer, and diabetes that are responsible for numerous deaths every year will now receive attention before attaining a dangerous stage. Immunizations and screenings will be provided at no extra-cost to the patients. This means that consumers will be receiving the services paid for and health care will be affordable. Providers will have less treating and more preventing to do, meaning that rushing patients to surgery unnecessarily for the sole purpose of provider’s profit maximization will be involuntarily terminated. Team medicine will be considerably bridge one provider to the next and that will create both quality care and for patient satisfaction.
This policy issue will greatly impact advanced practice nursing as more primary care providers will be needed to provide preventive services and home visits. More nurse practitioners will be hired for those preventive care clinics. At this time, several retail stores such as Wal-Mart, Walgreens and Target are establishing “open clinics” for screening services as well seasonal flu vaccination; each one employs nurse practitioners to provide those services so necessary for local communities. In addition, rehabilitation centers, nursing homes and assisted livings will save more money to staff nurse practitioners instead of calling doctors for every little thing.
Recommendations for Improvement of the Policy
The “Patient Protection and Affordable Care Act,” although appears to be the dream of consumers, will need some improvement for progression of its outcome. An essential recommendation for improvement is that the public option needs to be reintroduced and put in application as soon as possible in order to force the insurance companies to lower their premiums and comply with the policies created by the Department of Health and Human Services about this new law. If this cannot be effectuated, the Department of Health and Human Services needs to place caps on premiums based on age, income level, life style practices (smoking, heavy drinking, and drug abuse), and adherence to preventive services. In addition, an amendment to this current health care reform should require all the provisions to take effect at the same time immediately in order to prevent distractions or deviations from the norms.
Another recommendation is the elimination of buying insurance plans through employers. The reason for this is that employers do not really make health plans cheaper for employees; in fact, they don’t seem to contribute anything at all in the cost of each employee health plan. The Department of Health and Human Services should introduce a provision in this health reform to allow nurse practitioners to practice independently in order for the retail store’s open clinics to provide a full scale of preventive services. That would also permit the provision of adequate primary care services in rural areas.
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