THE AFFORDABLE CARE ACT: PAST,
PRESENT, AND FUTURE
The Affordable Care Act: Past, Present, and Future
The Patient Protection and Affordable Care Act (most often referred to as the Affordable Care Act or ACA) is
the largest piece of federal health legislation of the last 50 years in the United States and has had wiBdespread
impact on health insurance and health care delivery. The ACA was signed into law in 2010 by President Barack
Obama, and implementation of the ACA has been an ongoing, dynamic process met by opposition and
challenges. For this assignment, create a presentation that outlines the past, current, and future of the ACA. In a
presentation of 10-15 slides, address the following:
Briefly outline the process by which the Affordable Care Act became law. Include a timeline of key milestones.
Articulate competing viewpoints of the ACA, including supporting evidence for each viewpoint.
Describe successful and unsuccessful attempts to challenge the ACA since its passage, including grounds for
appeal and repeal attempts.
Analyze the current impact of the ACA on Medicaid, Medicare, and CHIP/SCHIP.
Describe future issues, needs associated with the ACA by key stakeholders including health care providers,
insurers, employers, the government, and the public.
Make recommendations for improvement of the ACA, including supporting evidence for recommendations.
Include a title slide, references slide, and speaker notes in your presentation.
BRIEF OUTLINE OF THE PROCESS BY WHICH THE ACA
BECAME LAW
The passage of the ACA into law followed a timeline of
significant events coupled with vital provisions that
include:
The support of the ‘public option,’ an insurance program
in June 2009.
June 2009, Nancy Pelosi, the speaker of the House of
Representatives, alongside several democrats, shared
their intention, involving an overhaul on the medical
system; the ACA under the title H.R. 3962 (eHealth,
2019).
August 25, 2009, senator for Massachusetts, Ted
Kennedy, died, thereby putting the 60-seat Democrats
majority at risk.
BRIEF OUTLINE OF THE PROCESS BY WHICH THE ACA
BECAME LAW (CONT’D)
September, 24, 2009, Paul Kirk appointed the interim senator
in Massachusetts, which temporarily restores the majority
rule (eHealth, 2019).
November 27, 2009, ACA supported by 219: 1 and rejected
by 39: 176, democrats and republicans respectively.
December 24. 2009, sixty Democrats supported the bill, while
39 republicans rejected it,
January, 2010, Scott Brown became Massachusetts’ senator
and mainly opposed the health reform
March 11, 2010, Democrats in Senate apply budgetary
reconciliation (eHealth, 2019).
March 21, 2010House of Representatives approve the bill
with 219 against 212 votes
March, 23, 2010, President Obama signs the bill into law
COMPETING VIEWPOINTS OF THE ACA
Ruling by a Florida judge that elements of the ACA were
unconstitutional (Lahey, 2017)
The Supreme Court declared the ACA unconstitutional.
Consistent condemnation by Republicans in Congress
who voted more than 50 times to amend or repeal in the
House of Representatives (Levy, 2019).
Republican campaigns for the replacement of the ACA
with systems that aimed at the provision of lower
premiums for all people (eHealth, 2019).
COMPETING VIEWPOINTS OF THE ACA (CONT’D)
In addition to the competing viewpoints of the ACA,
various attempts succeeded while others failed to
challenge its passage into law. These attempts include:
A prolonged campaign backed with President Trump’s
regard of the ACA as a costly failure.
President Trump’s attempts seemed politically
challenging as they would lead to disruptions in the
exchanges, thereby causing millions of people to lose
their medical cover.
The divide between the moderate and more-conservative
Republicans
SUCCESSFUL AND UNSUCCESSFUL ATTEMPTS TO
CHALLENGE THE ACA (CONT’D)
Intensification of the divide due to support of the ACA
bill by angry constituents (eHealth, 2019).
December 2017, President Trump approved the
enactment of the comprehensive tax bill. Which led to
the repeal of the individual mandate through the
reduction of the penalty.
Texas v. United States, the district court ruled that the
individual mandate was unconstitutional in 2019
(HealthPayerIntelligence, 2016).
CURRENT IMPACT OF THE ACA ON MEDICAID,
MEDICARE, AND CHIP/SCHIP
Transformation in the health care industry entails the
individual mandate that requires all people to acquire
medical coverage or else face tax penalties.
Insurers required to include more people as compared to
the previous health systems.
Increased emphasis on the adoption of models based on
pay-for-performance reimbursement
(HealthPayerIntelligence, 2016).
Within states that failed to expand their Medicaid thus
far, the majority of low-income individuals lack access to
the necessary care services.
CURRENT IMPACT OF THE ACA ON MEDICAID, MEDICARE,
AND CHIP/SCHIP (CONT’D)
A coverage gap exists in states that lack Medicaid expansion.
Patients are exposed to similar barriers to primary care access
that hindered the delivery of care services before enacting the
ACA (Obama, 2016).
Continuous coverage and subsidies that include CHIP,
Medicaid, and the marketplace.
a gaping hole and individuals exceeding the 100% poverty
level who are attributable to insurance coverage through the
marketplace (Levy, 2019).
Individuals under such standards and are equally poor have
too high incomes to qualify for Medicaid but too low-income
levels to be eligible for the exchange.
CURRENT IMPACT OF THE ACA ON MEDICAID, MEDICARE,
AND CHIP/SCHIP (CONT’D)
CURRENT IMPACT OF THE ACA ON MEDICAID, MEDICARE,
AND CHIP/SCHIP (CONT’D)
RECOMMENDATIONS FOR IMPROVEMENT OF THE ACA
Challenges facing the
American health system
before the ACA:
Costs incurred in health affect the
federal budget, the financial
welfare of virtually all
Americans, and the economy in
general.
The costs incurred on health care
had rapidly been on the rise for
decades (Silvers, 2013).
Millions of Americans lacked
insurance coverage
Due to these challenges, the ACA
was created with the intent to
improve elements such as:
Fairness
Affordability
Quality, and
Access to medical cover and
other related services
Re-orientation of the
payment systems towards
accountability and quality.
Use of tools such as the
CMMI, the ACO program
laws,
Continued bipartisan support
necessary for the
identification of the causative
factors and suitable
treatments for different
conditions through the
BRAIN initiatives.
Additional financial assistance to
make medical coverage provided
by the ACA more affordable while
maintaining the federal costs
below the initial projections
Re-consideration of the processes
through which public initiatives
compete with privately-operated
insurance providers
Addition of a general action plan
in sections where the limitations of
such opportunities exist
RECOMMENDATIONS FOR IMPROVEMENT OF THE ACA
(CONT’D)
CONCLUSION
The ACA was created with the intent of boosting the welfare
of the people through the incorporation of factors that initially
hindered the attainment of patient outcomes and further
affected the economy.
However, the realization of its desired objectives was faced
with numerous hurdles as it encompassed fundamental
aspects of the health care system, the insurance industry,
federal and state policies, and the public in general.
Although it succeeded in some areas, the fact that people lack
insurance coverage to date indicates the need for the constant
improvement and restructuring of various components of the
ACA.
REFERENCES
eHealth. (2019, October 31). History of the Affordable Care Act (ACA).