Académique Documents
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UWRT 1102-027
16 March 2017
Since the Affordable Care Act's implementation in 2010, it has been at the dead center of
nationwide controversy. While studies show that the Affordable Care Act, commonly referred to
as the ACA, is supported by over half of Americans, the majority of Republican politicians have
advocated for its repeal since the day of its debut (Dalen et al. 807). The ACAs primary goal is
to improve the health of Americans by increasing their access to health insurance (Dalen et al.
807). So far, the ACA has proved itself to be quite effective, as it has provided a net total of 16.9
million previously uninsured Americans with coverage as of 2015 (Health Insurance Grows).
There is no doubt that this is a substantial number, which makes the talk of a repeal increasingly
concerning, often proposing the question: if the ACA were repealed, how would this impact the
American public? Many of these newly insured Americans are vulnerable, as they are oftentimes
economically disadvantaged, burdened with chronic illnesses, or a part of a racial or ethnic group
(Steinbrook, et al.). A repeal of the Affordable Care Act would have a significantly negative
The Affordable Care Act is an act that was passed March of 2010 that successfully
extends affordable health coverage to millions of previously uninsured Americans, mainly due to
its provisions for state-based Medicaid expansion and subsidies to assist middle and lower
income individuals in purchasing private health insurance (Affordable Care Act History). An idea
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to overhaul the American health care system to implement a nationwide health system is hardly
new, it just was not successfully executed until former President Barack Obamas time in office
(Affordable Care Act History). The ACA includes a mandate, called the individual shared
responsibility payment, that requires Americans to obtain health coverage, or pay a penalty
(Eibner and Price). The mandate is perhaps one of the ACAs components most riddled in
controversy, as opponents argue that the mandate infringes on individual rights (Eibner and
Price). Proponents for the law claim that without the mandate, millions who would have
otherwise signed up for coverage would be uninsured (Eibner and Price). All arguments aside,
the evidence is clear. Without healthy individuals paying into the health care system, there will
not be enough funds to cover those who need frequent treatment (Eibner and Price). By requiring
that Americans acquire health insurance or pay a fine, it eliminates the facile route to forgo
coverage in the hopes that one will remain in optimal health (Eibner and Price). Ideally, with
healthy and ill Americans paying their premiums, there will be enough revenue to adequately
The state of Americas healthcare system prior to the ACA was plagued with problems,
with many private insurance companies having the freedom to deny those with pre-existing
conditions, and drop peoples coverage when they reached their lifetime limits (Basu).
Employer-based insurance is and has been the most widely utilized health coverage outlet in
America (Health Insurance). A noteworthy downfall to this popular system is that employer-
based health insurance can sometimes entail a lack of options, as many employers have only a
select amount of health care plans for their employees to choose from (Basu 5). The health care
options provided might not be suitable for every specific individuals health care needs (Basu 5).
Prior to the ACA, if an individual were to lose their job or choose to take time off, they would
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then need to find coverage through the individual market (Basu 5). If one were to develop a
medical condition after leaving their previous employer, they would be subject to higher
premiums or denial when applying for insurance due their pre-existing condition (Basu 5). This
system was problematic for many, especially those unemployed or with chronic illnesses (Basu
5). The inequalities that those groups faced when seeking coverage was one of the driving forces
in the institution of new health care reform. After the ACA was passed in Congress, it granted
protections for the public from harmful insurance practices, which was one of its fundamental
Medicaid expansion has had one of the most profound impacts on the vulnerable
populations access to affordable coverage (Hoadley and Searing). The Affordable Care Act does
not require, but instead encourages states to expand their Medicaid programs through generous
federal funding incentives to assist in the management of costs for the coverage of new
individuals (Brandon). Beginning in 2014, all individuals in families with a modified adjusted
gross income of 138% FPL or less who are under the age of 65 and not already covered, are
permitted to enroll in Medicaid (Brandon). This number is referring to states that have opted to
expand their Medicaid programs and accept the federal funding. Prior to the provisions in the
ACA, many low income groups found themselves ineligible due Medicaids specific restrictions
and variance across state lines (Brandon). States that have expanded their Medicaid programs
successfully (Hoadley and Searing). Medicaid recipients in these states no longer grapple with
daunting medical bills, in turn assisting the financial bottom line for safety-net clinics and
hospitals, as patients are more likely to pay for their care due to their improved financial status
(Hoadley and Searing). The money that hospitals would have traditionally had to use to cover
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uncompensated care can instead be invested in efforts to provide improved care and preventative
Since the ACA was in its infancy, there has been disagreement on all ends of the political
spectrum (Dalen, et al. 808). Health care policy is an highly complex partisan issue, and
oftentimes does not have a solution that will be mutually agreed upon by all parties involved
(Dalen et al. 808). When the Affordable Care Act was passed by Democratic majorities in the
House and Senate, 219 out of 253 Democratic party leaders voted yes, with all Republican party
leaders voting no (Dalen, et al. 808). Many opponents of the ACA argue that the individual
mandate is unconstitutional, the ACA has put insurance premiums on the rise, and that it is not
the sole responsibility of the federal government to ensure that Americans have access to
healthcare (Dalen, et al. 809). While there are many facets to the effects of the ACA that must be
considered, it is undeniable that the implementation of the ACA has had an overwhelmingly
positive impact on low-income in America (Dalen, et al. 808). More than 10 million individuals
gained health insurance in 2014 alone that would have otherwise remained uninsured due to the
Biased media influence plays a key role in the nations approval of the Affordable Care
Act. In a study referenced in the article titled, Why Do So Many Americans Oppose the
Affordable Care Act, it is found that after the ACA was fully implemented in 2014, its overall
approval ratings decreased by six percent from 2013, with fifty-five percent of Americans being
opposed to the individual mandate (Dalen et al. 808-809). It was also found that in 2014, only
forty-five percent of Americans believed that it was the responsibility of the government to
ensure its citizens had access to health coverage (Dalen et al. 808). With this information in
mind, it poses a pertinent question: If the ACA has had such success in providing affordable
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coverage to uninsured Americans as the evidence suggests, where is all this opposition stemming
from? It is likely that a portion of the opposition comes from heavy media influences (Dalen et
al. 809). The study also details that sixty percent of Americans reported that the information they
had about the ACA was delivered to them via the television (Dalen et al. 808). This is alarming,
as it is widely recognized that numerous media outlets have their own personal, political, and
financial agendas to push. In 2014, ninety-four percent of the $445 million spent on television
advertising for the ACA was used to display negative images and information (Dalen, et al. 809).
General disapproval in the ACA by the public due to misinformed media influences directly
decreases vulnerable Americans access to affordable health care due to the likelihood of elected
officials coming into power that will work to dismantle or repeal the ACA (Dalen et al. 810).
Without Americans being exposed to the legitimate effects of the ACA through reliable facts and
statistics, it is unlikely that America will achieve universal health care at any point in the near
Low income individuals make up a hefty portion of America, with approximately 15.2%
of Americans being below the poverty line in 2015 (Bureau). As of 2016, low income individuals
are usually recognized as having a pre-taxed income below $11,770 (Federal Poverty). For each
individual in one family, $4,160 is added to the previous amount (Federal Poverty). For example,
a single individual with one child that makes less than $15,930 is one-hundred percent of the
Federal Poverty Level, or below the poverty line (Federal Poverty). The Medicaid eligibility
standard is 138% of the Federal Poverty Level, so a single parent of one child can earn up to
$16,394 and still remain eligible for Medicaid in terms of annual income (Federal Poverty). For
the purposes of this discussion, low-income individuals will be further subdivided into the
The Affordable Care Act has played a significant role in assisting unemployed individuals
most widely utilized health coverage outlet in America (Health Insurance). When an individual
loses their job, they customarily lose their health insurance as well, leaving them unprotected in
the event of a medical emergency (Health Insurance). Prior to the ACA, they would be forced to
fork up the money to pay for private insurance off the individual market, usually having to pay
exorbitant premiums, particularly if said person has developed an pre-existing condition (Health
Insurance). However, since the implementation of the ACA, when an individual purchases
insurance from the individual market, occasionally referred to as the Health Insurance
Marketplace, insurance companies cannot deny an individual or install waiting periods (Eibner
and Saltzman). In addition to those protections, premium tax credits are now oftentimes offered
for those wishing to purchase private insurance (Eibner and Saltzman). Premium tax credits are
refundable tax credits that alleviate the high costs of insurance off the Health Insurance
Marketplace for eligible individuals and families with low to moderate income levels (Questions
and Answers). These tax credits have proved to be incredibly beneficial for those who do not
qualify to Medicaid, yet cannot afford unsubsidized premium rates and out of pocket costs that
come with private insurance (Questions and Answers). Along with the individual mandate, these
tax credits encourage unemployed or lower income individuals who would otherwise forgo
purchasing insurance to get covered (Eibner and Saltzman). With more people being a part of the
system, the market is stabilized, protecting subsidized enrollees from premium increases (Eibner
tax credits and abolish the mandate repeal, in turn causing considerable decreases in enrollment
rates and a steady incline of premium costs (Eibner and Saltzman). The analysis estimated that
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unsubsidized premiums would rise by 43.3 percent, with enrollment falling by 68 percent,
leading to 11.3 million Americans becoming uninsured (Eibner and Saltzman). In a circumstance
such as this, low-income and unemployed individuals will be priced out of the market (Eibner
and Saltzman), leading to a lack of necessary health care, higher uncompensated costs for
Low income women are a large group faced with a multitude of issues regarding the
deliverance of affordable care, particularly reproductive care. Since the Affordable Care Act has
been implemented, increased access to affordable reproductive care was made accessible for low
income women (Fox and Barfield). Unintended pregnancy rates are highly associated with low
income levels (Henshaw 27), and are oftentimes accompanied by delayed prenatal treatment and
fetal exposures to tobacco and alcohol (Fox and Barfield). These factors combine to result in
adverse health outcomes for both the mother and child, as well as poorer social and economic
outcomes overall. (Fox and Barfield). There are approximately 2.8 million unintended
pregnancies every year in the U.S., and while on the decline, more than 430,000 of these
pregnancies occur among adolescents from ages 15 to 19 (Fox and Barfield). The ACA has
worked to decrease unintended pregnancy rates by removing cost barriers for LARC, long-acting
reversible contraception, along with providing services to women such as education and
counseling at no cost (Fox and Barfield). The requirement of insurance companies to provide a
variety of preventative services without cost sharing by the ACA has proven to be effective, but
continues to face challenges due to problematic policies involving reimbursement for health care
providers and overall lack of awareness of the accessibility (Fox and Barfield). If the Affordable
Care Act were to be repealed, it would reverse the improvements that have been made by
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decreasing accessibility for those dependent on these LARC methods, in turn likely raising the
The homeless are another vulnerable, low-income population that would be heavily
impacted by a repeal, as 1.2 million Americans face homelessness each year (Fryling, et al.).
Homelessness is often defined as the absence of stable housing for more than two months,
examples include but are not limited to sleeping in a car, outside, or in a shelter (Fryling, et al.).
Medicaid expansion under the ACA was designed with vulnerable populations at the forefront,
striving to improve their accessibility to affordable health care (Fryling, et al.). Most homeless
Americans are eligible for Medicaid, however, this is not always made clear to them (Fryling, et
al.). A study was conducted in 2014, a 30-question survey that assessed access to
communication, awareness of the ACA, insurance status, and obstacles when attempting to
obtain coverage was given to 650 participants over a ten week period (Fryling, et al.). All adult
patients in treatment areas of the emergency department at San Francisco General Hospital on
weekdays between 9:00 a.m. and 5:00 p.m. were considered for enrollment, with 121 of the 650
participants being homeless (Fryling, et al.). Compared to the survey results of the non-homeless
population, homeless individuals report having less knowledge about the ACA, a weaker
understanding of the ACA and its enrollment process and qualification requirements, as well an
increased lack of internet access (Fryling, et al.). 70% of the homeless subjects were unaware
that they qualified for Medicaid, with 91% of these unsure subjects reported income levels below
138% of the federal poverty line, likely making them eligible (Fryling, et al.). However,
awareness measures have been taken to enroll homeless individuals, with service providers
playing a significant role by assisting these individuals with insurance applications and
strengthening connections to regular sources of health care (Winetrobe 147). The ACA has
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instilled changes in the healthcare system enable these populations to access vital health care
(Fryling, et al.). In addition to significantly poorer health outcomes and a lack of improvement in
life expectancy rates, a repeal would result in higher uncompensated ED costs due to the inability
With an estimated 15.2% of the population living below the poverty line in America
(Bureau), it is critical that these individuals be regarded when radical changes to the health care
system are proposed. There is no evidence to support the claim that a repeal of the Affordable
Care Act would benefit low-income populations in any respect. Even if not at first, a repeal
would eventually result in higher long-term costs for virtually all parties involved, as well as
resulting poorer health outcomes and life expectancy rates of vulnerable populations. As a
nation, Americans must work together to improve the welfare of all citizens.
Works Cited
affordablehealthca.com/history-affordable-care-act/.
Basu, Rituparna. The Broken State of American Health Insurance Prior to the
2015/BasuF2.pdf.
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Medicaid." Journal of Health Care for the Poor and Underserved, vol. 23 no. 4, 2012.
Bureau, US Census. Age and Sex of All People, Family Members and Unrelated
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doi:doi:10.1001/jama.2016.19913
Dalen, James E., et al. Why Do So Many Americans Oppose the Affordable Care Act?
The American Journal of Medicine, vol. 128, no. 8, 2015, pp. 807810. PubMed.gov, doi:
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www.rand.org/pubs/research_briefs/RB9646.html.
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Care Act: Impact on Individual Market Premiums and Insurance Coverage. Rand Health
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5158260/.
poverty-level/.
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PubMed.gov,
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Winetrobe, H., et al. Health Insurance Coverage and Healthcare Utilization among Homeless
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