Obamacare Public Policy and  Public Administration

Question 

Research Paper

The Research Paper must demonstrate understanding of the reading as well as the implications of new knowledge. The fifteen-page paper must integrate readings, class discussions, field research, and literature review into proposed solution.  It may include explanation and examples from previous experiences as well as implications for future applications.  The purpose of the Research Paper is for you to culminate the learning achieved in the course by describing your understanding and application of knowledge in the field of social science.

Your Research paper should focus on a topic selected in consultation with the course instructor, which was done in Week Three—see Research Paper Focus included herein. In this project, you will examine a specific political or social issue. The topic is the Patient Protection and Affordable Care Act—better known as Obamacare. You will: 

• Develop a public policy to address the changes or updates to the existing public policy-Obamacare. 
• In all cases, the focus should be on in the development of a public policy, to include utilizing all aspects of the public policy lifecycle. 
• Consider use of field assessments, literature searches, personal knowledge/experience, and community records to source content. 
• About 7 sample policy papers and one news article are included at the end of these instructions, not only for format—but to provide the writer with some idea of the various ideas and content related to the policy.
• The first paper, Research Paper Focus is my paper detailing how the requested paper will be constructed. Some of the information in the other papers are dated. The requested paper must contain current information with relevant facts and documentation.
• All sample papers herein are part of the TurnItIn database, and as such, will register in the match index. The requested paper must be original and plagiarism free.

Obamacare Public Policy and  Public Administration

The Patient Protection and Affordable Care Act

To many individuals not only in the United States, but from all over the world, ObamaCare was a bold step taken by the united state government. Others refer it as Patient Protection and Affordable Care Act (PPACA) or Affordable Care Act (ACA) which was aimed at transforming all the hospitals and physicians financially, technologically and clinically. Through ObamaCare, they could give better health services, improve the quality of the services offered, lower the cost as well as improve their distribution methodologies. Despite having positive intentions towards the American citizens in that it focused on increasing health insurance quality and affordability to the common citizen, the cat faced a lot of challenges before it was finally implemented by the Supreme Court. To some politicians and public figures in the country felt that the act did not follow the right channels in its formulation and creation. There are certain processes, procedures as well as rules that the government should have considered and followed before actually passing any legislation on its citizens. Despite being signed into law in 2010, the act was not put into practice until 2013 due to what most individuals consider as unconstitutional within the policy. With the Affordable Care Act in place, millions of Americans, particularly from the middle and low-income levels have access to health insurance irrespective of the existing conditions and requirements.

Signed into law by President Obama, some people feel that the Obama administration had crossed the boundaries on several occasions when it comes to public policies and ObamaCare is an example of this abuse of power. Generally, the ObamaCare involves the government’s responsibility too much in health care management and on the way interfering with the way services is offered and provided to the common citizens (Rosenbaum, 2011). It is worth noting that despite the reduction in the number of uninsured citizens in the United States, there is a high probability the ObamaCare is likely to increase the federal spending, which in turn increase the percentages of taxes charged on the people and as a result, the act creates more problems than solutions. According to policy makers and experts, ObamaCare is likely to face challenges such as inaccessibility to doctors, failures of the health systems to verify coverage and pay claims and high deductibles in the form of taxes.

ObamaCare was put in place based on the fact that the united state has the most inconsistent health care system that has failed to work as a single unit for a very long time. As a matter of fact, each state government has unique and diverse health programs, and at times they work in parallel to the federal health program, and as a result, they create fragmentation as well as confusion among most individuals. These parallel working programs have resulted in an increase in paperwork and bureaucracy which leads to loss of funds set aside for administration cost. Besides, the need for better health programs prompted the Obama administration to come up with ObamaCare program which attempts to improve the quality of services offered by the healthcare programs through the provision of health insurances to all citizens. Considering that there is an increase in the number and size of the aging population, which increases the need for more and quality care, the government felt the need to make a common health program that should be adopted can implement by all state governments as well as the federal government. Notably, the lack of proper, efficient and effective cost analysis systems that has led to poor cost measurements and lack of integrity and accountability in the healthcare industry has been the driving factor for the formulation and implementation of the ObamaCare (Jones, 2014). Thus, it is correct to say that the inability to effectively and accurately measure health costs as well as the lack of appropriate comparison of costs with outcomes has led to the development and implementation of Patient Protection and Affordable Care Act.

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Problem statement

The United States of America have been seeking ways and methods to regain its economic footing and rebuilding its prosperity in recent years. However, for this to happen, the country has to control the nation’s collective economic as well as human costs concerning their health. Poor health of citizens in a country is likely to exert immense force and pressure on employment rates, interest costs as well as other tangible factors that ultimately affect the ability of the country to maintain a strong worldwide economic position. As a result, the United States government implemented Patient Protection and Affordable Care Act with the aim of extending health insurance coverage to all people especially who lack it.

However, the policy is not popular with all Americans, with some especially the Republicans feeling that the policy brings more harm than good to the American citizens. The policy has both political and social effects on most individuals, particularly those in the formal sector. The law requires all businesses and enterprises with more than 50 employees offer health insurance to their employees and to some experts, such a requirement will have a negative impact on the employment level in the country especially in the formal sector. As a matter of fact, the employment level is expected to go down in the next two decades considering that many organizations will not be willing to have a large labor force to avoid insurance expenses.  On the other side, there are those who feel that the policy will have a positive effect on the lives of many Americans considering that 22 million would lose their medical insurance if the Act is replaced or repealed besides increasing employment opportunities in the healthcare industry by 9% (Oberlander, 2012). Most scholars, researchers, and politicians, as well as key figures in the society, have shown and produced mixed feelings concerning Patient Protection and Affordable Care Act. Some feel that the policy will produce positive reports and benefit every American citizen while others think that the policy will have negative effects on Americans not only concerning their health life but also their political and social lives.   It is in the middle of this confusion in finding the necessity and the importance to conduct research to determine political and social issues that arise from the use and implementation of Patient Protection and Affordable Care Act.

Research objectives

General objectives

To determine social and political impact of Patient Protection and the Affordable Care Act on the lives of American people

Specific objectives

1. To determine the effects of Patient Protection and Affordable Care Act on job creation and employment in the formal sector
2. To determine the effect of Patient Protection and Affordable Care Act on the constitution of the country

• To determine the effect of Patient Protection and Affordable Care Act on existing insurance companies covers as well as current doctors

Research questions

1. Do Patient Protection and Affordable Care Act affect job creation and opportunities in the formal sector?
2. Do Patient Protection and Affordable Care Act affect the constitution of the country?

• Do Patient Protection and Affordable Care Act affect the existing insurance companies, covers as well as current doctors?

Literature Review

Since its implementation, different scholars and politicians have developed different theories in the attempt of explaining why the Patient Protection and Affordable Care Act was developed and implemented in the United States. This [part of the assignment will review some of the existing literature that is related to Patient Protection and Affordable Care Act. The study will entirely focus on the political and social implications of the implementation of the ObamaCare.

Ethical Perspective of the Patient Protection and Affordable Care Act

The question of health care reforms brings important ethical issues such as justice with it, considering that for a long period, individuals, communities and the legislature has struggled to provide quality health services without sacrificing the basic rights of its citizens. Most of the provisions of the Act are designed to expand the insurance coverage, control costs, and target prevention, especially for the youths whose access to healthcare as well as health insurance has been called into questions in the recent past. Besides, the act also stipulates that insurers should not deny coverage for pre-existing conditions while the government should make efforts to subsidize insurance premiums and provide incentives for businesses to provide health care benefits to their employees (Manchikanti, 2011).

Generally speaking, the American people wanted four important factors to shape their health systems, prompting to the development and implementation of Patient Protection and Affordable Care Act. First and foremost, the American health system needed to be reformed so that it can provide quality health care and they can derive the greatest benefits. For very long time, the health system has remained fragmented with each state having its unique health programs making it difficult for the federal government set the standards for the quality of the services for being provided. However, with the implementation of the Patient Protection and Affordable Care Act the government has an opportunity to control the Quality of all the health care services given in the country. Secondly, there was the need to improve the freedom of choice where individuals can choose who, when, and where they want to get their health services. By improving the quality of the services, they offer as well as giving common services in all hospitals and clinics improve the consumers’ choice considering that there will be competition among health care organizations based on the services they offer and thus the consumer has a choice to choose whom they want. Finally, given the financial power of the American economy, mo0st citizens expect their health care to be affordable to all individuals irrespective of their economic background or their earning level so that they can have resources for other basic needs.  Moreover, there is the need for all citizens to participate in the costs as well as benefits of the health care, prompting the government to come up with a policy that brings equality and accessibility to all health care services in the form of Patient Protection and Affordable Care Act.

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Marketplace Competition Theory

The competitive market boasts a large number of producers who compete in the attempt of satisfying the wants and the needs of a large population of consumers. Often in a competitive market, there is no single producer or consumer who has the power to dictate the prices of goods and services or dictate how the market operates (Wilensky, 2012). In addition,   competitive markets prevent exploitation of consumers by the producers by not giving them the power and ability to determine how much to produce in the market.

Competitive markets regarding health care ensure that there is more than one single producer of a certain product and service in the market to eliminate monopoly as well as increase chances of competition among the producers.  Through the execution and implementation of Patient Protection and Affordable Care Act, the Obama administration brought competitiveness in the healthcare sector by setting the standards of the services offered by all health care organization as well as the provision of a common product in the form of health insurance among all employers. However, for these markets to work effectively and efficiently, all health organizations must be driven by the needs and desires to make a profit out of their services as well as an attempt to lure more and more customers from other organization through the quality of the services provided. The possibility of generating profits provides an incentive for the most organization to join the health industry and in the process; the government can increase the accessibility of health services to most if not all individuals. In addition, the need for rivalry in the health care industry prompted the government to turn on Patient Protection and Affordable Care Act as a way of bringing efficiency in the industry as well improve cost management in most organizations.

Conceptual Framework

Patient Protection and Affordable Care Act and job creation and opportunities

Despite providing opportunity and a chance for more than 22 million individuals in the United States who are not economically well to access health care insurance, Patient Protection, and Affordable Care Act is expected to increase the country deficit. However, experts believe that the negative effects PPACA will not be felt shortly, but its effects on the economy will be felt in the long term, and thus, to them, PPACA  brings more of bad news that good news. The Act contains other provisions such as new insurances mandates, new taxation percentages as stipulates employers’ penalties in case they fail to honor their responsibility concerning health policies that will have a direct implication in the cost of insurance cover as well as the decision of the employers to hire people.

Other new provisions such as new taxes, on insurance companies, pharmaceutical organizations and other medical facilities companies are likely to be shifted to the employers who are likely to reduce the number of individuals they hire in their organization to reduce as well as control such costs. Statistics show that elimination of annual coverage limits, forbidding insurance companies from excluding children with pre-existing conditions as well as the elimination of cost-sharing for preventive services in Medicare and private plans will negatively affect the lives of most Americans regarding employment opportunities. The provisions mentioned above of the Act will apparently lead to richer benefits package at the expense of higher insurance premiums which will prompt most employees to reduce their employees’ salaries and wages as well as job creation (Hall, 2014).

 It is worth mentioning that despite posing a threat to job creation in other sectors and fields Patient Protection and Affordable Care Act is likely to increase in the healthcare industry owing to the increasing number of aging population. Considering more individuals will have health insurance coverage, they can afford to cater for their health services which will increase the demand for home-based care which will, in turn, increase the number of individuals needed to take care of this aging population. However, the number of employment opportunities created in this industry cannot be compared to the number of jobs will be lost in other sectors owing to the new regulations.

Patient Protection and Affordable Care Act and the United States Constitution

Patient Protection and Affordable Care Act can be described a government statute that was formulated and developed by the federal government and enacted by President Barrack Obama on 2010. However, the act was not fully implemented until October 2013 considering that the Supreme Court had to rule in its favor after facing several constitution challenges from various parts of the economy and the country. To many, especially the Republicans who were against this law felt that the government abused their authority, power by attempting to control as well as manage the provision of health care in the industry. However, the first major concern of the Act regarding the constitution of the United States is that provision that requires many people if not all to carry health insurance or face a financial penalty. Most players feel that Patient Protection and Affordable Care Act is a controversial law and the fact that such clauses and provision conflicts with the constitutions commerce clause make it even more controversial and complex. Moreover, this act interferes with individual freedom to choose what is best for his or health despite being stipulated in the constitution of the country that at no single point should the freedom of choice and movement of an individual should be restricted unless he or she is a danger to himself as well as others. Further research indicates that Congress is given the mandate and the power to influence as well as regulate interstate commerce, but not to order persons and organizations to engage in it (Manchikanti, 2011). Thus, it is quite confusing to most individual why the government chose to ignore such important clauses of the American constitution resulting in rebellion from parts of the Congress and sectors of the economy. Despite being supported by the Supreme Court judges, the Supreme Court agreed that the act was overstepping its legal boundaries since the government cannot pinpoint the place in the constitution that provides the source of the power it is exerting. This prompted most Republican members to rebel against the government.

Patient Protection and Affordable Care Act and the existing insurance companies, covers as well as current doctors

Patient Protection and Affordable Care Act is projected to expand health insurance coverage to9 over 25 million individuals around the country. This influx of people with insurance coverage is likely to cause havoc and tsunami to the health care systems given that patients were likely to flood in many health care organizations and facilities overworking the already strained and fragile system. It is well known that the American health system has struggled for decades to effectively and efficiently serve the existing customers and thus, it is quite clear that the system is not ready to handle the increase in some patients as the Patient Protection and Affordable Care Act is implemented. The attempt to train new physicians, nurses as well as other medical practitioners will take months if not years leave alone forcing the government to incur an extra cost in training and educating new workers in the healthcare to meet the new demand (Rosenbaum, 2011). The truth is that a system overload is unlikely to avoid despite the willingness and dedication of most, if not all medical practitioners to help patients in need, but the mere logistics of expanded care delivery, the current growing shortage of personnel and limited resources demoralize most doctors and nurses.

Besides, five million individuals and business organization mainly in the healthcare insurance sector of the economy are likely to lose their market share as most of their policies are likely to be canceled. As the act is implemented, there is a reduction in Medicare reimbursement rates and cost pressures on insurance companies will force the elimination of higher priced doctors and insurance companies creating unemployment of the way. Despite assurances from the president, the truth is that this is likely to happen sooner than later. Additionally, the transformational changes that are likely to be brought by law are poised to complicate and negatively affect health care workers and their abilities to provide the much-needed care for the increasing number of people who have access to health care. These changes are likely to increase regulatory burdens, reduce payments, impose new penalties and disregard personal preferences and values, thus forcing most of the already existing players in the industry out of business.

Research Design

Research design provides the glue that helps in keeping the various parts of the study together. This research chose to utilize descriptive research design to gather and obtain information and data which were used to make the conclusion of the study. Descriptive research design assists a scholar in gathering information without changing the original habitat of the respondent. On the same note, this study used both primary and secondary data to complement the data obtained from the field and to make a sound conclusion regarding the central question.

The population of the study consisted members of the Republican Party who were in the forefront to rebel and oppose the new health care laws (Hall, 2014). In addition, the research sought to obtain the views and feelings of most doctors, nurses and other medical practitioners in the healthcare as well as workers in the health insurance industry. The population in a study can be described as a set of people, services or elements that are being investigated in the study. As a result, the population mentioned earlier was investigated to give their take on the Patient Protection and Affordable Care Act given the fact that they are the most widely affected parties both politically and socially by these laws. A population of 3200 was chosen to form the basis of this study.

Sampling design

Given the population size of the study, it might be a little difficult for the researcher to conduct interviews, deliver questionnaire as well as survey them all. As a result, it was prudent and necessary to get a sample out of the large population that could be studied and investigated to get the results. A sample is usually a subset of the target population and sampling involves the selection of subjects to b studied in the study. Usually, a 30% of the whole population makes a reasonable sample to give accurate and reliable results that can be used to make the conclusion of the study. Thus, a sample of 960 respondents was used in this study. On the other hand, given the differences between our target population as well as professional background, a stratified sampling design was used where the population was divided into groups with a common background. Thus, Republican Party members were divided into one group; insurance company workers were in the other group and finally health care workers in the other group (Oberlander, 2012). Each group will be asked an independent question based on their profession and areas of expertise.

Basically, primary data was gathered through the distribution of questionnaires either face to face or through the email to enhance the privacy of the respondents. On the other hand, secondary data were obtained from journals, books and articles from past studies to support the primary data obtained.

Results

From the table above, it is easy to tell that Patient Protection and Affordable Care Act did not have much support from various professions mainly because of its social and political repercussions that come along with its implementation. Despite being supported by the government against the will of the people from some quarters, where only 105 members of our sample supported the act to 443 who felt that the new health care policies are likely to bring more harm than good to the health care industry. Some of the reasons cited by most parties for not supporting the new act included:

1. Increase in health care costs – through the Patient Protection and Affordable Care Act the youths have 44% increases in premiums attributed to the 3:1 ration forcing the young and working generation to subsidize the old in the health insurance market where they are forced to pay three times of what they used to pay. This forces the younger generation to go without the health insurance despite the knowledge that they will be fined if caught.
2. Harder to keep jobs – because o the new provisions of the Patient Protection and Affordable Care Act most employers are forced to cut their workforce as well as the hiring hours to avoid the extra cost that comes in the form of insurance packages to avoid the risk of being fined. Such coverage, such as federal standardized health insurance for all employees in an organization is very expensive for investors forcing them to cut their workforces or completely go out of the business.
3. An explosion of the national debt – most of the republic party members cited their displeasure with the fact that the national debt had skyrocketed over a single year. Statistics show that by March 2015, the Patient Protection and Affordable Care Act had a net cost of $1.207 trillion. It is a clear indication that in the next ten years, the cost will rise to 17 trillion, which will be financed by the citizens through taxation which means an increase in tax to the peasants(Jones, 2014).

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In conclusion, it is correct to state that despite having the best intention at heart of bringing cheap medical care to the American citizens, Patient Protection and Affordable Care Act is likely to bring more harm than good not only to the American economic systems but also to the labor market. If the above discussion is anything to go by, the citizens are likely to suffer more than they enjoy the new health care laws with an increase in tax, increase in unemployment as well as live with the fear that the government can formulate another law that limits their freedom. The truth is that the ObamaCare shows that the government can use excessive power to control individual and organizational activities that they feel are not important to the nation considering that it challenged the constitution in this case (Wilensky, 2012). Moreover, the new rules have both social and political repercussions that are likely to be felt for the next two decades if drastic measures are not taken to correct and rectify the situation. Despite the new president-elect promising to honor and protect Patient Protection and Affordable Care Act, he is under constant pressure to do away with these laws so that he cannot make the same mistakes that President Obama made.

References

Hall, M. A. (2014). Obamacare: what the Affordable Care Act means for patients and physicians.                         . Bmj, 349(7), , g5376-g5376.

Jones, D. K. (2014). Pascal’s Wager: health insurance exchanges, Obamacare, and the                               Republican dilemma. . Journal of health politics, policy and law, 39(1), , 97-137.

Manchikanti, L. &. (2011). Obamacare 2012: prognosis unclear for interventional pain                             management. . Pain Physician, 15(5), , E629-40.

Oberlander, J. (2012). The future of Obamacare. . New England Journal of Medicine, 367(23), ,               2165-2167.

Rosenbaum, S. (2011). The Patient Protection and Affordable Care Act: implications for public               health policy and practice. Public Health Reports, , 130-135.

Wilensky, G. R. (2012). The shortfalls of “Obamacare”. . New England Journal of Medicine,                    367(16), , 1479-1481.