Healthcare Reform in the United States
Table of Contents
Introduction
The Obama Administration initiated many reforms in the healthcare sector since its ascendancy to power eight years ago. One such change was the enactment of the Affordable Care Act, which has impacted approximately 30 million citizens, who are now able to access health insurance (Anderson, 2014). Many of the reforms have targeted increasing healthcare access for the US citizens. Owing to the changes that the development has brought, it is not surprising that the number of beneficiaries of healthcare is increasing, although the pressure is mounting for the health sector as it explores ways of undertaking the changes. Moreover, the prospect of guaranteeing accessible healthcare is under threat because of workforce challenges.
Some figures support additional reforms in the sector. For instance, in their study, Axelrod, Millman, and Abecassis (2010) indicate that in 2007, approximately 62% of personal bankruptcies were associated with medical expenditure. Even though 78% of those individuals had insurance covers, gaps in the coverage contributed to their insolvency. In addition, before the enactment of the ACA, insurance premiums were increasing at an unsustainable rate. Anderson (2014) observed that, given that nearly fifty percent of US citizens use prescription drugs, and private companies selling subscription drugs make billions of profits, the sector is in need of far-reaching reforms, such as the changing of the rules on coverage to expand accessibility.
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Literature Review
Many authors have reviewed the impact of Obama reforms on healthcare. Anderson (2014) observes that many effects are associable to the reforms instigated by the Obama administration. For instance, focusing on the Affordable Care Act (ACA), Anderson (2014) indicates that the development negatively impacts the already overwhelmed industry in terms of manpower. The author contends that the President’s aspiration to ensure universal healthcare access was in jeopardy because of healthcare workforce shortages. Hence, the governmental control over the sector and the disappointment of the US citizens are likely to persist.
Despite expectations, the increased workload might be counterproductive to the sector. According to Anderson (2014), healthcare professionals are encountering increased stress and instability, which contributes to the rise in burnout and dissatisfaction among employees in the industry. In addition, the author observed that the ACA’s new guidelines imposed 190 million more hours pertaining to paperwork per year. Such changes negatively impact the financial and administration issues, such as the time it takes to deal with patients, besides bringing the government into the provider-patient association. In addition, even though the reforms seem to be helpful, since they reduce costs, they are also viewed as punitive based on their imposition of penalties that might push health providers closer to insolvency. Such an eventuality poses a risk to the problem that was intended to be solved.
The statistics continue to be discouraging. According to Obamacarefacts (2012), healthcare statistics paint a grim picture of the United States healthcare sector. The author acknowledges that reforms serve as the entry point towards fixing the industry. Obamacare is effective, although not enough to fix the challenges that the country currently faces. Supporting the need for additional reforms Obamacarefacts (2012) indicates that long before the ACA was adopted, the number of uninsured people had been rising; besides, the number of individuals incurring personal debt and impoverishment resulting from medical costs increases, healthcare costs are skyrocketing, for-profit healthcare organizations expand, and the national deficit and debt grow. In essence, the US healthcare sector has been getting out of control for a long time.
Arguing in favor of healthcare reforms, the White House (2014a) observes that market failure and inefficiencies undermine the delivery of accessible care to the citizens of the United States. The White House (2014a) indicates that although the system espoused positive virtues, it was plagued by notable deficiencies and market failure. In particular, the variations in Medicare spending, despite the absence of differences in medical needs and/ or outcomes, point to a certain form of manipulation or deception. The implication is that roughly 30% of the costs incurred in the sector can be saved. Among the main sources of inefficiency is the payment system that rewards inputs as opposed to outcomes. In addition, administrative costs are high, and the focus on the prevention of diseases is limited. Furthermore, market imperfections are common as incentives for inefficient coverage are left to thrive. In particular, asymmetric information influences the selection of insurance, which leaves healthy people unable to receive reasonable rates.
The change under discussion has both advantages and disadvantages. According to Obamacarefacts (n.d.), there exist both pros and cons of the changes initiated by the President. Based on the above piece, the benefits and shortcomings of the reforms affect various stakeholders in different ways. For example, for low and middle income earners, the benefits are immense. However, high earners do not receive significant gains from the reforms. Given the disproportionate nature of the population (low and middle income earners constitute a larger part of population), it is evident that an average US citizen has little to lose. Although bigger earners are likely to suffer, the provisions that guarantee coverage and the elimination of sex discrimination are major changes that take place in the US healthcare industry.
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According to Medical Mutual (n.d.), the implementation of the ACA has implications for almost all US citizens. The reforms introduce individual mandate, preventive care, low income subsidies, extended dependent coverage, pre-existing conditions, and appeals. For example, the reforms make it illegal for insurers to deny individuals healthcare covers because of pre-existing conditions. On the other hand, low income subsidies allow persons who are not eligible for covers through state programs to receive federal subsidies based on one’s level of income in order to buy private insurance. Consequently, it is clear that the reforms are contributing to the expansion of health insurance coverage and to the easing of the burden of the poor.
According to the American Public Health Association (2014), the ACA has brought unprecedented reforms into the US healthcare industry by impacting the activities of both public and private entities. The American Public Health Association justifies the reforms based on a number of considerations. For instance, according to the APHA (2014), the reforms will help to deal with such issues as the increasing number of the uninsured, ballooning health expenditures, poor emphasis on prevention, poor health outcomes, and widening health disparities. The American Public Health Association observes that although the ACA does not solve the problems right away, it does create the platform for change. The organization contends that the reforms improve healthcare coverage by enhancing affordability and accessibility. In addition, the American Public Health Association observes that the law can reduce discrepancies and improve preventive care, health outcomes, and the overall health in the country.
The American Nurses Association has advocated for reforms in the healthcare system that would guarantee accessibility and quality for many years. Following the enactment of the Patient Protection and Affordable Care Act (PPACA), many US citizens became able to access healthcare services through increased insurance and improved preventive care. The American Nurses Association (n.d.) lauded the decision by the Supreme Court that upheld the ACA allowance of tax subsidies to low income earners. In this regard, it is evident that the reforms in the healthcare sector protect the interests of the poor.
Johnson (2009) cited Obama, stating that that the prevailing costs of healthcare were exorbitant in the past, and they were about to explode. According to Johnson’s assessment (2009), the US healthcare sector is excessively large because it accounts for one-sixth of the country’s economy, the figure being larger than that of any other sector. In addition, Johnson (2009) cites Obama, saying that fixing the healthcare sector is the first step towards repairing the US economy. In essence, the fact that the healthcare industry receives considerably more funding than other areas has denied other sectors of the economy substantial resources. Thus, the crux being witnessed in the economy is partly attributable to the problems affecting the healthcare system.
Moreover, the healthcare reforms have pushed employers into uncharted territories. In particular, they must now spend more money because of the insurance covers they are required to provide to their workers according to the law (MacDonald, n.d.). Another effect has been merging within the healthcare system. The reason cited is the rise in maintenance costs. In addition, the author acknowledges that coverage has increased, and the introduction of subsidies for the poor has been a life changer for many US citizens.
According to Healthcarebusinesstech (n.d.), the reforms in the healthcare sector are likely to improve the industry by providing better services and narrowing the existing inequality gap. According to the source, businesses and physicians will also be affected by the reforms. For example, private physicians are disadvantaged by the reforms, since they reduce their profit margins. Although the observation is valid, the community of doctors is small compared to that of other citizens. Hence, it is not fair to champion the privileges of a few at the detriment of the vast majority of people. Further, according to The PBS NewsHour (n.d.), one of the most notable effects of the reforms is the increase in the number of US citizens who are eligible for Medicaid.
Area Development (n.d.) focused on the impact of the reforms on the business sphere. In the article, Area Development acknowledges that health costs have got out of control, and they were negatively affecting the economy in the past. Area Development indicates that the change is likely to help businesses, since they have previously faced rising costs each year. Hence, the reform affecting the cost of insurance would make healthcare cheaper, thus allowing businesses to use resources for other purposes.
MacDonald (n.d., b) acknowledges that the reforms initiated by Obama have had a tremendous effect on the insurance landscape in the United States. Largely because of the provisions of the ACA, US citizens now have improved access to healthcare, and they are currently relatively benefitting from their earnings. The author stresses that the law has reduced the number of the uninsured and removed previous conditions that were discriminatory to particular groups of people, such as those with pre-existing conditions.
The White House (2014b) observed that the reforms were long overdue owing to their role in taming the healthcare costs that had been rising for decades. Thus, the changes will increase the competitiveness of the country, reduce the rate at which families become bankrupt, and address other long-term consequences. As the White House (2014b) observed, with the adoption of the ACA, the long-running impunity by the insurance sector was brought to an end.
Analysis
The policy reformation led by the Obama Administration has a large-scale impact on the healthcare sector, with far-reaching ramifications. One of the effects that recur in the literature is the alteration of the insurance sector in reference to the extension of covers to US citizens. Unlike the past state of affairs, where insurance firms imposed various conditions and limited the extent to which policy holders benefited, the new regulations have brought increased hope by issuing policy directives that bar insurance entities from disadvantaging the citizenry, as observed by the White House (2014b) and MacDonald (b). It is evident that the eradication of the pre-existing conditions has allowed for the elimination of some of the discriminatory barriers previously erected by insurance organizations. Overall, the changes led to increased insurance coverage, enhanced access to healthcare, and improved benefit terms for policy holders. In addition, it is evident that the implementation of the ACA has contributed to the narrowing of the gap between the rich and the poor in terms of access to healthcare, a position supported by Healthcarebusinesstech (n.d).
Based on the literature reviewed, businesses have been suffering mainly because of the constantly increasing insurance costs. Such a financial situation was detrimental to the business community, especially smaller entities. This was because it was difficult for such enterprises to afford the insurance covers for their employees. In essence, the uncontrolled insurance coverage of the healthcare sector was harming the business sphere in the US. With the new policy, insurance firms are controlled, and they cannot haphazardly adjust their premiums, as indicated by Business Area (n.d). The implication is that the ease of doing business improved with the enactment of the ACA, which boosted the economy of the country. This became possible since enterprises now do not have to spend excessive resources on health insurance; instead, they may invest more in other areas.
Despite the fact that all the reviewed sources agree that the changes were long overdue, owing to the need to control the healthcare sector, some of them, for example, Anderson, concede that the changes might compromise healthcare accessibility. The author believes that increasing the coverage of individuals based on the new guidelines expands the number of people that depend on the existing system (Anderson, 2014). In such a scenario, the changes may affect the healthcare system in such a way that operational and treatment facilities and the workforce may become unable to handle their responsibilities. In such circumstances, the problem that was to be solved might worsen. Although the issue of burnout has been reported, it is not dire. According to the literature observed, the physicians operating privately are also affected by the changes. In particular, the Healthcarebusinesstech (n.d.) indicate that such practitioners are likely to suffer from lower profit margins.
The primary objective of designing the ACA was to enhance the quality of care in the United States by ensuring that low and middle income earners are not denied access to healthcare. Big corporations were benefiting from the sector, an aspect that led many observers to opine that the economy was losing in terms of competitiveness as the industry was suffocating the development of other sectors. In order to increase the accessibility of healthcare, the ACA proposed many changes that have led to an expansion in the number of citizens eligible for health insurance. Although many challenges remain, it is apparent that the objective of the increased number of citizens with health insurance has been attained.
Synthesis/Integration
The issue of healthcare reforms is quite complex. It is baffling that the United States spends significant funds on the sector, yet this does not generate the desired outcomes. For instance, it was perplexing that despite the considerable expenditure, inequalities remained rampant as a high percentage of citizens did not have health insurance. It is difficult to understand the criteria that insurance companies were deploying in deciding the premiums paid. Regardless, it is evident that private interests outweighed public concerns. Consequently, it is arguable that the introduction of Obamcare reforms was a major turning point that has had a a significant impact on the nation’s health sector. Regardless of the debate on the topic, based on the evidence presented in the paper, the reforms are critical in reforming the ailing sector.
According to Anderson (2014), changes at the policy level are required if the country is to move forward. The author observes that following the tenet of primum non nocere, which is loosely translated as “first do no harm”, the government should focus on the base of the problem instead of granting immense supervisory powers to government officials who are unaccountable yet first to issue random edicts.
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According to the literature reviewed, inefficiencies lead to an increase in the costs of healthcare. Given the finding that up to 30% of the costs are avoidable, stakeholders need to explore ways of the reduction of such inefficiencies. Policy makers need to streamline the industry by outlining the need to align coverage with the health of individuals. Besides, they need to share all the relevant information to allow US citizens to make informed choices.
Without any exception, the reviewed articles suggest that the healthcare sector needed reformation. In addition, the sources indicate that the healthcare sector is bound to improve due to the ACA, although in his article, Anderson (2014) perceives a possibility of the burnout challenge. Indeed, the healthcare industry currently faces numerous challenges, and even more may emerge. As Johnson (2009) indicated, the sector was so flawed that not a single policy shift could be enough to correct all the problems in it. The reviewed sources capture pertinent concerns pertaining to the ailing industry. As Anderson (2014) indicates, the changes introduced targeted accessibility to healthcare without paying sufficient attention to infrastructural expansion. In this regard, introducing additional changes targeting key infrastructural facilities becomes essential.
To address the problem, expanding infrastructural facilities and implementing training and health programs is essential. In addition, the government must invest in research and development in order to generate knowledge on the improvement of outcomes and how to manage increased numbers covered by insurance. Moreover, healthcare professionals must play their role in the enhancement of the delivery of care. In this regard, abiding by best industry practices, and exploring avenues for improvement would be ideal among healthcare professionals.
Conclusion
Health dynamics continue to change in the USA. Despite the amount of resources the US invested in the sector, the healthcare sphere still faces numerous challenges. The policy changes introduced by the Obama Administration greatly affected the sector, and the outcomes are likely to emerge with time. To solve the problems the healthcare sector faces, more than just a single policy shift is needed. In this regard, the Obamacare approach is only a starting point for the addressing of the spiraling healthcare bill in the country.
It would be useful to envisage the challenges that are likely to emerge in the process of reforming the sector if the proposed solutions are to be effective. For instance, it is apparent that although the intention of the changes was to improve outcomes in the sector, certain challenges related to those changes are anticipated. By adding more patients without expanding the infrastructural base, the US may experience the reduced quality of healthcare. Thus, it would be reasonable for the US to continue the reformation by considering the expansion of infrastructural facilities.