Exam 13: Issues in Public Policy: Politics, Principles, Priorities, and Practices

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The Patient Protection and Affordable Care Act (ACA), also known as Obamacare, was signed into law in 2010 with the goal of increasing access to affordable healthcare for all Americans. The basic framework of the ACA includes several key components:

1. Individual Mandate: The ACA required most Americans to have health insurance or pay a penalty. This was intended to increase the number of healthy individuals in the insurance pool, which would help lower costs for everyone.

2. Health Insurance Exchanges: The law established state-based health insurance marketplaces where individuals and small businesses could compare and purchase health insurance plans. These exchanges were designed to increase competition among insurers and provide more affordable options for consumers.

3. Medicaid Expansion: The ACA expanded Medicaid eligibility to cover more low-income individuals and families, with the federal government providing funding to states to support this expansion.

4. Insurance Reforms: The law included provisions to protect consumers, such as prohibiting insurance companies from denying coverage to individuals with pre-existing conditions and allowing young adults to stay on their parents' insurance plans until age 26.

5. Subsidies: The ACA provided financial assistance in the form of premium tax credits and cost-sharing reductions to help lower-income individuals and families afford health insurance.

The ACA has had several successes, including a significant reduction in the uninsured rate in the United States. According to the U.S. Census Bureau, the uninsured rate dropped from 16% in 2010 to 8.8% in 2016. The law also provided important consumer protections, such as the elimination of lifetime and annual limits on essential health benefits and the requirement for insurance plans to cover preventive services without cost-sharing.

However, the ACA has also faced criticism and has been the subject of ongoing political debate. Some of its main failings include rising premiums and deductibles for some individuals, as well as limited choices in some insurance markets. Additionally, the individual mandate was repealed in 2017, which has raised concerns about the stability of the insurance market and the potential for adverse selection.

Overall, the ACA has made significant strides in expanding access to healthcare and improving consumer protections, but it also faces challenges in terms of affordability and sustainability.