The Affordable Care Act: Implications for the American Public

Health care reform is one of the most controversial issues in American politics today, and for good reason. Ensuring access to adequate health care is an important issue that deserves attention. The Patient Protection and Affordable Care Act (PPACA), signed into law in 2010, represents the most significant change in health care policy since the passage of Medicare and Medicaid in the 1960s. In this paper, I’ll argue that the Affordable Care Act (1) improves access to reproductive and maternal care, (2) has the potential to reduce rates of cancer-related death in young adults, and (3) significantly reduces the population of underinsured Americans. These are each positive steps in the process of improving the quality of American health care.

Reproductive and Maternal Care

The Affordable Care Act improves access to reproductive and maternal care for millions of American women. In 2012, a fourth of all women of reproductive age went uninsured at some point during the year (Grande & Srinivas, p. 1301). By improving access to coverage for low-income adults of child-bearing age, the Affordable Care Act makes reproductive health care more available to pregnant women who were previously uninsured or underinsured. In the past, Medicaid covered some aspects of neonatal care and delivery for low-income women, but did not provide sufficient reproductive health care for women before or after pregnancy. Under this system, many conditions that commonly arose during pregnancy (e.g. gestational diabetes) were considered pre-existing and thus excluded from future coverage. For women of childbearing age who sought coverage through the individual market, maternal care was rarely provided (Grande & Srinivas, p. 1301). Preventative services such as vaccinations, cervical cancer screenings, STI screening, and contraceptive coverage were also often unavailable. The Affordable Care Act seeks to fill these coverage gaps by expanding access to Medicaid to those with low incomes. It also prohibits insurers from charging pregnant women for the medical conditions that arise as a result of pregnancy (Grande & Srinivas, p. 1301). These changes have the potential to reduce both mortality and morbidity in pregnant women and their infants.

Cancer-Related Deaths of Young Adults

The Affordable Care Act has the potential to reduce rates of cancer-related death for young American adults. In the past 50 years, reductions in cancer-related mortality have primarily benefited children and older adults. Lack of progress particularly evident in young adults between the ages of 15 and 25 – in the past 30 years, this group has not seen statistically significant reductions in cancer-related mortality (Bleyer, Ulrich, & Martin, p. 6018). The percentage of young adults with health insurance drops dramatically at the age of 18, regardless of income. This occurs to such an extent that young adult Americans are have less access to health care services than young adults in any other “socioeconomically advantaged country” (Bleyer et. al, p. 6020). In the contemporary United States, young adults face unique financial and sociological barriers to acquiring health insurance. The National Cancer Institute cites these barriers as a major reason for the current failure to adequately prevent, diagnose, and treat cancer in young adults (Bleyer et. al, p. 6019). Existing research demonstrates that a lack of health insurance significantly increases the time between the onset of cancer-related symptoms and the decision to seek medical care. This gap contributes to higher rates of mortality and morbidity amongst those who lack insurance. By improving access to health care coverage – especially access to preventative care – the Affordable Care Act will improve the likelihood that young adults will seek medical attention in a timely manner and thus, will reduce rates of mortality and morbidity.

Reducing the Number of Underinsured Americans

The Affordable Care Act significantly reduces the population of underinsured individuals in the United States. Research conducted in 2010 suggests that the Affordable Care Act will reduce the number of underinsured Americans by as much as 70 percent within the first few years of its implementation. In 2010, 80% of individuals with annual incomes below $20,000 were uninsured or underinsured, and more than half of all individuals with incomes between $20,000 and $39,999 were in the same situation (Schoen, Doty, Robertson, & Collins, p. 1765). The researchers conducting this study controlled for income, health status, age, and ethnicity in order to determine that underinsured and uninsured adults are significantly more likely to go without health care because of costs. These individuals are more likely to forgo care than higher income individuals, and reported behaviors that include the failure to fill prescriptions, not following up on recommended care, and forgoing recommended diagnostic tests. Among the uninsured, individuals engaged in these types of behaviors three times more often than those who had access to medical coverage. Among the underinsured, individuals engaged in these types of behaviors more than twice as often as other Americans (Schoen et. al, p. 1766). These behaviors negatively effect the health and longevity of millions of Americans each year (Rosenbaum, p. 133). Because the population of underinsured Americans is comprised primarily of low-income adults, improving access to coverage for this segment of the population is an essential part of the Affordable Care Act’s provisions.

Though the Affordable Care Act remains controversial, almost everyone agrees that something must be done to improve the state of America’s healthcare system. The Affordable Care Act makes several positive steps that improve the access to quality health care for millions of low-income Americans. In this paper, I’ve demonstrated that the Affordable Care Act (1) improves access to reproductive and maternal care, (2) has the potential to reduce rates of cancer-related death in young adults, and (3) significantly reduces the population of underinsured Americans. Though much more must be done to improve rates of mortality and morbidity in low-income families, the Affordable Care Act is an important step in the right direction.

References

Bleyer, A., Ulrich, C., & Martin, S. (2012). Young adults, cancer, health insurance, socioeconomic status, and the patient protection and affordable care act. Cancer, 118(24), 6018-6021.

Grande, D. & Srinivas, S. K. (2013). Leveraging the affordable care act to improve the health of mothers and newborns. Obstetrics & Gynecology, 121(6), 1300-1304.

Rosenbaum, S. (2011). The patient protection and affordable care act: Implications for public health policy and practice. Public Health Reports, 126(1), 130-135.

Schoen, C., Doty, M. M., Robertson, R. H., & Collins, S. R. (2011). Affordable Care Act reforms could reduce the number of underinsured US adults by 70 percent. Health Affairs, 30(9), 1762-1771.