The Affordable Care Act -In the Rear View Mirrow

Affordable Care Act (Belle)
The Affordable Care Act (ACA) of 2010 has broad implications. However, the fundamental premise is that this expansive health care coverage is based on the assumption that some 43 million uninsured Americans will be covered with health insurance. In order to meet this lofty goal, the federal government created state health exchanges. As a result of creating these state health exchanges, the Feds are hoping to ensure that its goal is achieved. The underlining policy objective is that the state exchanges will somehow evolve into a sustainable insured health insurance market. The one way that this policy objective could possible be met is to create competition among health care insurers, resulting in a decrease in costs of health premiums and subsequent reduction in overall healthcare costs.

From a efficiency perspective, a central question is whether the exchanges will attract enough good risks to avoid an adverse [d]eath spiral? From a pure economic policy aspect, this question raises other question as to how much of financial incentives it will a take for major private sector players to buy into this government mandate? For example, In Massachusetts, Governor Dukakis developed a compressive health plan. Even with financial incentives, ultimately the health plan was legislated but never implemented, due to the same zero-sum corporate conflict( Martin, 2008, p. 296). Consequently, like Medicaid, ACA is a 1000-pound gorilla of health care bathing in a pool of bureaucratic inefficiency and rising costs.

Now, from a cost-effectiveness perspective, the costs of the ACA is enormous. The notion that market competition will drive prices down is a political contradiction due to the fact that “extensive regulation of the health insurance market needed to achieve the social values of managed competition, and the proposed subsidies for lower income patients, are inconsistent with the laissez faire political values”( Rosenblatt, 2008, p.140). ACA ‘s state exchanges model opposes redistributive subsidies and pro-consumer market regulation and favors unprecedented tax cuts and redistribution upwards towards wealthy healthcare companies. Consequently, there has been much political debate and state reluctance to participate.

As Kraft and Furlong (2013) asserted, ” reducing the deficit by cutting entitlement programs may raise the strongest ethical argument, especially since it relates to Social Security and Medicare” (p. 266). At what point does fairness and responsibility intercept? I contend that both fairness and responsibility intercepts at the point of freedom. Freedom of choice or perhaps freedom to pursue life, liberty and happiness! ” In 2006, the United States spent $2.1 trillion on health care, more than twice what the nation spent on food and more than China’s citizens consumed on all goods and services. Now, putting ACA in perspective, at a time when the nation has nearly $17 trillion in national debt and is running annual trillion-dollar budget deficits, largely attributed to existing entitlements, Obamacare creates two new entitlements projected to cost nearly $1.8 trillion over the next decade (Heritage Foundation, 2013). So the prevailing question is-do we as a nation have the courage to take the responsibility to ensure the health of citizens while ensuring the fiscal responsibility of our country? Perhaps the words of Benjamin Franklin provides a temporary degree of equanimity-“The secret to happiness is freedom. The secret to freedom is courage.”

Center for Medicare and Medicaid, Office of the Actuary (2013). Retrieved from on January 1, 2014.

Custer, W. S. (2013). Risk Adjustment and the Affordable Care Act. Journal Of Financial Service Professionals, 67(6), 25-26. Retrieved from EBSCO host database on January 1, 2014.

Kraft, M.E. & Furlong, S.R. (2013). Public Policy: Politics, Analysis, and Alternatives (4th ed.). Thousand Oaks, CA: Sage Publications.

Long, P., & Gruber, J. (2011). Projecting the impact of the affordable care act on california. Health Affairs, 30(1), 63-70. Retrieved from

Nanda, U., PhD., Malone, Eileen,R.N., M.S.N., & Joseph, A., PhD. (2013). The impact of the affordable care act on healthcare design. Contract, 54(8), 84-85. Retrieved from

Rosenblatt, R. (2008). Health politics and policy (4th ed.). Clifton Park, NY: Delmar Cengage Learning.


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