Public Health Reform: Affordable Care Act


The affordable healthcare act, signed into law in 2010, has led to an unprecedented improvement in healthcare for Americans ( Japsen, 2014). The government requires insurance companies to cover all people under minimum cost of insurance coverage. A court ruling compelled all states to allow the Medicaid Eligibility Expansion plan but the decision was again overruled due to varying consequences of the act in different states. This essay discusses the current status of public healthcare in the USA, the Medicaid Eligibility Expansion plan, its advantages and disadvantages, and offers suggestions to improve it. It concludes with the idea that milestones achieved in healthcare should be defended while at the same time taking into account protection of state economy.

Current Status of Public Health in the United States

The year 2014 has been an important year in the provision of quality health care in the USA. The Affordable Healthcare Act, in a manner never witnessed before, guarantees Americans treatment irrespective of insurance status or existence of a recurrent condition ( Japsen, 2014) . The act also promises capping of beneficiaries benefits, an event that could otherwise lead them to a financial crisis. Women will not be victimized based on their gender. Most importantly, this act will be available to all qualifying Americans, including senior Medicare employees, who will receive health care at no cost.

However, there are an increasing number of healthcare plans that limit patients to certain health care providers by reducing accessibility of healthcare centers. This is a trend that has existed before as witnessed in a lot of Medicare Advantage plans, as well as privatized health care insurance plans available in big institutions. Another major stumbling block currently being experienced is the fact that some states within the country are against the idea of denying this healthcare to individuals who earn more than 133% salary above the poverty level ( Wells, 2013)

Medicaid Eligibility Expansion Plan

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The ACA increased the number of individuals qualifying for Medicaid and the requirement became effective in the first month of 2014. The act specified that only individuals between the ages of 18-64 and with incomes not exceeding 138% of the national poverty level. The act states that costs involved shall be subsidized 100% in the first two years but will be scaled down to 95% and then 90 percent. This figure is kinder compared to 50-57% of federal Medicaid match ( Japsen, 2014) .

All states are required to allow eligibility expansion failure to which Medicaid would be withdrawn. The act imposes new federal rules that will streamline Medicaid eligibility and the process of enrollment for individuals who currently qualify and those that will be potentially covered. Streamlining intends to substantially increase registration of new individuals to the Medicaid program, reduce inefficiency in the Medicaid program, and to increase the period of enrollment into Medicaid ( Wells, 2013) .

This act has a contingency plan to deal with the states that refuse to implement various enrollment programs within their borders. After the court ruling in NFIB vs. Sebelius halting forceful participation of all states, the program can become optional for some of these states. As the states await new court rulings, a state plan amendment managing enrollment is in place. States will have the freedom to opt into or out of the Medicaid Eligibility Expansion program whenever they please. However, they stand to lose funding of some costs involved initially should they opt to fully abide by the act later on ( Zhu & Johansen, 2014).

Below is an analysis of the effect of the Medicaid Eligibility Expansion plan in relation to the options states have to implement or disregard it altogether.

Advantages of Medicaid Eligibility Expansion Plan

Increased Medicaid funding will be enjoyed by states that implement this act. Around one billion dollars will be available, and these funds will boost economic performance leading to job creation ( Sommers & Rosenbaum, 2011) . Hospitals which are already facing a lot of pressure from uncompensated beneficiaries will be relieved. More people will stay healthy thus reducing absenteeism from work and, consequently, increasing job performance. The disparity in health care provision between poor and rich states will decrease. States will realize that it is better to enroll more of their people as their taxation will increase dollars earned.

Disadvantages of Medicaid Eligibility Expansion Plan

Supporting this plan amounts to endorsing the current regime as it is widely considered a political tool to increase popularity. This program is flawed, impractical, and is characterized by high bureaucracy. What is needed is not an expansion of a poorly structured plan but reforms targeting improvement of its design. It is evident that money to fund various programs might be unavailable in the future, a period when opting out could be politically impossible. This situation will keep getting worse as time elapses and new people are enrolled. The state budget will be forced to shoulder increased expenses. This will be possible up to a point where priority in spending will lead to crumbling out of the plan altogether ( Sommers & Rosenbaum, 2011) .

Suggestions for Plan Improvement

The aforementioned disadvantages could potentially be hurtful, and I recommend that the plan be revised to fix glaring loopholes. In case alterations to contracts are made, proper explanation ought to be given. All decisions on healthcare networks working with the government ought to be recorded. As explained before, the plan has some advantages to all states, which ought to be tapped to avoid lagging behind in economic development ( Japsen, 2014) . This requires a delicate balance on incremental enrollment. A threshold should be considered for every state depending on its current budget and economic performance. The act should be made flexible to allow states to opt out should they be unable to manage the program perhaps due to prioritizing on expenditure.


This year has ushered in an unprecedented improvement of healthcare. It is now available to all Americans. However, there are some states that do not fully abide by this act and, in particular, are against expanding eligibility to healthcare. Care ought to be taken to sustain milestones achieved, but at the same time protecting the economy of individual states.


Japsen, B. (2014, April 2). Inside Obamacare: The fix for America’s ailing health care system. Forbes Media.

Sommers, B. D., & Rosenbaum, S. (2011). Issues in health reform: how changes in eligibility may move millions back and forth between Medicaid and insurance exchanges. Health Affairs, 30(2), 228-236.

Wells, W. (2013). Medicare made easy. CreateSpace Independent Publishing Platform.

Zhu, L., & Johansen, M. S. (2014 , July 15). The refusal of 24 states to expand Medicaid under

Obamacare will maintain their high levels of inequality in healthcare coverage. (Web log post) LSE American Politics and Policy.

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