Policy Analysis

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AffordableCare Act

Overviewof the Health Care Policy

TheAffordable Care Act (ACA) (also known as Patient Protection andAffordable Care Act (PPACA) or Obamacare) is a national healthcarepolicy of the United States. The statute was ratified on 23 March2010 by President Barack Obama (Shaw et al., 2014). It is the mostsignificant recent healthcare reform since the ratification ofMedicaid and Medicare in the year 1965. The ACA seeks to create acomprehensive healthcare system which is accessible and affordable toall Americans (Lathrop &amp Hodnicki, 2014). The policy impactshealthcare insurance, costs, employers, children, individuals,government programs, and quality of care. It aims at the advancementof the healthcare delivery, minimization of healthcare costs, andexpansion of healthcare coverage.

TheACA requires healthcare facilities and healthcare providers totransform their healthcare practices clinically, technologically, andfinancially. It is believed that these efforts can lead to theprovision of accessible and quality care, reduction of healthcarecosts, and achievement of positive health outcomes (Mechanic, 2012).The ACA has altered the structure, administration, and regulation ofhealth coverage in the United States by introducing both practicaland philosophical changes (Obama, 2016). For instance, the lawincreases payments to Medicaid and expands eligibility to theprogram. It is believed that the ACA will extend healthcare coverageto the 32 million Americans who were previously not insured.

WhoBenefits from or is Given an Advantage by the Policy

TheACA is beneficial or advantageous to various parties. To begin with,the law introduced individual insurance marketplaces where individualAmericans or families can directly purchase health insurance. Personswhose incomes are below the 400% of federal poverty level (FPL) aregiven premium subsidies that can enable them to purchase healthcoverage (Davis, Abrams &amp Stremikis, 2011). The ACA providessmall business insurance marketplaces. These marketplaces enable theAmerican firms with less than 50 employees to provide healthinsurance to their workers (Shaw et al., 2014). The policy hascontributed to the expansion of Medicaid. Many Americans are noweligible to this program. These include those ones who earn less than138% of the FPL (Keim-Malpass, Letzkus &amp Kennedy, 2015). Thiscategory of people contains poor Americans.

Oneof the goals of the ACA is to reduce payments for certain Medicareservices. This can help to make the program more affordable to thepeople of the United States. By reducing Medicare payments andexpanding Medicaid, the law aims at increasing the number of insuredAmericans and making healthcare services accessible to many(Keim-Malpass, Letzkus &amp Kennedy, 2015). The ACA requires thatemployees who work for more than 30 hours a week must be insured.This move contributes to an increase in the number of insuredAmericans. The ACA plays an important role in lowering the healthcarecost. It is estimated that the policy can lead to the reduction ofthe money that the American federal government spends on health byabout $ 124 billion (Koh et al., 2012). This is expected to happen inthe next ten years.

Whois Disadvantaged by the Policy

Althoughthe ACA plays a significant role in the promotion of universalhealthcare coverage, it is disadvantageous to some parties. The lawstill leaves many Americans uninsured. It is estimated that underthis policy, about 19 million people in the United States who are notinsured will continue to be ineligible to Medicaid and healthcarecover subsidies (Harrington, 2010). Among these are those ones withhigh incomes. These people are ineligible to both marketplace taxcredits and some Medicaid programs. They comprise about 16% of theuninsured and ineligible population of the United States (Harrington,2010). ACA cannot be of any benefit to them.

TheACA does not recognize undocumented immigrants in the United States.These people are excluded from tax credits and the benefits ofMedicaid expansion. About 23% of the uninsured Americans who areineligible to various health programs are the immigrants who are notdocumented (Sonfield &amp Pollack, 2013). Low-income and poorindividuals living in the states that do not allow the expansion ofMedicaid do not benefit from the ACA. These people remain ineligibleto Medicaid and various marketplace tax credits. This categorycontains about 5.3 million Americans (Sonfield &amp Pollack, 2013).The ACA also requires all legal citizens of the United States to getinsured. It as well makes it mandatory for larger employers to ensurethat their employers are covered.

How/FromWhere Funds are directed to cover the Cost of Implementing the Policy

Itis estimated that in the next ten years, the implementation of theACA will cost about $940 billion. However, the policy is expected toreduce federal deficit during this period (Mechanic, 2012). The costof implementing the ACA mainly comes from Medicaid and Medicaresavings, healthcare industry fees, and taxation of various healthinsurance programs. Most of these funding sources were solicited bythe administration of Obama when it was making important deals withimportant stakeholders in the healthcare system (Koh, Graham &ampGliend, 2011). The common forms of funding from such deals includerebate given to state programs by drug manufacturers, Medicareadvantage payments, and productivity adjustments.

ResearchLiterature on the Topic

LiteratureReview Question

Howdoes the ACA promote health care reforms in the United States?

LibraryDatabases Searched, Search Terms, Combinations, Limits, and FiltersUsed to Obtain Research on the Policy/Issue

The library databases searched for information included CINAHL,PsycINFO, Medline, and Cochrane Library. The researcher made use ofthe following search terms: “Affordable Care Act” (or ACA),“Patient Protection and Affordable Care Act” (or PPACA),“Obamacare,” “health care reforms,” “health care changes,”“promote,” “enhance,” “advance,” “United States” and“America.” During the search, the terms were combinedappropriately in order to come up with the required data. Theresearcher was keen on date limits since he selected studiespublished within the last 7 years. Inclusion and exclusion filterswere used to select relevant studies. The studies describing ACA, itsprovisions, benefits, disadvantages, and funding were selected. Thedatabases search led to the selection of 15 studies for the currentresearch.

of the Results

Articleswith Pertinent Information

(Seein the appendix section).

Numberof Research Articles Produced with Clinically Meaningful andStatistically Significant Support for the Policy


Numberof Research Articles Produced with Non-Significant Results


Numberof Research Articles Produced Opposing the Policy



Thecurrent study provides important information on how ACA promoteshealth care reforms in the United States. The policy helps to expandhealth care coverage, increases access to Medicaid, and reducesMedicare payments. In the study, 10 out of the 15 articles providedrelevant information. The rest had less significant information. Itis important to note that two of the articles selected opposed ACA.However, most of the articles supported the policy. Generally, theliterature review shows that ACA works to make health care accessibleand affordable. It is an evidence-based initiative which needs to beeffectively implemented. This can help to improve the delivery ofhealthcare services in the United States.


Davis,K., Abrams, M. &amp Stremikis, K. (2011). How the Affordable CareAct Will Strengthen the Nation`s Primary Care Foundation. JGen Intern Med,26:1201.

Harrington,S. E. (2010). U.S. Health-care Reform: The Patient Protection andAffordable Care Act. Journalof Risk and Insurance, 77(3): 703-708.

Keim-Malpass,J., Letzkus, L. C. &amp Kennedy, C. (2015). Health literacy and theAffordable Care Act: a policy analysis for children with specialhealth care needs in the USA. RiskManag Healthc Policy, 8:31–36.

Koh,H. K., Berwick, D. M., Clancy, C. M., Baur, C. et al. (2012). NewFederal Policy Initiatives To Boost Health Literacy Can Help TheNation Move Beyond The Cycle Of Costly ‘Crisis Care.’ HealthAff.

Koh,H. K., Graham, G., &amp Gliend, S. A. (2011). Reducing Racial AndEthnic Disparities: The Action Plan From The Department Of Health AndHuman Services. HealthAff, 30(10) 1822-1829.

Lathrop,B., &amp Hodnicki, D. (2014). The Affordable Care Act: Primary Careand the Doctor of Nursing Practice Nurse. TheOnline Journal of Issues in Nursing,19(2).

Mechanic,D. (2012). Seizing Opportunities under The Affordable Care Act ForTransforming The Mental And Behavioral Health System. HealthAff, 31(2): 376-382.

Obama,B. (2016). United States Health Care ReformProgress to Date and NextSteps. JAMA,316(5): 525-532.

Osborn,R., Moulds, D., Schneider, E. C., Doty, M. M. et al. (2015). PrimaryCare Physicians In Ten Countries Report Challenges Caring ForPatients With Complex Health Needs. HealthAff, 34 (12): 2104-2112.

Patel,K. &amp Rushefsky, M. E. (2015). Healthcare Politics and Policy inAmerica (4th ed.). Journalof Public Integrity, 17(1): 94-96.

Pitts,S. R., Carrier, E. R., Rich, E. C. &amp Kellermann, A. L. (2010).Where Americans Get Acute Care: Increasingly, It’s Not At TheirDoctor’s Office. HealthAff, 29(9): 1620-1629.

Rosenbaum,S. (2011).The Patient Protection and Affordable Care Act:Implications for Public Health Policy and Practice. PublicHealth Reports (1974-), 126(1): 130-135.

Shaw,F. E., Asomugha, C. N., Conway, P. H. &amp Rein, A. S. (2014). ThePatient Protection and Affordable Care Act: opportunities forprevention and public health. TheLancet, 384(9937): 75–82.

Sonfield,A. &amp Pollack, H. A. (2013). The Affordable Care Act andReproductive Health: Potential Gains and Serious Challenges. Journalof Health Politics, Policy and Law, 38(2): 373-391.

Winkelman,T. N. A., Kieffer, E. D., Goold, S. D., Morenoff, J. D. et al.(2016). Health Insurance Trends and Access to Behavioral HealthcareAmong Justice-Involved Individuals—United States, 2008–2014.J Gen Intern Med,1-7.


Table1: Selected articles with pertinent information.

First Author



Independent Variable (IV)

Dependent Variable (DV)

Policy Implementation




Breanna Lathrop.


Doctor of Nursing Practice (DNP) nurses.

Role of DNP nurses.

Preventive healthcare, and preventive care challenges.

Through community based programs.

How DNP nurses use ACA policy strategies to promote effective preventive care.

ACA has transformed preventive and primary care in the United States.

Barack Obama.


Public data, data from government agencies, and published research findings.

Actions that can improve the healthcare system, and lessons from the policy.

Pursing health reform.

Through comprehensive reforms that helps to improve healthcare affordability, accessibility and quality.

Effects of ACA.

ACA has led to positive changes in the healthcare system.

David Mechanic.


Persons with mental and behavioral health problems.


Mental and behavioral health system.

At Medicaid services and Medicare centers.

ACA tools and programs.

ACA is important for the redesigning of the flawed mental health system.

Jessica Keim-Malpass.


Children with special health care needs (CSHCN).

Special health care needs.

Health literacy.

Incorporation of health literacy approaches in ACA.

Limited health literacy, expansion of health insurance, and increase in enrolment rate.

ACA contains important health provision policies for the wellbeing of CSHCN.

Karen Davis.


Patients, and healthcare providers.


Primary care foundation.

Increasing rates of reimbursement for providers, at patient-centered medical homes.

Access to primary care services, and coordination within the continuum of care.

ACA helps to promote the delivery of patient-centered primary care of high value.

Howard K. Koh.


General American population.

Quality of care, and improvement of health care.

Health literacy and health care organizations.

Within private and public health care organizations.

Limited health literacy.

ACA helps to boost health literacy.

Scott E. Harrington.


ACA provisions.


Health insurance

In insurance markets.

Expansion of health coverage.

ACA helps to reduce the cost of healthcare.

Howard K. Koh.


Diverse communities in the United States.


Health disparities.

In the Department of Health and Human Services (HHS).

Ethnic and racial health disparities.

ACA helps to reduce racial and ethnic disparities in the health care system.

Frederic E Shaw.



ACA and United States health system.

United States health policy

Within the health care system.

Cost of care, and access to healthcare cover.

ACA helps to reduce basic problems in the United States health care system.

Adam Sonfield.


American population.


Reproductive health.

Within the reproductive health system.

Increase in insurance coverage, and improving access to various reproductive healthcare services.

ACA can improve the reproductive health of the people of the United States.

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