Introduction
The Affordable Care Act, also known as Obamacare, is a federal law in the United States that offers health insurance coverage to individuals with low income. Enacted on March 23, 2010, this legislation is seen as a major regulatory reform in the American healthcare system. Its primary objectives include enhancing the quality and affordability of health insurance, expanding coverage for both private and public sectors, and decreasing healthcare costs for individuals and the government (Musumeci, 2014).
Despite its implementation of mandates, insurance exchanges, and subsidies, the Affordable Care Act (ACA) aimed to ensure that all insurance companies cover eligible applicants irrespective of pre-existing conditions. Nevertheless, it is not widely regarded as the ideal healthcare solution for the United States due to its financial demands and narrow focus on a particular demographic. The ACA was declared constitutional by the Supreme Court on Ju
...ne 28, 2012.
Eligibility Requirements for ACA Healthcare Program
The eligibility criteria for the ACA healthcare program are determined based on specific financial requirements outlined by the Federal Poverty Level (FPL). The FPL serves as a policy guideline used by both the U.S federal government and state governments to determine the level of cost assistance for citizens. However, it is important to note that not everyone benefits from this statute (Fitzgerald et al., 2015).
Two programs, CHIP and Medicaid, provide health insurance coverage to a significant number of Americans, including parents, individuals with disabilities, children, and seniors. While the federal government mandates coverage for certain groups, states have flexibility in extending coverage to other societal groups (Medicaid, 2015).
Many states have expanded their coverage to include more people, particularly children and individuals with disabilities. In 2015, a family o
three needed to have an income below $27,724 to qualify for the Federal Poverty Level (FPL). Those earning 138% or less of the FPL were eligible for Medicaid and CHIP. However, it's important to note that only residents in states with expanded Medicaid can access Medicaid benefits. Therefore, individuals who don't meet the income requirements are not eligible for programs established by the ACA.
The eligibility criteria for ACA benefits vary based on whether a state has expanded Medicaid. In states without expansion, individuals must earn less than 133% of the Federal Poverty Level (FPL) to qualify. However, in states with expansion, eligibility is limited to those earning less than 138% of the FPL (Obamacare Facts, 2015). Therefore, individuals whose incomes exceed the government's designated poverty levels are ineligible for healthcare benefits. It is important to note that most U.S. citizens surpass these poverty thresholds due to the country's developed economy. As a result, taxpayer funds only benefit a portion of society rather than the entire population. The ACA program covers both private and employer insurance but imposes specific conditions for employer-provided coverage.
Depending on various factors such as income, family size, the age of their children, and whether their state has expanded Medicaid, families who receive health insurance through their employer may be eligible for Medicaid or CHIP. The aim of the ACA program is to provide health insurance coverage for both adults and children. However, research suggests that children tend to derive greater benefits from these programs compared to adults. As individuals transition from childhood to adulthood, there is a higher chance of losing access to these benefits. Garfield and Damico (2016) argue that due
to states not expanding their programs, eligibility for medical assistance in non-expansion states is limited.
In 2016, Garfield and Damico found that a family of three only received 44% of the poverty income threshold. However, states without expanded Medicaid eligibility still leave out adults without children. Furthermore, because of the Affordable Care Act's emphasis on aiding low-income families, individuals below the poverty line do not get financial support for other coverage choices. Consequently, adults living in non-Medicaid expansion states encounter a "coverage gap" when their incomes exceed the Medicaid limit but fall below the tax credits offered for marketplace premiums.
Research shows that despite its aim to help low-income earners, the ACA has not achieved this goal. The majority of low-income earners are Latinos, African Americans, and Hispanics, while white individuals primarily occupy higher income brackets. Ideally, the program would have had a minimal impact on white individuals if it had been successful. However, studies assessing the law's effects indicate that minority groups actually benefit more from it, even though many still face a coverage gap. In a study by Sneed (2015), it was found that around 7.4 million white individuals gained coverage through the ACA.
During this time period, the program provided benefits to a total of 4 million Hispanics and 2.6 million black Americans, while also resulting in a decrease of uninsured white individuals by 6%, reducing their rate from 14.3% to 8.3% (Sneed, 2015). Comparatively, minority groups saw significant declines in uninsured individuals compared to the white majority population. Hispanics experienced an impressive reduction of uninsured individuals by 11.5%, bringing their rate down from an initial figure of 41.8% to 30.3%. Similarly, African Americans also
witnessed a remarkable decline in uninsured individuals by 103%, lowering their rate from 22.4% to just 12.1%.
Impact
The Affordable Care Act (ACA) has a significant impact on various parties involved in the insurance process, including individuals, insurance organizations, business and government entities, and tax-exempt entities. According to Obamacare Facts (2015), the ACA's statutory tax provisions bring about substantial changes to the tax filing procedures for families and individuals. Moreover, the law outlines benefits for employers and organizations. However, one drawback of this legislation is found in the tax credit provision which requires individuals and their dependents to have health coverage and provides a tax exemption for those who pay with their tax returns.
Buying health insurance policies from the marketplace makes individuals eligible for a premium tax credit, decreasing revenue for states and the federal government. The implementation of the ACA law has worsened the existing budget deficit in the United States and is expected to continue growing in upcoming years.
According to a report by Obamacare Facts (2015), the estimated net costs of the insurance provisions of the Affordable Care Act (ACA) were $1.207 trillion as of March 2015. The budget deficit for the following year was lower than projected, indicating an increase in subsidies provided to individuals. This suggests that as more people receive subsidies and healthcare costs rise, total healthcare spending will surpass revenue.
Conclusion
Addressing the issue of healthcare access for U.S. citizens requires a comprehensive approach instead of solely relying on the ACA law. The high financial costs and specific population targeted by the ACA make it inappropriate according to critics.
Every government has the responsibility to address both the concerns of minority members in
society and the health issues that affect all citizens. Despite evidence that shows the Affordable Care Act (ACA) benefits minority members in the US, many still lack coverage due to states not expanding Medicaid programs. Adults face higher risks of not receiving coverage compared to children. Additionally, the tax subsidies provided by the law contribute to the US budget deficit.
References
- FITZGERALD, M. P., BIAS, T. K., ; GURLEY-CALVEZ, T. (2015). The Affordable Care Act and Consumer Well-Being: Knowns and Unknowns. J Consum Aff, n/a-n/a. doi:10.1111/joca.12059
- Garfield, R., ; Damico, A. (2016, January 21). The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid – An Update | The Henry J.
The Kaiser Family Foundation provides the information found at http://kff.org/health-reform/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid-an-update/. For Medicaid eligibility information, visit Medicaid.gov.
Retrieved from https://www.medicaid.gov/medicaid-chip-program-information/by-topics/eligibility/eligibility.html
(2015, July). ObamaCare Deficit and Debt - Obamacare Facts. Retrieved from http://obamacarefacts.com/obamacare-deficit-debt/
Sneed, T. (2015, September 22). More Whites Gain Obamacare Coverage Than Blacks And Latinos Combined. Retrieved from http://talkingpointsmemo.com/dc/obamacare-white-black-hispanic-numbers
