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The Affordable Care Act: Is it Enough to Address Healthcare

Accessibility?

Aneesh Hehr
PS 1010: Dr. Buccellato
28 March 2016
Introduction
Disparities in healthcare have been an issue ever since the industrialization of America.1
Should it be a private good on the market or a public good that the government is responsible
for? With the implementation of the Affordable Care Act, it seems that the focus has shifted to
viewing healthcare as a public good. This change in how we approach healthcare makes sense
considering that it has been endorsed as a basic right in the Universal Declaration of Human
1 How did America end up with this health care system? post-gazette.com Pittsburgh PostGazette, April 27, 2014.

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Rights in the United Nations Charter.2 This means that the government is now liable for the equal
distribution of this resource, just like any other public good. How effective is the Affordable Care
Act when it comes to increasing accessibility amongst the general population? Accessibility to
healthcare is critical because it helps foster a preventative approach to medicine, which is needed
to improve both quality and quantity of life.3 While the Affordable Care Act has certainly
increased the number of individuals with health coverage, it has certain shortcomings. This first
section of this essay will identify specific policies outlined in the Affordable Care Act, agencies
responsible for the implementation of the policy, and how the approach to making healthcare
more accessible has changed over time in America. The second part will consist of a
comprehensive evaluation of the effectiveness and feasibility of the Act. Furthermore, specific
shortcomings will be outlined such as the financial burden on small businesses, the
unsustainability, and the failure to acknowledge the underlying causes of inaccessibility. The
focus of this essay will be at the federal level of government.
Description of the Policy
One of the main goals of the Affordable Care Act is to impose requirements on private insurance
companies to create a federal floor such that there is no discrimination based on salary.4 This is
executed through various forms of public policy which include redistribution, subsidization,
taxation, market incentives and regulation. The ACA redistributes through taxing individuals
based on income. Individuals who make more than $200,000 yearly have to pay a surtax of 3.8

2 Guy Faguet, The Affordable Care Act: A Missed Opportunity, a Better Way Forward (New
York: Algora Publishing, 2013), 92.
3 Preventive Health Care Helps Everyone, WRH, accessed March 13, 2016.
http://www.wrf.org/preventive-healthcare/preventive-healthcare.php
4 Annie Mach and Bernadette Fernandez, Private Health Insurance Market Reforms in the
Patient Protection and ACA. Congressional Research Service (2016): 2.

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% on investment income plus an additional 0.9 % on payroll tax.5 Through this, the expense of
healthcare for low-income individuals can be managed. Healthcare coverage is also encouraged
through financial incentives. For example, taxation is used as a way to penalize individuals who
do not have healthcare. Furthermore, the federal government has imposed regulatory laws
forcing insurance companies to cover individuals with pre-existing health conditions. 6 This had a
significant impact on increasing the number of people registered for coverage considering 129
million Americans have pre-existing health conditions.7 Insurance companies must also report
quality of care to ensure that they are not charging high premiums for substandard care. In fact
insurers must provide rebates to consumers if their spending on health benefits is too low.8 This
market incentive discourages individuals from opting out of health insurance as they are
compensated if their healthcare needs are not met.
The main agency responsible for implementing these policies is the Department of Health and
Human Services. The HHS is responsible for aspects of the Affordable Care Act that deal with
private and public health insurance.9 Moreover, they are responsible for preventing insurance
industry abuses, regulating the quality of care (through coverage gaps such as the donut hole)
and preserving public programs such as CHIP, the childrens insurance plan.10 The federal
5 David Cordell and Thomas Langdon, Financial Planning Under the Affordable Care Act,
Journal of Financial Planning Volume 25 Issue 9 (2012): 30.
6 Ibid
7 FACT SHEET: The Affordable Care Act: Healthy Communities Six Years Later,
whitehouse.gov, Office of the Press Secretary, March 2, 2016.
8 Ibid
9 Read the Law, HHS.gov Health Care, accessed March 10, 2016.
https://www.whitehouse.gov/the-press-office/2014/04/17/fact-sheet-affordable-care-act-numbers
10 Ibid

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government also provides market incentives to federal health centers. These centers are primarily
focused on providing healthcare in areas with fewer providers and low-income individuals. The
department provides grants to these centers to promote the provision of healthcare in areas with
low accessibility.11 The HHS is also responsible for facilitating the administration and operational
elements of the insurance market.12 This includes overseeing the regulation of coverage when it
comes to health benefits provided through employment. Through the ACA, federal regulation has
increased to make sure that insurance companies are not charging high premiums for
compromised healthcare and this requires the intervention of the HHS. There are also other
policies that are implemented through agencies at different levels (such as Medicare at the
federal level and Medicaid at both the state and federal level), however the focus of this essay is
the Affordable Care Act.
There was not always a lot of intervention from the federal government in matters of healthcare.
The first employer-based health insurance was rooted in the industrial past and was offered to
people working in mining, steel and railroads. However, the thought of compulsory health
insurance had immense disapproval from physicians and insurance companies.13 Healthcare was
not considered as a social policy until the depression, during Franklin D. Roosevelts term.
However, his desire to build compulsory healthcare into the social security act failed, reflecting
that the population did not want federal intervention. This was the case once again as in 1992
Bill Clinton tried to enroll Americans in a health policy and the plans did not pass through
11 Elayne Heisler, Federal Health Centers: An Overview, Congressional Research service
(2016): 2.
12 Annie Mach, Private Health Insurance Market Reforms in the Patient Protection and ACA
2.
13 Healthcare Crisis History, PBS, accessed March 10, 2016.
http://www.pbs.org/healthcarecrisis/history.htm

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congress. Following this, policies were implemented to increase access to medicine. This
included the donut hole which reduced cost of medicines for older Americans.14 Eventually the
Affordable Care Act was signed into law in 2010 as an attempt to increase accessibility and
affordability.
Evaluation of the Affordable Care Act
Looking purely at enrollments, the ACA has encouraged many more people to purchase health
insurance. In fact, the enrollment reached 20 million individuals as of March 3, 2016.15 This
number is significant considering the number of people who could not enroll for insurance prior
due to pre-existing health conditions. Furthermore, certain services are now offered at little to no
cost and are emphasizing preventative care. For example, individuals do not have to pay out of
their pocket for flu shots, yearly checkups, birth controls and cancer screenings.16 The Affordable
Care Act has also alleviated the burden on certain aspects of the healthcare system. For example,
wait times at hospitals have been an issue compromising the quality of care in an emergency
room.17 Due to this inefficiency, patients with life threatening emergencies have to wait long
periods of time before receiving treatment. In some cases this can result in complications or even
death. With more people adopting a preventative approach to healthcare, they are more likely to
seek medical attention before the condition turns into an emergency. As a result less people visit
the emergency room, decreasing wait times at the hospital.
While the Affordable Care Act has certainly increased accessibility to healthcare in some ways, it
has major shortcomings when it comes to efficiency. The actual cost of the policy is very hard to
14 Read the Law, HHS.gov Health Care.
15 Gardiner Harris, Obama Says Enrollment in Affordable Care Act Reaches 20 million, The
New York Times. March 3, 2016.
16 Ibid
17 Michael Robinson, ER rooms failing to meet wait time goals by a long shot, The Star,
January 28, 2016.

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determine. This comes from the fact that democrats and republicans are providing information at
opposite ends of the spectrum. Politicians against the act claim that it exceeds $2 trillion in
expenses and those in favor of the act claim this data is based on selective findings.18 Regardless
of what the cost is, there needs to be a clear understanding of its financial burden. Furthermore,
this lack of clarity makes it hard to determine the acts sustainability. Another aspect of the
Affordable Care Act that has been heavily scrutinized is its impact on small businesses. Due to
certain regulations in the policy, businesses have been forced to keep a smaller workforce. Any
employer with more than 50 employees must offer healthcare at an affordable rate. On paper this
seems like a good way to promote healthcare coverage through employment. Instead, businesses
are simply keeping a small task force or limiting the number of hours an employee can work.19
This leads to another aspect that is overlooked by the ACA, the shortage of physicians in
America. Increasing amounts of doctors are choosing to specialize rather than practise as
physicians.20 This problem hinders accessibility to healthcare because physicians are usually the
first point of contact when seeking medical attention. If there are fewer physicians, federal
centers will not be able to offer services in areas with less healthcare coverage. Another criticism
is that the federal control over the distribution of healthcare is not as strong as we believe. So far,
it has provided tax cuts and subsidies in order to decrease the financial burden on families.
However due to its financial unsustainability, the actual power belongs to private insurance
companies (as they provide many Medicare and Medicaid HMO plans).21 This is troublesome
18 Purva Rawal, The Affordable Care Act: Examining the Facts (Santa Barbara: ABC-CLIO,
2016), 40.
19 Ibid., 107
20 Katie Hafner, As Population Ages, Where are the Geriatricians? The New York Times,
January 25, 2016
21 Faguet, The Affordable Care Act: A Missed Opportunity, a Better Way Forward, 201.

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due to trend of insurance premiums over the last decade. From 2001 to 2014 the insurance
premiums have increased for both single payers and families (according to a figure from the
Congressional Budget Office). For single payers, the average rate has increased from $2500 to
$5000 and for families it has increased from $7500 to $15 000, despite the average income
remaining constant.22 However, not all sources agree that Obamacare is increasing debt at an
alarming rate. In some cases it is projected to reduce the federal deficit by $109 billion in the
following decade.23
Finally, it is impossible to analyze the shortcomings of the ACA without mentioning the
infamous website crash. According to HHS officials, the navigators on the website did not have a
proper direction and lacked a contingency plans in case HealthCare.gov failed.24 Anyone who
was skeptical of Obamacare was further deterred by this hindrance. In some ways, this
technological failure reduced accessibility to healthcare as Americans couldnt register right
away. Furthermore, this raises many questions about the security of the website. If we are
required to submit personal information, how trusting can we be of a website that is prone to
crashing?
Conclusion
Future articles would include a normative analysis of the Affordable Care Act and
possible solutions to the underlying problems highlighted in this article. This essay can serve as a
foundation to base future articles focused on improvements to the ACA. Overall, the Affordable
Care Act has certainly increased the number of people with healthcare coverage in the United
States and has enforced regulation to increase quality of care. However, specific shortcomings
22 Private Health Insurance Premiums and Federal Policy, Congressional Budget Office,
February 11, 2016.
23 Rawal, The Affordable Care Act: Examining the Facts, 34.
24 Oversight Report on Obamacare Navigator Program Reveals Mismanagement and Lax
Oversight, Congressional Documents and Publications, December 16, 2013.

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are decreasing the effectiveness of the policJy. If they are not addressed in a timely manner, any
future attempts to increase healthcare accessibility will be futile.

Bibliography
Cordell, David and Thomas Langdon, Financial Planning Under the Affordable Care Act.
Journal of Financial Planning Volume 25 Issue 9 (2012): 30-31.
FACT SHEET: The Affordable Care Act: Healthy Communities Six Years later,
whitehouse.gov Office of the Press Secretary, March 02, 2016.
Faguet, Guy. The Affordable Care Act: A Missed Opportunity, a Better Way Forward Algora
Publishing, 2013.
Hafner, Katie, As Population Ages, Where Are the Geriatricians? The New York Times,
January 25, 2016.
Harris, Gardiner, Obama Says Enrollment in Affordable Care Act Reaches 20 million. The
New York Times, March 3, 2016.
Healthcare Crisis History, PBS
http://www.pbs.org/healthcarecrisis/history.htm (accessed March 10, 2016).
Heisler, Elayne, Federal Health Centers: An Overview. Congressional Research Service
(2016): 1-29.

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How did America end up with this health care system? post-gazette.com Pittsburgh PostGazette, April 27, 2014.
Mach, Annie and Bernadette Fernandez, Private Health Insurance Market Reforms in the
Patient Protection and Affordable Care Act (ACA). Congressional Research Service
(2016): 1-19.
Oversight Report on Obamacare Navigator Program Reveals Mismanagement and Lax
Oversight Congressional Documents and Publications, December 16, 2013.
Preventive Health Care Helps Everyone, WRH
http://www.wrf.org/preventive-healthcare/preventive-healthcare.php (accessed March 13,
2016).
Private Health Insurance Premiums and Federal Policy, Congressional Budget Office,
February 11, 2016.
Rawal, Purva. The Affordable Care Act: Examining the Facts ABC-CLIO, 2016.
"Read the Law." HHS.gov. US Department of Health and Services, August 26, 2015.
Robinson, Michael, ER rooms failing to meet wait time goals by a long shot. The Star,
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