The passage of the Patient Protection and Affordable Care Act (most often referred to as
the Affordable Care Act or ACA) was a monumental milestone in terms of national health
reform. What were some reasons why previous health reform efforts failed? Why was this
effort at national health reform successful? Describe the social, economic, and political
contexts that contributed to the passage of the ACA. In your opinion, what elements of the
ACA are working, and what are some areas that need improvement? Use evidence to
support your viewpoint.
The enactment of the (ACA), on March 23, 2010, sought to achieve three main objectives that
include the reformation of the market for private insurers, particularly for people and
communities groups that purchase medical cover. The secondly objective entailed the expansion
of the Medicaid platform to the poor and working individuals and families who earn an income
of at least 133% as stipulated by the federal poverty level (Silvers, 2013). Thirdly, as a reform in
the health care sector, the ACA sought to change the medical decision-making processes applied
across the nation. As such, some of the reasons behind the failure of the previous health reforms
include the influx of uninsured individuals and families as most of them lacked affordable
employer or other forms of minimum essential coverage.
Additionally, the previous health reform efforts failed to restructure the link between the
people and the medical system that had, over the years, restrained Americans to stringent and
discriminatory standards at the federal level. In these standards, people were mandated to
purchase insurance coverage regardless of whether they could afford it or not, requirements
which previous health reforms failed to restructure (Lahey, 2017). Nevertheless, the
implementation of the ACA reform at the national level proved successful as it set a wide range
of federal standards that contributed to the creation of exchanges in medical coverage at the state
level for both individuals and enterprises. These exchanges simplified the processes of
PUB 650 2
purchasing health insurance through the creation of a holistic market for medical coverage
products that qualified for tax subsidies at the federal level (Silvers, 2013). Moreover, the
exchanges availed insurance products that adhered to standards at the federal and state levels,
thereby leading to their certification as qualified health benefit plans.
Most fundamentally, the economic, social, and political contexts that contributed to the
passage of the ACA include disparities between democrats and republicans with regards to the
changes introduced in the health care sector. These factors were coupled with recessions in the
economy that limited most poor and working individuals and families from accessing the
necessary care services due to lifetime and annual dollar coverage limitations (Silvers, 2013).
Similarly, due to poverty and social status, most people were limited to an inferior category of
the Medicaid program that further restricted them from accessing the necessary care services due
to lack of insurance coverage. Nevertheless, the enactment of the ACA in 2010 played an
integral role as it banned such limitations and further introduced the use of the modified
community rating system that necessitated variation in prices to a limited degree based on factors
such as age or the size of a family.
Upon in-depth of the ACA and its progress thus far, some of the working elements
identified include the empowerment of the exchanges to select qualified health plans, the
calculation of subsidy eligibility, and the coordination of enrolment with Medicaid programs
across the state. However, some areas that need improvement include the regulation of the
incentives provided to individuals and entities in which specialty care is directed as most of them
adversely impacted patient care decisions (Lahey, 2017). More precisely, the agency costs
incurred while purchasing a specific health plan should be regulated as they lead to the
dominance or exploitation of decisions, especially when one party has differential information.
PUB 650 3
Lahey, S. J. (2017). Affordable Care Act, Public Legislation, and Professional Self-Regulation:
Implications for Public Policy. Surgical Patient Care, 817-826.
Silvers, J. B. (2013). The Affordable Care Act: Objectives and Likely Results in an Imperfect
World. The Annals of Family Medicine, 11(5), 402-405.