The controversial issue of healthcare coverage for all individuals is an ethical and moral issue that Americans struggle with and as socially proactive as they are on there are many issues arising of it. Healthcare is not only about health and coverage but the major issue is about funding, what can be funded and what cannot be funded and how is going to be funded. Universal healthcare in other countries offers insight into some of the biggest issues and best alternatives for providing healthcare to all and to resolve the health care rising cost. The ethical issue of health care has led to the Accountable Care Act or Obama Care policy development and legislation. More time, data and research has to be done before the definite results of this legislation can be proven.
A controversial issue
Considering the opposing views about Accountable Care Act legislation, it’s reasonable to understand why universal health care has elicit such a heated political controversy among political parties as well as throughout American people. Unlike other Western industrialized nations, the U.S. has not established a universal health care system. Since health care is a fundamental defining policy of the modern state, and since Obama’s health care reform can be seen as an expansion of the role of government, it can be analyzed in a global context (Ha, 2012). The issue of health care reform brings important ethical issues of justice to the forefront, as individuals, communities, and the legislature struggle with how to provide quality health care for the many without sacrificing the basic rights of even the few (Sorrel, 2012).
The divide on health care coverage, cost and sustainability for all Americans and the increased cost of health care in United States led to legislations being brought to seek out a solution to the issue. The American Recovery and Reinvestment Act was the first of these laws, this act signed into law in 2009 by President Obama. The Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act was also signed into law. Also enacted and accompanied by the Health Care and Education Reconciliation Act. Another legislation that became a law in 2010 is the Patient Protection and Affordable Care Act (Patel, 2013).
Provisions in the act are designed to expand insurance coverage, control costs, and target prevention (Gable, 2011). One of the primary targets is adults aged 19-64, since their access to health care and use of health services deteriorated between 2000 and 2010, particularly among those who were uninsured (Kenney, McMorrow, Zuckerman, & Goin, 2012). The PPACA includes reforms such as prohibiting insurers from denying coverage for pre-existing conditions, expanding Medicaid eligibility, subsidizing insurance premiums, and providing incentives for businesses to provide health care benefits. Insurance companies will no longer be able to drop clients when they become ill. The act has the potential to improve health outcomes across all income and age groups at a reduced cost (Sorrel, 2012).
Steps in the state and federal policy development process. The steps of the development process focus in the four “pillars” of health reform: improving the quality of care, making health insurance affordable, supporting personal responsibility, and developing a sustainable approach to health care financing. This platform will help focus the initiative to tackle the growing costs of health care while preserving the highest quality of care for all Americans and avoiding cost-shifting wherever possible (Bipartisan Policy Center, 2013).
Many ACA provisions went into effect immediately or soon after the health reform law was enacted in 2010; others are being phased in over time. Several major reforms, including the Medicaid expansion, insurance exchanges, and minimum coverage provision (“individual mandate”) will go into effect in 2014, and still others will go into effect later. APHA recommends several great resources for tracking state progress on creating health insurance exchanges, funding states have received through various ACA provisions, and states’ intentions regarding the Medicaid expansion, and other topics (APHA, 2010).
Policy development vs implementation.
Policy development starts with knowing what the problem is and how the policy will improve the issue. So the importance of analyzing the data about the problem needing fixed. When writing the policy provide the opportunity for the input of the policy makers to suggest changes which provides different viewpoints. To present the policy to the committees for approval or changes as needed. Policy Implementation is ready to start with a timetable of how the implementing of the policy and briefing the States. Implementation of the Affordable Care Act is an enormous administrative challenge, and many details of its implementation are still developed by the Department of Health and Human Services (Wann, 2013). Policy development starts from the moment the public, the legislature think there is an issue and a solution is needed. The ACA development started many years ago back in the 90s when the Clinton administration specifically Hillary Clinton supported the creation of a Universal Health Care system, that laid the foundation on which ACA started to gather the issues and started to research possible solutions.
The issues was brought by the public to the press, to the meetings and hearings during the elections campaign and started to gather strength and support on President Obama challenge not only the American people, but the entire Congress to bring out to the negotiations idea on how to increase access to care while reducing cost. The ACA legislation development follows several tenets as the building block in which the legislation was written and develop on, Quality affordable health care for all Americans, the role of public programs, Improving the quality and efficiency of health care, prevention of chronic disease and improving public health, Health care workforce, Transparency and program integrity, Improving access to innovative medical therapies, Community living assistance services and supports and Revenue provisions (Democrat Senate, 2004).
The implementation process of the legislation follows the same tenet but there is not planning and changing is the plan drafted and written how each steps will be attained and when and lastly the evaluation of the development and the implementation and sitting back in the drafting table to fix any encountered issues. The development and implementation phases of the legislation cannot be seen as two different path but rather as a process of two collaboration between the two parts using the same foundation to build. To summarize the differences between development and implementation would be that the developments of the policy consist of the idea to the final written policy. The implementation of the policy is the start of putting the policy in action.
The stakeholders became involved with the affordable care act because even though this was controversial many believed that the needs were far greater than the issue and some changes were needed. Stakeholders for this legislation is the entire country of United States as the affected party, the health care providers, the legislators, the President of United States. In health care, the overarching goal for providers, as well as for every other stakeholder, must be improving value for patients, where value is defined as the health outcomes achieved that matter to patients relative to the cost of achieving those outcomes. Improving value requires either improving one or more outcomes without raising costs or lowering costs without compromising outcomes, or both. Failure to improve value means, well, failure (Porter, Lee, 2013).
Stakeholders are heard during the elections periods where the issues to be discussed should and have to be of interest to the public to be added to the political platform. The press plays an important role on serving as the echo or the microphone to put the issues that are important for the American people. The Health care providers were a major force on the legislation development as their input from a business standpoint played major role on discussing areas that were part of the problem as well as area that needed to stay the same and it also serve as another voice of the public on such a controversial issue.
Congress as a stake holder not only play a vital role on policy development and drafting but was the starting point of bringing the issue to the front and placed it in the agenda to be discussed and heard and last the President and its executive branch as the approval seal to the developed policy. In summary the Affordable Care Act has pique the interest not only as a national issue but a global one. Like any policy development the issues have to discuss by the stakeholders representing health care and each and every one has a specific interest in the issue to be solve.
American Public Health Association, (2014), ACA Implementation. Retrieved
August 4, 2014 from http://www.apha.org/advocacy/Health+Reform/implementation/ Bipartisan Policy Center, (2013). Managing Costs, Preserving Care: Health Care Cost Containment Report Release. Retrieved on August 4th, 2014 from http://bipartisanpolicy.org/projects/health-care-cost-containment-initiative Patel, K. Parker, R. Villaruel, A.Wong,W (2013). Amplifying the Voice of the Underserved in the Implementation of the Affordable Care Act. Retrieved on August 4th, 2014 from http://www.iom.edu/Global/Perspectives/2013/AmplifyingTheVoice Ha, J. (2012). Health Care Reform vs ObamaCare: Partisan framing of FOX, MSNBC, NYT snd WSJ. Retrieved on August 4th, 2014 from http://gnovisjournal.org/2012/11/30/health-care-reform-vs-obamacare-partisan-framing-of-fox-msnbc-yt-and-wsj/ Porter, M. E. (2013), The Strategy that will fix health care. Harvard Business Review, Retrieved On August 4th, 2014 from http://hbr.org/2013/10/the-strategy-that-will-fix-health-care Sorell, M. J. (2012), Patient Protection and Affordable Care Act: Ethical Perspectives. Retrieved on August 4th, 2014 from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/Columns/Ethics/Patient-Protection-and-Affordable-Care-Act-Ethical-Perspectives.html