The Patient Protection and Affordable Care Act (PPACA)

Write a paper discussing what you believe the key issue for implementation of the PPACA
will be in the next two years. How does the legal structure and current health legislation
affect this issue either facilitating its resolution or to hindering it. Keep in mind Starr’s
observation that “institutional legacies shape how people apply their values to specific
spheres” (9) and include in your discussion how the legal system not only directly affects
the issue but also indirectly affects the issue by shaping the values and preferences of the
key actors in the system.
4 pages only. 3 pages text, 1 page citations
� 1 margins
� Times New Roman or other serif type, 11pt.
� 1.5 spacing
� Title: must be short and descriptive. Center on page, bold. 5
� Issue statement – one very short paragraph. Left justified heading “Issue” bold. Clearly
state the issue that will be discussed. If you have a question that you are asked to answer it
will be restated here.
� Brief answer – one very short paragraph. Clearly state your answer or outcome to the
problem or issue. Left justified heading “Answer” bold.
� Analysis – two and one half pages. Clearly and concisely analyze the problem or issue.
The analysis justifies your brief answer and elaborates. Left justified heading “Analysis”
� Use APA formatting for your paper


The Patient Protection and Affordable Care Act (PPACA) was essentially, an amendment
of the Public Service Act. The main goal of this act was to make health insurance affordable, and
quality alongside lowering premium rates for the uninsured. The Act mandates the Secretary in
the Department of Human Services, and Heath alongside the states to conduct premium reviews
on a yearly basis. It also requires health insurers to identify an unnecessary increase in premiums

before implementing them. Further, it mandates issuers to justify the suggested increase on the
website of the assurer. The secretary is expected to ensure that disclosure of public information
on such justifications, and increases of the health insurance issuers are undertaken. The act avails
$250,000,000 to enable them conduct reviews in relation to premium increases (Gruber, 2011).
Key issue Facing implementation of the PPACA
a) Projected Increase of costs
The estimated cost of the coverage provisions in the PPACA over the next two years is an
increase by approximately $ 255 billion. These costs are associated with the coverage of the
entire provisions in the act, net savings for the provisions of Medicare and Medicaid, expansion
of eligibility to Medicaid and Medicare, and addition of CHIP funding. The Office of the
Congressional Budget has consistently said that the cost of PPACA implementation is
insignificant. This is because, the costs in most cases are offset over a period time through tax
increases in specific area, and also reducing the budget in some other areas (Foster and S.
Heffler, 2009). However, I do believe that there would be added costs in relation to PPACA
implementation as states create insurance exchanges, and the need for enforcement. Additionally,
despite the perception of the congressional budget, it is apparent that the law requiring those
pre-existing to be covered alongside offering subsidies to those with low or no income source
will result into a deficiency of the congress budget.
In essence, it is estimated that implementation of PPACA is subsequently going to
increase the costs of insurance in America over the next few years. This is because; the current
structure of heath registration is not very effective for the smooth running of PPACA. It may be
true that PPACA may slow down the cost of such increases; however, it is not capable of making
basic changes to the current heath, and legal structure that is already in inadequate.

In addressing the issue of affordability of PPACA, the law has however, established
some measures to tackle this issue. Apparently, this act has created a limit concerning the
premium amount that can be utilized for products not relating to healthcare. This translates that
approximately 80% of all the money collected from insurance premiums ought to be utilized for
purposes relating to heath care alone. This measure may be effective in controlling healthcare
costs. Provision of subsides in the new law is also meant to make the program affordable
especially to low income earners, and those with no reliable source of income. Families with low
income are assisted in paying for their premiums, on a descending scale that is based on their
needs. In this way, those who find it hard to afford the premiums will find it possible to do so.

Alteration of the existing individual insurance plans

Obama categorically stated during the debate on the passage of the PPACA, act that “if
you find your health plan good, you will still be able to keep it” (Barr, 2011). However the law
is clear that only those insurance plans that were in effect prior to enacting of PPACA and had
not been significantly changed since then could be retained. Insurance plans that do not
effectively satisfy such criteria, and or are not in compliance to the new law requirement for
insurance standards are cancelled. Moreover, the law does not forbid insurers from cancelling
plans that are deemed older for particular reasons such as the cost of maintenance. These will
therefore led to cancellation of many insurance plans.

The need to change insurance plans will negatively hamper the implementation of the
PPACA owing to the requirements of complying with the new law. As of November 2013, not
more than five states in the whole nation had actually established exchanges or planned to alter
their insurance plans in line with the new regulations. Approximately the same number has

decided not to do anything at all about their current insurance plans (Gruber, 2011). This means
that more than half of the states are either unable or unwilling to comply with the new
regulations. This may translate that a completion of PPACA implementation in two years will be
an uphill task especially as HHS undertakes the development of health care exchanges across the

Although the agencies for PPACA implementation had faced objections to regulatory
actions even before the law was enacted, such oppositions have been slowed, as the regulatory
challenges were resolved in courts. Despite this, there could still be more challenges in
implementing certain provisions by insurers.



Barr, D. A. (2011). Introduction to U.S Health Policy: The Organization, Financing, and
Delivery of Health Care in America JHU Press. ISBN   9781421402185 .
Foster and S. Heffler, (2009), Updated and Extended National Health Expenditure Projections,
2010 -2019. Memorandum dated June 29, 2009.
Gruber, J (2011). Health Care Reform: What It Is, Why It’s Necessary, How It Works. United
States: Hill, and Wang. p. 101. ISBN   978-0-8090-5397-1