Health Care Case Study

The individual mandate is a tax penalty for those who do not obtain health insurance. This is a highly controversial aspect of the Affordable Care Act that is currently up for debate. Under the latest version of the GOP tax-reform bill, the individual mandate is up for elimination. Eliminating the individual mandate would ultimately cause healthier people to opt out of health care insurance. This would leave only unhealthy people being the ones who purchase health insurance, which in the long run would lead to higher healthcare costs. By ending the mandate premiums would rise and businesses would possibly shift to high-deductible plans or cut coverage entirely.

All American must have health insurance without exceptions or they will pay a penalty or some money to the government filing their taxes.

Understanding the Affordable Care Act (ACA) can be problematic, the goal of the ACA is to address the fact that millions of Americans do not have health insurance, yet they are contributors to the health care market, consuming health care services for which they do not pay. While this may seem to be a great idea, many Americans are not really sure how they are affected by this Health Care Reform. The goal is to make health insurance affordable, secure, and reliable for all. The ACA is a minimum coverage provision, individuals are given health insurance by amending the tax code. There is an individual mandate which stipulates all non-exempt individuals must maintain a minimum level of insurance or pay a tax penalty. ACA extends Medicaid, states have to accept or they will not receive Federal funding. The act also includes an employer mandate to obtain health coverage for employees. The Affordable Care Act has changed the way health care is provided and the way individuals will participate (The Affordable Care Act Cases. (n.d.). Retrieved September 3, 2015)

The Affordable Care Act is a law that was enacted on the 23rd of March 2010. Regardless of the fact that it was put into place in 2010, there are still numerous aspects of the law being debated today. The law has several provisions that are expected to take effect between the year of 2010 and 2020 (Reid, 2012). Among the significant reforms in the law includes a clause prohibiting insurers from refusing people coverage due to some preexisting conditions. In addition, these companies should offer the same price for all clients who are in the same geographical location and are the same age. Another reform was that families that are in the poverty line should receive federal subsidies if they decide to buy insurance through an exchange. The government also created minimum standards for insurance policies. The government also established health insurance exchanges as platforms for comparison of different policies. The Affordable Care Act also has an individual mandate

The United States does not have a universal health insurance coverage available for its citizens, therefore, there are varied obtainable coverages. Some coverages are offered through employers while others may be obtained through government programs. As of 2010, with the introduction of the Patient Protection and Affordable Care Act, many more citizens were able to receive health insurance (Rosenbaum, 2011). Furthermore, this began the healthcare reform as it is today.

Challenges were evaluated and although the ACA has provisions for healthcare, numerous individuals still remain uninsured and blame the high cost of healthcare insurance as the primary reason they do not have healthcare coverage. In a survey by the Kaiser Foundation in 2014 showed that 48% of uninsured people stated the cost for healthcare was too expensive as the primary reason they were uninsured. Many workers do not have accessibility to healthcare coverage through an employer, and others, predominantly poor working adults from states with no Medicaid expansion, stay ineligible for public healthcare insurance coverage. Furthermore, undocumented immigrants are not eligible for Medicaid or other healthcare from the Marketplace.

Furthermore, Obamacare will bring unforeseen expenses not only by increased monthly insurance premiums, but also through tax penalties for Americans that don’t comply. Unless you qualify for an exemption, you are now required to purchase health insurance or pay a non-compliance penalty (Patton). The Affordable Healthcare Act will now force insurance companies to provide coverage to Americans that are considered high risk or have pre-existing health conditions. Considering, the majority of young Americans are generally healthier; they will be paying a higher premium

The Affordable Care Act (ACA) highlighted the importance Medicaid played in insuring every American receive healthcare coverage. (42 U.S.C., 2010) Medicaid provides health benefits to over 71 million across the country. While involvement is optional, all 50 states participate in the program and requirements differ across the nation. The flexibility given to each state has allowed them to make their own decisions to work towards improvements that they believe would best benefit their region (Feldstein, 2015, p. 125-126).

As per the law United States legal citizen whose income is 133 percent lesser than the poverty line can be enrolled for Medicaid. Operated by state government but Medicaid is funded jointly by state and federal governments. Funding to Medicaid is by federal government called as Federal Medical Assistance Percentage is calculated based on state per capita income and typically varies between 50 to 75 %. But the Obama care act provides Medicaid expansion through which federal government will pay 100 % of Medicaid costs during 2014, 2015, 2016 but 95 % of costs during 2017, 94% during 2018, 93% during 2019 and 90 %during 2020. Not essentially all states accept this Medicaid expansion program, typically states ruled by democrats implement this expansion but states ruled by republicans deny the expansion. As per study health reform monitory survey4, those states who accepted Medicaid expansion has uninsured rate of only 7.3% but in not accepted states have uninsured rates of 14.1% which constitutes half of nations uninsured population.

This is where Congress’ power to tax comes in. Article 1 Section 8 of the US Constitution states that, “the Congress shall have power to lay and collect taxes, duties, imports, and excises, to pay the debts and provide for the common defense and general welfare of the United States; but all duties, imports, and excises shall be uniform throughout the United States”. Although it is not upheld that Congress can use its power to require that everyone buy health insurance, it was agreed on by majority vote that the penalty imposed on those who do not buy a healthcare plan is a tax that Congress can impose by using its power to tax. With this, it is understandable that while Obama cannot make anyone buy insurance, he can penalize them for it in the form of a tax. According to the U.S. government, since the Affordable Care Act was passed, 16.4 million Americans have gained health insurance. However, 13% of adult Americans still lack coverage (Patient’s Rights Council). Many people are actually choosing to pay the tax rather than spend a large amount of money for insurance that they do not want, but there is another problem with that option. Although the tax is only $95 (or 1% of the family income, whichever is greater) after a year of having not enrolled in a healthcare plan, the penalty rises to $325 (or 2% the family income) the next year and $695

Still, not all states are required to expand Medicaid because the Supreme Court left it as an option for each state. In 2017 states can request federal waivers to opt out of requirements such as

The government has to pay for healthcare reform somehow. Taxing business is a big strategy and employers with fifty or more employees will be fined $2,000 per employee if they do not provide affordable medical coverage. (Rubin)

Medicaid is expanded up to 15.9 million men, women and children below 138% of the poverty level.

In 2014, almost everyone will be required to purchase health insurance or face a $695 annual fine. There are some exceptions for low-income people, but if employers do not offer health insurance, individuals will be required to purchase health care insurance on their own (Wolfe, 2012).

The ACA requires insurers to accept all applicants, cover certain conditions, and charge the same rates despite one 's sex or pre-existing health status. There are ten provisions that make up the ACA which were to be implemented over time, from 2010 through 2020. The first provision is individual insurance, which prohibits insurers to deny coverage based on one 's pre existing health conditions. States were also required to make insurance available to children who are not insured through their families. Medicaid was also expanded to include individuals and families with an average income of thirty thousand dollars a year. This mandate will not cover those who are illegal immigrants, eligible individuals who choose to not be enrolled in medicaid, those who choose to pay the penalty, individuals whose insurance would cost more than 8% of their income, and those who live in states that opt out of the medicaid expansion.