The Patient Protection and Affordable Care Act (PPACA) or as it is commonly called, the Affordable Care Act (ACA), and its amendment, the Healthcare and Education Affordability Reconciliation Act of 2010, was signed into law on March 23, 2010 by President Barack Obama. The goal of the act is to improve the accessibility and quality of the U.S. healthcare system. There are nearly 50 healthcare reform initiatives that are being implemented during 2010–2017 and beyond. The passage of this complex landmark legislation has been very controversial and continues to be contentious today.
There were national public protests and a huge division among the political parties regarding the components of the legislation. People, in general, agreed that the healthcare system needed some type of reform, but it was difficult to develop common recommendations that had majority support. Criticism, in part, focused on the increased role of government in implementing and monitoring the healthcare system. Proponents of healthcare reform reminded people that Medicare is a federal government entitlement program because when individuals reach 65 years of age, they can receive their health insurance from this program. Millions of individuals are enrolled in Medicare. Medicaid is a state-established government public welfare insurance program based on income for millions of individuals, including children, that provides health care for its enrollees.
However, regardless of these two programs, many critics felt that the federal government was forcing people to purchase health insurance. In fact, the ACA does require most individuals to obtain health insurance only if they can afford it. But with the healthcare system expenditures comprising 17.6% of the U.S. gross domestic product and with millions of Americans not having the accessibility of health care, resulting in poor health indicators, the current administration’s priority was to create mandated healthcare reform. The Congressional Budget Office estimates that the act will enable an additional 32 million Americans or a total of 94% of Americans to have access to health insurance (ProCon.org, 2013b).
The goal of the act is to improve the accessibility and quality of the U.S. healthcare system. There are nearly 50 healthcare reform initiatives that are being implemented over several years. As discussed earlier, the main bone of contention is the requirement of the act that U.S. citizens and legal residents must purchase health insurance or pay an annual fine for inaction. As a result of this mandate, there were over 20 states that filed lawsuits, primarily questioning the constitutionality of this mandate. The second major contentious issue is whether Medicaid expansion requirements were constitutional because the federal government could withhold federal Medicaid funding to states that refuse to expand their Medicaid programs. On June 28, 2012, the U.S. Supreme Court upheld the constitutionality of the ACA in a 5–4 ruling in the Florida v. Sebelius lawsuit regarding individual health insurance mandates and the National Federation of Independent Businesses v. Sebelius lawsuits filed regarding Medicaid expansion (ProCon.org, 2013a). However, the federal government could not withhold federal funding to states that refuse the Medicaid expansion because it could be considered coercion. As a result of this decision, the federal government is required to develop state incentives to accept the Medicaid expansion and to restrict the type of funding limitations to states who refuse the Medicaid expansions (Svendiman & Baumrucker, 2012).