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Robert Wright Ms. Eaker English 1102 March 29, 2014 Round Table The Patient Protection and Affordability Care Act took effect March 23, 2010 after both House of Representative and Senate passed the Bill. Before the implementation of the Patient Protection and Affordable Care Act (ACA) also known as Obamacare many Americans went uninsured because of the high prices of insurance, unable to receive insurance because of a preexisting conditions, or simply felt that they didnt need insurance or it was cheaper to pay for their doctors visit out of pocket. With healthcare cost on the rise this issue left many hospitals, clinics, and Urgent Care Units footing the bill for more than 47 million uninsured Americans. The healthcare system was unregulated before 2010 which allowed insurance companies to deny coverage to Americans that had a preexisting condition such as a genetic heart disease or cancer, insurance companies would also charge women more for insurance than men or change the premium of a persons health insurance with no notice. These factors combined count for more than __% of why most Americans were uninsured. Senator Obama became President Obama and put his Democratic ran House of Representatives and Senate to work on a bill that would insure all Americans the opportunity to be insured. The Bill set standards for basic health insurance coverage, expanded Medicaid insurance for low income families, created a government healthcare marketplace. The market place is where insurance companies compete with other insurance companies insuring the person looking for insurance coverage get the best price. The bill also eliminating preexisting

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conditions, and terminating annual monetary caps on coverage and penalizing individuals that did not purchase health insurance. Healthcare was one of the biggest issues in the 2008 Democratic Presidential Primaries and the 2009 U.S. Presidential Election. Senator Obama ran his campaign on the basis of his promise to reform health care. Throughout the presidential campaign we start to hear one of the biggest and most important voice of the uninsured American, the 2008 Census estimated 47 million people were found to be uninsured. Decreasing the number of uninsured is the goal of the Patient Protection and Affordable Care Act. Before moving any further we need to understand the one aspect that determine who receives government assistance on who doesnt. The Federal Poverty Level (FPL). This formula is based off of your gross income and the number of family members. In order to be considered for benefits your FPL would have to be below 100%. When the census most uninsured Americans states cost of premiums and out of pocket cost such as copayments as a reason for not having health care coverage. The majority of uninsured Americans are families that have lower income and cant afford to pay the out of pocket cost for insurance. Although Medicaid fills in gaps in coverage for over 40 million low-income Americans, coverage for adults is very limited. Non-elderly adults must meet stringent financial eligibility standards, and even the poorest are generally ineligible if they do not have children. Parents may qualify for Medicaid, but their financial eligibility levels are set much lower than children's. Uninsured rates vary widely across states largely due to differences in state economies and levels of employer-sponsored coverage, the share of families who live on low incomes, and the scope of state Medicaid programs. Eligibility requirements for state Medicaid programs vary and can

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be very strict. In addition, with often complex enrollment procedures, public coverage can be difficult to obtain and even more difficult to maintain over time. Another large groups of people contributing to the number of uninsured Americans are people who have either lost their jobs or employers did not offer insurance or the insurance company refused to provided them coverage.
Sometimes

workers are not eligible for health insurance because they are a part-time worker or

they may be newly employed and in a waiting period before their benefits are available. Among workers in firms offering health coverage, those in firms with a greater percentage (greater than 35 percent) of part time workers are less likely to be covered as opposed to those in firms with a smaller percentage (less than 35 percent) of part time workers. Seventy one percent of workers in firms with fewer part time workers are covered while only 35 percent of workers in firms with more part time workers. The concern of this particular group of people is cost and how much they will have to pay for health care insurance when inflation and other living expenses get the better half of their paychecks. As stated before most uninsured families have low income so additional taxes, bills, or penalties can be seen as adding to the hardship. Another voice that we have heard in the news and political advertisements are the small business owners. Small businesses before werent required provided health insurance if they had less than 100 fulltime employees, now small companies are mandated by law to provide health insurance to their employees. The Affordable care Act now require small businesses with 50 fulltime employees or more to provide health care insurance to their employees. The recession of 2008 made it very difficult for small businesses to prosper. After 4 years the economy is finally

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showing signs of recovery and small business are now staying afloat and competing with bigger companies. Small business owners now feel like they have to jump through another hurdle and are weary of what this means for the future of their business. Most small business owners find the ACA confusing to understand and are not sure how the new law will affect them. Politicians have been the front runner in the media and have spoken the loudest on the issue of ACA. Republican politicians, particularly the House of Representatives republicans have voted 50 time to repeal the ACA. On the bases speculations that it will kill millions of job and the bumpy rollout of the massive law is proof it will fail. In addition to killing jobs and the bumpy roll out. The politicians have argued daily about the U.S. Budget and deficit. The most recent government shutdown was because of the ACA, opposition leaders like Ted Cruz Texas Republican Representative and Michelle Bachman Minnesota Republican Representative and other Tea Party members tied delaying or defunding ACA to the Budget for Fiscal year 2014 (October 1,2013-September 31,2014). The Senate and President would not negotiate with the Republican House of Representatives and other Tea Party members on a bill that was already in place and funded from the Budget for Fiscal year 2013. The gridlock lead to a 16 day government shut down. The Budget was finally approved and ACA still remained operational. Another issue politicians discuss when asked about ACA is Medicaid and Medicare, the government assisted health care for low income and elderly (65 or older). ACA expanded Medicaid to the 133% FPL and pay 100% of medical bills for 2014, 2015, and 2016; 95% in 2017, 94% in 2018, and 93% in 2019 and 90% 2020. Some politicians believe Medicaid is unsustainable. The government spend an estimated $211 Billion on Medicare and State childrens Health Insurance Program (SCHIP).

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The media cover the Affordable Care Act daily; many stories about it whether they are true or false have been about cost as the underlying factor of a problem with healthcare reform. The importance of cost present challenges in a different ways on an individual, business, and government level.

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