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Ashton Irvin
Professor Padgett
ENGL 102
11 April 2017
Healthcare has been a topic of debate for many years. However, since the Obama
administration and the enactment of the Patient Protection and Affordable Care Act (PPCA, for
short the Affordable Care Act (ACA), this debate has become more prevalent. Obama was not
the first person to think of universal healthcare as a solution to the healthcare problem, but he did
take one of the first major steps in implementing it. The Affordable Care Act was enacted in
2010, and it represents the most significant overhaul of the United States health care system
since the passage of Medicare and Medicaid in 1965 (Rudnicki). This act worked towards a
more uniform health care that helped cover more people in the US. Since its enactment, more
than twenty million people have gained insurance. Throughout Obamas presidency, many
people talked about wanting to repeal the healthcare act, but with Obama still in office, it was
protected. According to the authors of Expected and Unexpected Consequences of the Affordable
Care Act, no matter your position, the ACA is a reality. However, now that Obama is out of
office and Trump is president, the law is no longer under protection (Oberlander). With the recent
election, the future of the PPCA is looking uncertain because the current administration is
uncertain with what they want to do with the act (Pollack). The debate now is whether or not we
should repeal the act and replace it or keep it, and the debate is going to continue unless we are
able to reform the ACA. If this act were more popular amongst Americans and if more
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Americans shared the same views, more people would want to reform Obamacare rather than get
rid of it (Oberlander). In order to solve this problem, we as a nation should find a way to
implement the positive effects that the ACA has had on healthcare in the United States and
The positive effects of the ACA can be split into three categories: insurance industry
reform, expansion of coverage, and the triple aim of improved access, improved outcomes, and
reduced costs of care (Rudnicki). The price of insurance varies from company to company, and
they all have different coverages. One of Obamas main intentions for the ACA was to make
healthcare uniform. He wanted everyone to have the same coverage at the same price, or the goal
as Scott Gottlieb said was to make sure everyone had exactly the same set of benefits. Before
this, people could choose the insurance they needed based on the coverage that they needed. For
example, a family would choose a plan with pediatric care whereas an elderly person would
choose a plan that met their health needs. This caused the price of insurances to vary, but now
everyone with Obamacare pays the same amount of money for the same coverage no matter the
actual coverage you need (Gottlieb). A huge appeal that the PPACA has on Americans, is the
patient protection part. This part of the act ensures that Americans can still be covered by
insurance despite pre-existing conditions which is a problem many Americans face with other
insurances. The last category of the positive outcomes improves access and outcomes and
reduces costs of care. According the original goal of the act, it was supposed to increase the
opportunity for thirty to forty million Americans to be covered by health insurance (Hader). One
way that this was achieved is that it allowed more people to qualify for Medicaid. This allows
more people who are unable to afford insurance to apply for health coverage through the state.
Richard Hader said that the Affordable Care Act was our opportunity to set the direction of
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healthcare. This suggests a shift and a hopeful improvement in not only healthcare coverage but
Despite the positive outcomes of the healthcare reform, it has its flaws. One of these
flaws is that it has changed the way that Medicaid is administered. Obamacare was supposed to
help increase the number of people who could qualify, but it also said that the state could choose
not to expand (Why Is Obamacare so Controversial?). This causes poor and working-class
families that do not qualify to pay for private insurance which can be expensive (Why is
Obamacare so Controversial?). Another problem that Medicaid faces under the ACA is that even
though it recognizes the importance of Medicaid, it does not anticipate the ongoing need to
support safety net providers, and many Americans depend on safety net providers for health
care (Shin). It has been predicted that insurance premiums could rise an average of twenty-five
percent this year, and this is not a recent prediction (Why is Obamacare so Controversial?).
There will also be an increase in government subsidies, but those who have health coverage
under Medicaid, will not be able to benefit from these subsidies (Why is Obamacare so
Controversial?). According to Pew Research, seventy-six percent of people disapprove of the law
because they believe it is too expensive (Motel). This raises the question of whether or not the
Affordable Care Act is actually affordable. Pew Research also says that the number one reason
that people disapprove of this healthcare law is because it has too much government involvement
(Motel). This goes into the fact that it is required for all United States citizens to have health
insurance. If people do not sign up for health insurance, they are fined, so it is clear to see why
Enrolled Through
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In order to expand and achieve universal coverage, the health care act requires all US
citizens to have health insurance. This goes back to Obamas plan to have a uniform healthcare
where people pay the same and get the same coverage. This sounds like a great plan until people
are having to pay more for coverage that they do not necessarily need. In some cases, Americans
cannot afford Obamacare because the aid that is available is not substantial enough to buy it.
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This has caused some Americans to just pay the fine for not having healthcare because the fines
are too small to convince them to enroll (Why is Obamacare so Controversial?). For some, not
being on Obamacare is better for them because they can choose the coverage they want or need
for cheaper. This leads to another major problem because many insurance companies are backing
out of Obamacare because of a lack of Americans signing up. This causes insurance costs to
increase for everyone which then causes another decrease in participation, and this is due to a
lack of appeal from the healthcare act (Why is Obamacare so Controversial?). When Obama first
brought up the act, many people only looked at the positives because it was said that the goal
was to increase healthcare coverage across the United States. As you can see from the chart
above, there was an increase of enrollment early on, but enrollment began to decrease by 2013.
Many people began to see the negative aspects of the Affordable Care Act because although it
increases the coverage a person receives, it means that people are paying for coverage that they
In order to shrink the division amongst those that approve and those that do not approve,
our government needs to find a way to incorporate the positive aspects of the ACA while fixing
the negative aspects that Americans have problems with. Some of the biggest reasons that people
support this law is because it expands health coverage to the uninsured, and it assures coverage
for people with pre-existing conditions (Motel). This is one aspect of the healthcare act that
needs to be carried into the next healthcare reform. A contradictory position on the ACA has to
do with Medicaid. In order to increase approval, we need to keep the part where qualifications
for Medicaid increase, but we need to require states to issue this. This may only directly affect
one group of people, but it will be one step closer to helping solve this problem. In a new,
reformed healthcare act, we need to make sure that people are paying for the coverage that they
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actually need instead of just giving people coverage for everything. This could be improved if we
started with a framework for health, rather than health insurance (Rudnicki). This means that if
we are able to give people only the coverage they need at an affordable price, we will be able to
improve the health of individuals rather than make them pay for coverage they do not need. The
triple aim goal was a good thought process, but it is the most expensive option and assumed
that if everyone has health insurance, then they also have health care. This means that when the
ACA was created, it was designed with a flawed assumption (Rudnicki). We need to target health
care places and officials and make quality universal rather than price because if quality is the
same, then the price will eventually become universal. Ultimately, the goal of the new reform
needs to target individuals needs to help improve their health, and from here we need to figure
public opinion
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By creating a new healthcare act or policy that fixes the flaws and implements the
positive effects of the Affordable Care Act, we will be able to work towards resolving this debate
on healthcare. The United States has witnessed a major shift in healthcare over the past few
years, and this is going to continue to change whether we reform the act or not. As seen in the
chart above, more people strongly oppose the healthcare act than they approve it. Overall, there
are more people who look at the act as being more negative than it is positive. Personally, I
benefit from Obamacare because most other insurances do not accept me because of preexisting
conditions. However, my parents end up paying three hundred dollars a month for my insurance
when they only end up paying around four hundred dollars a month for them and my brother. A
reformed health care act needs to include patient protection from pre-existing conditions and
increased coverage while making states implement Medicaid and decreasing the cost of plans so
that more people will be able to afford to sign up. We will never be able to completely resolve
this problem because the debate has occurred for a very long time, but a new, reformed act will
Ashton,
You deserve much kudos for taking on a complex and difficult topic. You clearly have done lots
of reading and the research youve compiled here is great. It seems to me that your thesis is
largely like youre taking the current temperature (or use a hammy medical metaphor) of the
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ACA. I dont think anyone needs persuading that the law isnt perfect and that certain aspects
need amending. What I would like is to get a clearer sense of who your audience is and what you
want to persuade them of. Is it people who want to repeal and replace? if so, that would really
guide the direction of your argument. And I think thats where my biggest concern is: there
doesnt seem to be a guiding compass for this paper aside from saying there are problems with
the current law. Maybe you want to persuade folks who want to toss the whole law out to slow
down and reconsider. Im not sure. But in revision picture your audience and write for that
Works Cited
Gottlieb, Scott. "Do You Win Or Lose Under Obamacare? What You Must Know To See How
You'll Fare." Forbes. Forbes Magazine, 20 Nov. 2013. Web. 22 Feb. 2017.
Hader, Richard. "Affordable Care Act...Ready, Set, Go!." Nursing Management, vol. 43, no. 8,
Motel, Seth. "Chapter 2: Views of the Affordable Care Act and Its Future." Pew Research Center
for the People and the Press. N.p., 04 May 2014. Web. 10 Apr. 2017.
Oberlander, Jonathan. "The End of Obamacare." New England Journal of Medicine, vol. 376, no.
Pollack, Craig Evan, et al. "A View from the Front Line - Physicians' Perspectives on ACA
Repeal." New England Journal of Medicine, vol. 376, no. 6, 09 Feb. 2017, pp. e8.1-e8.3.
EBSCOhost, doi:10.1056/NEJMp1700144.
Rudnicki, Marek, et al. "Expected and Unexpected Consequences of the Affordable Care Act:
Gastrointestinal Surgery, vol. 20, no. 2, Feb. 2016, pp. 351-360. EBSCOhost,
doi:10.1007/s11605-015-3032-8.
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Shin, Peter and Marsha Regenstein. "After the Affordable Care Act: Health Reform and the
Safety Net." Journal of Law, Medicine & Ethics, vol. 44, no. 4, Winter2016, pp. 585-588.
EBSCOhost, doi:10.1177/1073110516684801.
"Why Is Obamacare so Controversial?" BBC News. BBC, 11 Nov. 2016. Web. 27 Feb. 2017.