Description
In this paper, describe how you propose to change or replace the health policy from Paper 1 (below) with a better alternative.
Please see the attached guidance on how to meet (and, hopefully, exceed!) competency on the various parts of this paper.
This paper should be 5-6 pages (double spaced, 12-point font, including reference page with appropriate citations in APA format). Use at least 5 citations from reputable sources.
The policy proposal should have the following sections:
Top of the page:
Address your policy proposal to someone who has an opportunity to make the change–perhaps a federal, state, or local legislator,
Use the following format:
To: Name of the person, Title of the person
Office Held: Name of the office they hold.
Issue: brief phrase describing the policy issue of your policy proposal
Brief Problem Statement (2 paragraphs).
- What needs to be changed and why?
- What is your evidence (from professional experience and in the research literature) that supports your argument that this is a problem?
Proposed Policy Solution.
- State clearly the policy change(s) you are advocating for.
- Why is/are these change(s) needed?
- What long-term goal will this policy achieve?
- Here is where you discuss the evidence to support your policy change, including how/if the proposal satisfies the four general problems discussed by Darnell and Lawlor (2012): access, costs, quality, and accountability.
- What strategy will work to get this proposal passed?
- Who, what, when and where will you have to focus on to get this proposal passed?
- What are at least 2 logistical, financial, political and/or other obstacles that stand in the way of this policy being approved?
Implementation Strategy and Challenges.
The following criteria are used in grading the assignment:
1. Is the writing style academic, professional, and technical?
2. Is the information presented comprehensive and well-ordered?
3. Are underlying assumptions clearly stated and justified with research?
4. Are major points clearly thought-out and adequately emphasized?
5. Are alternative explanations considered and understood?
6. Are conclusions supported by appropriate and sufficient evidence?
7. Does the work meet the criteria specified by the guidelines for the assignment?
8. Does the work reflect cultural sensitivity and adherence to the ethical standards of the profession?
9. Is the work well-written and free from spelling, punctuation, and grammatical errors?
10. Is APA format used, including non-sexist language and appropriately cited references?
The following is paper 1
Medical care in the United States is a privilege, not a right. As a result, many people were historically left with either no health insurance or inadequate health care. These people might present to emergency departments when their condition is already acute and significantly harder and costlier to treat. While there have been many efforts to address the health of the American people, the Affordable Care Act (ACA) made an important attempt to bring about change by addressing the lack of insured people.
Prior to the implementation of the ACA, many low-income people were unable to afford health insurance. And this resulted in countless preventable deaths. In fact, at least 45,000 annual deaths could have been avoided with better access (Griffith et al., 2017). Moreover, the healthcare crisis was exacerbated with the Great Recession of 2007. The GDP contracted more than 4% and brought about the worst economic crisis since the Great Depression of the 1930s (Courtemanche et al., 2018). According to the U.S. Department of Labor, by February of 2010, employment had declined by 8.8 million compared to before the Great Recession (Goodman & Mance, 2011). With many people out of work and out of an income, with some having lost their work-related health insurance, the issue of accessible healthcare became painfully obvious to many Americans. This presented a significant challenge when Obama took office, and it was clear that a lot had to change to help the most disadvantaged people, those from low socioeconomic backgrounds.
Having said that, people who lived under the federal poverty line or hovered right above it were not the only ones who were at a disadvantage prior to the ACA. Higher-income people with pre-existing conditions also struggled to afford health care. That is because insurance companies could charge higher premiums for pre-existing conditions until the ACA made this practice illegal. Moreover, the ACA prohibits insurance companies from outright declining people with pre-existing conditions (HHS, 2017). These protections are crucial because around the time the ACA was proposed, at least 50 million non-elderly Americans had a pre-existing condition and 20% of them were uninsured (CMS, n.d.). By adding new insurance regulations, the ACA intended to insure as many people as possible, including those with pre-existing conditions. Health insurance companies could no longer raise prices for patients with a pre-existing condition and treat those conditions as auto insurances do a bad driving record.
Furthermore, along with the increase of poverty caused by the Great Recession came fear about losing healthcare benefits. And people realized that the healthcare system has left them vulnerable and uninsured. Healthcare was intensely debated during Obama’s first presidential run, and Obama vowed to make sweeping changes. He outlined the principles that set out to make healthcare cost-efficient for both consumers and government, ultimately delivering change in the form of the ACA.
The ACA “represents the most significant transformation in the American health care system since Medicare and Medicaid” (Manchikanti et al., 2011, p. E35). And getting proposals of this magnitude to become law can be an uphill battle. Congress held a plethora of hearings to discuss health reform policy (Majette, 2011), yet passing the ACA was especially challenging. It didn’t help that not one Republican from the House (U.S. House, 2010) or Senate (U.S. Senate, 2009) voted in favor of it. Considering this fact, turning the ACA into reality was no easy feat and should not be taken for granted. Passing the ACA took time, resilience, and repeated compromise.
Andrulis et al. (2010) describe the legislative movement that eventually produced what we call the ACA. Andrulis et al. state that in November of 2009, the House of Representatives passed a bill entitled The Affordable Health Choices Act of 2009 (H.R. 3962), and in December of that year the Senate passed its own health care proposal, entitled The Patient Protection and Affordable Care Act (PPACA; H.R. 3590). Andrulis et al. point out that the Constitution requires any bill that is related to revenue to originate from the House, which explains why the Senate’s proposal is titled H.R. 3590 (with H.R. denoting House origination). In other words, although the Senate’s PPACA contained their own health care proposal, the bill technically originated from the House due the aforementioned revenue law. The ACA is considered a revenue policy because it has many tax provisions.
The goals of the ACA were to expand coverage, control costs, and improve quality of care (Gorin et al., 2015) in a coordinated effort that includes different medical practices, care coordination, and improvised funding streams. The ACA increases coverage by expanding the Medicaid program, creating a new marketplace with subsidies, and mandating that large employers provide health insurance. Furthermore, the ACA controls cost by restructuring the payment system to one that puts emphasis on quality over quantity.
An additional goal of the ACA was to reduce health disparities among different groups. An action plan to reduce health disparities included inter-agency collaborations to monitor health disparity efforts. These agencies include SAMHSA, CMS, IHS, HRSA, and AHRQ (Majette, 2012). One provision is called the Title IV Prevention of Chronic Disease and Improving Public Health, and this aims to bring attention to ways of building healthier communities, increasing preventative services, and supporting public innovation (Majette, 2011). By allowing different agencies to contribute to the future development of health care in a collaborative manner, the ACA intended for innovation to continue to evolve according to the needs of people in the U.S.
While the House and Senate would typically work together to make changes and try to pass a bill, Andrulis et al. note that after the death of democratic senator Edward Kennedy (D-MA), a person who held a crucial vote, a compromise between the House and Senate appeared slim. That is why, on March 21, 2010, the House chose to approve the Senate’s version of the healthcare reform (the Patient Protection and Affordable Care Act). Two days later, on March 23, 2010, former President Obama signed the historic policy into law. The PPACA alongside the Health Care and Education Reconciliation Act of 2010 (HCERA; H.R. 4872) created the entirety of what people refer to today as the ACA (Cannan, 2013).
The actual implementation of the ACA did not come without its glitches, most symbolically when on day one healthcare.gov, the site that is used to shop and sign up for health insurance, crashed. It was attributed to the overwhelming demand and bad coding. The eventual rollout of the ACA happened over a period and was fully implemented in January of 2014. The changes for the ACA were immediate and any health plan enrollment that happened after the law became public had to meet new standards (Price, 2014).
Not long after its implementation, the results began to come in. By 2016, the average cost of treatment in both private and public facilities had decreased significantly compared to 2008 (Gaffney & McCormick, 2017). Furthermore, more than 20 million people became insured thanks to the ACA (Cohen et al., 2019). Additionally, the ACA reduced coverage disparities across racial groups by 23% (Courtemanche et al., 2019). New sets of data continue to pile up and the real, long-term impact of the ACA might take decades to find out.
While the ACA became a reality and affected countless lives, it has faced many legal challenges even while Obama was still in office (O’Keefe, 2014). Having said that, the ACA has not significantly changed since its implementation. There are two major exceptions. The first came with the passing of the Tax Cuts and Jobs Act in 2017, which got rid of the individual mandate, though technically it simply reduced the penalty of not having health insurance to $0.00. The change was driven by the efforts of former President Trump, who promised in his presidential campaign that he would approve a bill to “repeal and replace disastrous Obamacare” (ABC News, n.d).
Prior to the removal of the individual mandate, some people had faced penalties of over $2,000 for not having health insurance. People of extremely poor socioeconomic status had a difficult decision to make. Should they pay the penalty of not having insurance or should they purchase a plan that they can barely afford? And now, with the mandate removed, they must weigh the risk of being uninsured and saving costs in the short-term versus increased immediate poverty for gains that come with access to healthcare. When people need every cent to support their family, deciding whether to pay for something they do not immediately need can be a difficult decision. Another major challenge was a 2012 Supreme Court decision, National Federation of Independent Business v. Sebelius, that ruled that states do not have to expand their Medicaid program. This ruling had a major impact on accessibility of healthcare. In fact, people living in states that did not expand Medicaid were twice as likely as those living in states that did expand Medicaid to be uninsured (Cohen et al., 2019). Both the individual mandate removal and lack of Medicaid expansion will likely continue to affect the number of insured people. It is worth mentioning that CMS, in 2018, released new policy guidance that allows states to require able-bodied adults to engage in “skills training, education, job search, volunteering or caregiving” as a condition of Medicaid (CMS, 2018). This is a demonstration program and is not present in all states. Adding this condition to Medicaid has the potential of discouraging people from applying and remaining in compliance (or insured).
Today the ACA continues to survive almost in its original form. While the ACA has overcome many legal challenges, the arrival of COVID-19 brought its own set of trouble that the policy could not anticipate. Many people have lost jobs due to the pandemic, and as a result lost their job-tied health insurance. And President Biden has therefore opened the marketplace for a special enrollment period, which is normally open only at certain months, to accommodate those people. However, even those who remained insured, accessing appointments became harder than ever.
Having said that, in some respects healthcare is now more accessible because insurance companies have adapted to the demands of the pandemic by increasingly embracing telehealth services. This was helped when CMS announced that they are easing restrictions on what appointments can be done remotely (CMS, 2020). At the same time, many people that have transportation issues due to poverty might also have a lack of internet access. And improving broadband accessibility could be key to improving healthcare access in a COVID and post-COVID world. The future of healthcare continues to be on the mind of people in the U.S., and although President Biden plans to continue to support the ACA (Biden, 2019), healthcare is likely to evolve in the coming years.
