The document summarizes the Affordable Care Act and identifies some of its flaws and deficiencies. It discusses two main goals of the ACA - to increase the number of insured individuals while reducing overall healthcare costs. However, it notes the ACA has yet to achieve these goals. One deficiency is that individuals who remain uninsured face a penalty fee, which does not actually encourage accessing healthcare. Another issue is the "coverage gap" where many remain uninsured. The document proposes solutions like a state-run program to cover those in the gap and bundled payments to replace fee-for-service. It argues more reform is still needed to control rising costs while expanding access.

1. Running head: AFFORDABLE CARE ACT 1
HCS 410- Community Health Organization and Administration
Project Assignment #2 – Affordable Care Act
Dr. Ballantyne
Gina Leymeister
Alvernia University

2. AFFORDABLE CARE ACT 2
Abstract
The Affordable Care Act has many flaws within its piece of legislation. The objective of
the Affordable Care Act is to insure more of the population while reducing the total cost
of healthcare in America. This piece of legislation has yet to reach both desired goals. By
analyzing the reforms that are necessary to ensure that the population has health care
coverage, many solutions can be discovered. However, the solutions need power behind
them to become implemented. By identifying the deficiencies of the Affordable Care Act,
one can begin to find achievable solutions.
Keywords: Affordable Care Act, The United States, goals, solution, cost

3. AFFORDABLE CARE ACT 3
Affordable Care Act
On March 23, 2010, the Affordable Care Act (ACA) was signed into effect by
President Obama. The Affordable Care Act covers 16.4 million people who would not
have coverage before this piece of legislation. There were many key events and
provisions that lead to the creation of the ACA. The legislation has many goals, but two
of the goals are to increase the number of those uninsured while reducing the money
spent on healthcare. However, it is not evident given the current statistics, that the United
States has achieved either of the two goals listed prior. Like any piece of legislation, there
are deficiency’s that are prevalent (History of the Affordable Care Act (ACA)).
One of the main deficiencies of the Affordable Care Act is that if one does not have
healthcare then he or she has to pay a fine for not being covered. If an individual does not
want to enroll in a healthcare plan, then one is affected by being charged a fee at the end
of the year. The fee that one has to pay depends on one’s household size, income, and
other subjective circumstances. This deficiency is contrary to the main goal of the
Affordable Care Act (Cutting Health Care Costs).
The goal of the Affordable Care Act is to ensure that all citizens have healthcare
coverage. Therefore, the fine is meant to discourage a person to not have insurance, but at
the same time, is not encouraging the access to healthcare. Many who chose not to enroll
in a healthcare plan, decide to pay the fee because to the individual it is more cost
efficient. However, many do not choose to not have coverage, but fall into a “coverage
gap”. The coverage gap includes all individuals that make more than the poverty line or
the 138th percentile and are not entitled to Medicaid. In addition, the coverage gap also

4. AFFORDABLE CARE ACT 4
includes those who are not age 65 or older for the Medicare program. Therefore, this
leaves 23 million persons still uninsured (History of the Affordable Care Act (ACA)).
A solution to this problem would entail creating a program funded by the state that
would insure those who fall into the coverage gap. The program would run like Medicaid
with an entitlement purpose, but would cover the individuals until one can afford a plan
in the private insurance market. However, to protect the misuse of the program each
individual will have to meet with a representative of the program yearly to insure that the
use of the program is still needed for the family or individual. In addition, the cost of this
program will increase the cost spent on healthcare, but at the same time reduce the cost.
Therefore, there will be no loss or gain on the money spent in the healthcare system.
The money spent on healthcare in The United States does not justify the number of
those still uninsured, procedures that are not top quality, and numerous underpaid
professionals. In general, The United States spends $8,745 per capita every year, whereas
other countries spend on average $3,484 per capita. The Gross Domestic Product (GDP)
of the United States expenditure is 17.6 percent. America spends more than any other
country on healthcare without having the best quality of care (Deficit-Reducing Health
Care Reform).
There are two reasons that America has an increase in expenditures compared to other
countries. One stems from the medical technology, and the other fragmented health
insurance that does not have a set price. The United States is more advanced in
technology than most countries but does not have a cost-effective way of delivering
healthcare. Health insurance drives the price of healthcare to be higher since there are

5. AFFORDABLE CARE ACT 5
different rates that can be set for health insurance coverage (Key Facts about the
Uninsured Population).
According to the New England Journal of Medicine, national health spending is
projected to continue to grow faster than the economy, increasing from 18 percent of the
economy to about 25 percent by 2037 (Cutting Health Care Costs). In addition, even with
the new law, federal health spending is projected to increase from 25 percent of total
federal spending to about 40 percent by 2037 (Cutting Health Care Costs). The statistics
listed prior are eye opening to the reader to understand the importance of cost controlling,
which the Affordable Care Act has attempted to implement, but has not succeeded
(Cutting Health Care Costs).
However, there is a center that focuses on the control of healthcare costs. This center
is called The Center for American Progress. The Center for American Progress has
leading health policy experts that include current and former federal and state officials,
executives of health insurers and hospital systems, physicians, and economists. The main
focus of The Center for American Progress is to develop bold and innovative solutions to
contain health care costs. Their recommendations are in agreeance with the author to
offer a suitable solution to control health care expenditure (Cutting Health Care Costs).
This first solution is to promote privately negotiated payment rates within global
spending targets. This would entail payers and providers negotiating payment rates that
would be suitable for all payers and providers in that particular state. If there was a
universal fixed rate, then the cost would decrease in the area of payment rates. The
privately negotiated rates would have to fit within a global spending target for both the
public and the private payers in the state. The only difficult aspect of this solution would

6. AFFORDABLE CARE ACT 6
be the agreement of the fixed rate-spending target. However, this rate could be within a
range, so that there can be a medium rate, but no rate could exceed a given amount
(Cutting Health Care Costs).
In addition, instead of paying a fee for each service, physicians and hospitals should
receive a fixed amount for a bundle of services. This could be titled bundled payments.
The Center for American Progress projected that within 10 years; Medicare and Medicaid
should base at least 75 percent of the payments on alternatives for fee-for-service
payment (Cutting Health Care Costs).
Moreover, in order to control the cost of materials and supplies that are needed for
medical care, the government should not be the one to set the prices for the material. The
manufacturers and suppliers should compete to offer the lowest price. The market-based
prices should then be extended to all federal health programs. This would in turn reduce
the overall cost, but increase the revenue for medical supplies and materials. The experts
in regulating the economy and analyzing the budget agree that action needs to be taken to
control health care expenditure. According to Ezekiel Emmanuel, who is a senior fellow
for The Center for American Progress,
"Ever-rising health care costs reduce middle-class families' take-home pay and threaten
America's standing in the world. These proposals would build on the health
reform law to dramatically improve our health care system. As Congress looks to
cut the budget— and health care spending in particular—these proposals offer a
roadmap that can transform the system and produce substantial savings."
(Cutting Health Care Costs)

7. AFFORDABLE CARE ACT 7
The quote above describes what the increase in health care costs is creating in the
economy. The middle-class families are falling into the coverage gap, and are being
neglected in the system. The Affordable Care Act has reached millions with coverage but
has not figured out a promising way to insure the coverage of those who fall into the gap.
The author thinks that it is vital to control cost while increasing coverage. The goals of
insuring the uninsured and controlling cost are two goals that should be achieved
together. By achieving the goals, it will create an efficient health care system with cost
control (Key Facts about the Uninsured Population).
The time span in order to achieve these goals will be determined by which president
will be willing to carry out the reforms that are necessary. The United States needs to
focus on accomplishing reforming the healthcare system, but at the same time reducing or
maintain the same cost expenditure. If the solutions mentioned previously are achieved,
then The United States may increase in rank from 37th, instead of decreasing from 37th.
The Affordable Care Act is effective by covering millions who are not insured, but it
is not effective by ignoring the issue of spending more per capita than other country and
having the lowest life expectancy rate. This piece of legislation has its benefits and its
flaws by benefiting everyone as a whole, but then leaving others having to qualify for
other benefits.
In conclusion, there is a quote by Andy Stern, who is also a senior fellow at The Center
for American Progress that sums up the reform that needs to take place to save America’s
healthcare system. Andy stated,
“The passage of the Affordable Care Act was not the last step in the push to reform our
health care system. If Team USA is to succeed in the 21st century, we need to

8. AFFORDABLE CARE ACT 8
continue to reform the health care sector to lower costs and increase efficiency,
while also raising the quality of care. Health care reform, as detailed in this report,
can be the engine that puts our country back on track”(Cutting Health Care
Costs).
The author agrees that the ACA was not the last step; therefore reform needs to start now.

9. AFFORDABLE CARE ACT 9
References
Cutting Health Care Costs. (2012, August 2). Retrieved from
https://www.americanprogress.org/issues/healthcare/news/2012/08/02/11970/cutti
ng-health-care-costs/
Deficit-Reducing Health Care Reform. Retrieved from
https://www.whitehouse.gov/economy/reform/deficit-reducing-health-care-reform
History of the Affordable Care Act (ACA). (2014, October 22). Retrieved from
https://www.ehealthinsurance.com/resource-center/affordable-care-act/history-
timeline-affordable-care-act-aca
Key Facts about the Uninsured Population. (2012, October 5). Retrieved from
http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/
Sorum, Paul (Dr.) The Flaws in the "Affordable" Care Act and How to Remedy Them.
Retrieved from http://www.pnhp.org/news/2011/october/the-flaws-in-the-
“affordable”-care-act-and-how-to-remedy-them