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HCMG101 Health Care Systems Question: At your last physical, you got into an argument with your primary care provider, Dr. Bob Knowitall. He is against what he calls Obamacare and said he was happy Donald Trump finally was able to repeal and replace it. Dr. Bob says that President Obama’s changes to the healthcare system were unnecessary because “everyone, regardless of how poor they are could always get care when they needed it before Obamacare.” He said, “The federal government has run the health care system too long! It’s time for doctors to take control of the healthcare system!” Since you have taken a health policy class at Southern, you know that Dr. Bob is wrong. Write an essay responding to Dr. Bob letting him know why his statements are incorrect and school him on the history of healthcare reform and where it stands now with “repeal and replace.” At the end, let him know if you agree that repealing and replacing the ACA and why. Answer: During the tenure of President Barack Obama, the United States witness the revolutionary creation of the Patient Protection and Affordable Care Act on 23rd March, in the year 2010, which is now abbreviated  as ‘Obamacare’ or ‘Affordable Care Act’. This legal framework yielded beneficial implications on the healthcare system of the nation, through the provision of required medical health insurance for all citizens irrespective of their race, gender, level of income or ethnicity. However, this beneficial healthcare reform has been met with considerable criticism by the opposition considering its financial implications and possible lack of feasibility (Han et al., 2015). The following argumentative essay aims to discuss on the key advantages and shortcomings of the Affordable Health Care act, followed by an opinion considering the negative implications of its ‘repeal and reform’. Hence, this essay argues that the ‘Obamacare’ was a necessary reform in the American healthcare system. Despite the beneficial implications of Obamacare, it has stirred considerable controversy especially after the election of present President Donald Trump, which has focused on the unfeasible financial implications of this reform, followed by prevalence of high healthcare costs and the increase in the number of uninsured individuals. This has led to the possibilities of repealing and reforming the Affordable Care Act, focusing in replacement of subsidies in income with provision of subsidies based on age, along with compulsory maintenance of coverage by citizens for a year, without which a 30 percent extra charge payment may be required (Manchikanti & Hirsch, 2016). As observed in the case study, Mr. Knowitall believed that the Affordable Care Act was an unnecessary reform in the American healthcare system. However, according to Sommers et al., (2015), the most beneficial implications of this reform was that it considerably reduces increments in the cost of healthcare, which was observed in the 1.2 percent increase in treatment procedure cost in the year 2016 – a significantly less amount in the history of healthcare as compared to the 2004’s increase of 4 percent. Obamacare achieved this through the provision of insurance for all along with cost-free availability of preventive treatments, hence allowing citizens to avail affordable medical care before extravagantly spending in emergency care (Sommers et al., 2015). Further, as opined by Garthwaite et al., (2017), the reform insurance ensured coverage of several chronic, mental illness and addiction disorders, without which, the respective patients would be required to undertake expensive emergency treatments, further passing them on to taxpayers and Medcaid expenses. The reform also exhibited considerable regulations on the insurance providers, to prevent them from demanding high premiums from patients already presented with an illness, denial of coverage, imposition of limits in lifetime and annual dollars as well as cancellation of insurance for patients who developed a disorder (Garthwaite et al., 2017). Most importantly, the reform implicated beneficial qualitative improvements in the history of American healthcare reform, since it compelled the Secretary of Health and Human Services to undertake re-evaluation of the current procedural terminology codes associated with various operative procedures as well the functioning of concerned physicians (Lanford & Quadango, 2016). However, despite benefits, according to Squires and Anderson (2015), the reform resulted in considerable negative implications, ironically resulting in increased costs of healthcare, due to the provision of preventive treatment for the first time for patients carrying prolonged illnesses. Further, the Affordable Care Act also extracted taxes from citizens who avoided insurance, along with an estimated four million Americans choosing to avoid payments for coverage and engaged in payment of the tax, estimated to be an amount of 54 million dollar. The reform also compelled companies engaged in pharmaceuticals to reduce the ‘doughnut hole’ in insurance, through payment of extra 84 billion dollars to further prevent increments in the cost of drugs for consumers (Squires & Anderson, 2015). However according to Saltzman, Eibner and Enthoven (2015), the eradication of the insurance benefits exhibited by Obamacare will significantly affect the health status of over 13 million Americans belonging to families which are economically underprivileged and hence, will now be faced with the burden of decreased affordable healthcare options and increased financial consequences of necessary treatment procedures. Further, Obamacare ensured effective coverage for various mental illness disorders, which will now be extensively effected. This will turn out to be a major setback for the patients inflicted with mental disorders due to their reluctance to undergo treatment considering the high expenditures and associated social stigma (Saltzman, Eibner & Enthoven, 2015). To conclude, I believe that the effect of the repeal and reform of the Affordable Care Act will yield disastrous effects and negative health implications on the overall health status of the concerned citizens. As opined by Glied and Jackson (2017), large number of Americans belonging to families overcome with financial difficulties will be burdened with reduced accessibility, increased financial difficulties and decreased availability of treatment procedures which would have been otherwise beneficial. The added burden of absence of subsidies along with mandatory payment of coverage will further compel such citizens to avoid undertaking treatment options, which will result in increased deaths and associated increase in morbidity and mortality rates of the nation (Glied & Jackson, 2017). Further, as stated by Wen, Behrle and Tsai (2017), Obamacare not only ensured efficient coverage of severe mental disorder but also treatment of Opioid Use Disorders. Hence, reduction of appropriate Medicaid as a result of reforming and repealing will further result in patients avoiding treatment for this disorder due to the added expenditures. The avoidance of adequate treatment will further result in harmful health implications such as the increased risk of birth of infants with neonatal abstinence syndrome by pregnant women suffering from this disease. Lack of treatment also results in future occurrences of adherence to substance abuse by children belonging to such families, along with an increased exhibition of criminal and antisocial behaviors (Wen, Behrle & Tsai, 2017). Hence, with due consideration of the above facts, it can be concluded that repeal and reform of the Patient Care and Affordable Healthcare Act would result in negative physiological, psychological, social and economical consequences in the country, especially for citizens whose lives rely extensively on the availability of affordable, accessible and quality healthcare. The need of the hour is for the citizens of American to consider these implications before accepting such controversial reforms. The government must also consider the vast reach and dependency of citizens on Medicaid and the possible implications which may result due to its repeal, before undertaking such a fundamental decision. References Garthwaite, C., Gross, T., Notowidigdo, M., & Graves, J. A. (2017). Insurance expansion and hospital emergency department access: evidence from the Affordable Care Act. Annals of internal medicine, 166(3), 172-179. Glied, S., & Jackson, A. (2017). The future of the Affordable Care Act and insurance coverage. American journal of public health, 107(4), 538-540. Han, X., Yabroff, K. R., Guy Jr, G. P., Zheng, Z., & Jemal, A. (2015). Has recommended preventive service use increased after elimination of cost-sharing as part of the Affordable Care Act in the United States?. Preventive medicine, 78, 85-91. Lanford, D., & Quadagno, J. (2016). Implementing ObamaCare: The politics of medicaid expansion under the affordable care act of 2010. Sociological Perspectives, 59(3), 619-639. Manchikanti, L., & Hirsch, J. A. (2016). Repeal and replace of affordable care: a complex, but not an impossible task. Pain physician, 19, E1109-13. Saltzman, E. A., Eibner, C., & Enthoven, A. C. (2015). Improving the affordable care act: An assessment of policy options for providing subsidies. Health affairs, 34(12), 2095-2103. Sommers, B. D., Gunja, M. Z., Finegold, K., & Musco, T. (2015). Changes in self-reported insurance coverage, access to care, and health under the Affordable Care Act. Jama, 314(4), 366-374. Squires, D., & Anderson, C. (2015). US health care from a global perspective: spending, use of services, prices, and health in 13 countries. The Commonwealth Fund, 15, 1-16. Wen, L. S., Behrle, E. B., & Tsai, A. C. (2017). Evaluating the impact of Affordable Care Act repeal on America’s opioid epidemic. PLoS medicine, 14(8), e1002380.

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