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The Patient Protect and Affordable Care Act (PPACA), popularly referred to as Obamacare, has been a very controversial topic since its introduction in 2009. Some people support this act that mandates citizens to purchase health insurance; their justification is that it is beneficial for the people. Plus, car insurance is mandatory for car owners, so why shouldn’t health insurance be mandatory for healthy and unhealthy persons? However, there are others that are against this reform because they believe it’s an unnecessary infringement upon the freedom to choose for oneself whether to buy insurance or not. In this paper we will explore the reasons why the Patient Protection and Affordable Care Act is not an entirely beneficial reform when taking into account three aspects: small business, ethics and quality care.
The Patient Protection and Affordable Care Act include provisions that make it mandatory for businesses to provide their employees with health coverage. This doesn’t necessarily sound like a bad thing, right? Most workers not only desire, but deserve, such benefits from their employment place. However, that benefit may increasingly become scarce as employers are finding ways to get around providing the sort of coverage that this reform is calling for. The first maneuver employers are implementing is not providing health coverage to employees. Under this mandate, companies that have more than 50 full-time employees must work within the bounds of the Affordable Care Act to supply their workers with health insurance or face a $2,000 fine per year for each uncovered full-time worker.
Though this penalty may seem high, the cost of providing specified health coverage to each full-time worker is even higher. Therefore, many employers are opting to pay the fine rather than providing health benefits to their employees. During a hearing by the United States Small Business Committee on the Affordable Care Act, Matt Tynan, Secretary and Treasurer of Tynan’s VW and Tynan’s Nissan, verified this strategy: “Instead of trying to do the best by our employees, it will become a simple math calculation. Is the fine less than providing coverage for our people?” (25). Though this may be tragic, it is the reality of the situation. The very act that mandated businesses to provide their employees with health insurance also provided a loophole so that they don’t necessarily have to abide by the law. By that mere fact, this mandate is actually producing the opposite effect that it was originally aiming for.
Another strategy that employers are using as a means of getting around providing health coverage to workers is by limiting the number of full-time workers employed at their workplace, thereby limiting the number of employees they must provide with health benefits. A full-time worker is considered anyone who works 30 hours or more per week for a business. Therefore, employers are cutting hours and reducing the rate by which they hire people all in an effect to reduce the amount of money put into health insurance plans for full-time workers. An article that appeared in the Wall Street Journal highlighted this tactic: “In January, nearly half of small-business owners with at least five employees, or 45% of those polled, said they had had to curb their hiring plans because of the health law, and almost a third—29%—said they had been forced to make staff cuts, according to a U.S. Bancorp survey of 3,173 owners with less than $10 million in annual revenue that will be released Thursday” (Needleman & Logun).
The act of employers cutting hours in the pursuit of curtailing the number of employees they must provide with health insurance creates a different dimension of issues. For example, this could create financial issues for the workers. To put this more into perspective, let’s engage in mathematical computations then apply the figures to the expenses of living. Let’s suppose that legislators were successful in increasing the minimum wage to $15/hr, then a full-time worker would earn $450 after a week of working without the imposition of taxes. Therefore, the yearly salary of this full-time worker would be $23,400; this is also before taxes are taken out. Evidently, this is not enough money to even be considered middle class. Roughly, the income needed to be considered as middle-class $25,000 to $75,000.
Cutting workers’ hours will certainly plunge them further into financial crises. One can clearly see how this could have a devastating effect on the American economy. It could be argued that such a drastic measure would not even be a factor without the introduction of the Affordable Care Act. But some may also blame the greedy, conniving employers who would detriment their employers just to save a few bucks. Either way, there is a cause and effect relationship here and there is no getting around that.
The United States of America championed the words “freedom” and “liberties”. The Declaration of Independence, the very document that declared our freedom from the tyrannical ruling of our mother country, Great Britain, contained the ever-so-popular phrase, “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable rights, that among these are life, liberty and the pursuit of happiness” (Declaration of Independence, Constitution of the United States, Taft-Hartley Act). To add on, other “unalienable rights” include: speech, religion, press and up until recently, the right to choose whether or not to enroll in a health insurance plan. This leads into the ethical question for the Affordable Care Act: should citizens be required to purchase healthcare?
Granted-nobody can truly be certain of all the things the future entails, but does this truly justify the bullying of citizens into purchasing health insurance? The Supreme Court’s ruling on the matter would certainly say so. Winning in court by 5-4, Chief Justice upheld this act stating that the penalty for not obtaining health insurance is just a tax: “The Affordable Care Act’s requirement that certain individuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax… Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness” (Liptak). True, Congress (or more specifically, the House of Representatives) does have the power to levy taxes; however, it’s hard to justify taxing people for things that are personal and does not directly affect those around them. Additionally, heavy taxation for not complying with an act that mandates such a personal decision is rather ludicrous. “Americans who don’t pay for insurance and don’t qualify for Medicaid will be assessed a tax of $95 (or 1 percent of income, whichever is higher) in 2014.
The tax will increase substantially to $325 (or 2 percent of income) in 2015, and $695 (or 2.5 percent of income) in 2016. Individuals with annual incomes above $200,000 and couples with incomes above $250,000 will pay higher taxes to help cover costs of the program. And, in 2014, families can only deduct medical expenses that exceed10 percent of income, rather than today’s 7.5 percent of income” (“What if I don’t have health coverage?”). As mentioned before, numerous people have argued that healthcare should be a mandatory insurance that citizens much purchase, especially since it is mandatory that car owners purchase car insurance. That is a flawed argument simply by looking at interconnections. Suppose there is an accident whereby the person at-fault did not have car insurance (regardless of the fact that it is illegal), this creates an issue for the victim.
The victim must go through a series of steps to retrieve financial compensation from his/her insurance company for the damage caused by the accident. Even then, compensation is not always guaranteed and if it is received, it will not always cover the entire extent of the damage. However, the choice to not purchase health insurance doesn’t directly affect another being. Once again, let’s venture in presuppositions. For this case, suppose a person who doesn’t have health insurance suddenly get sick with the flu. A friend of the person happens to catch the flu. The fact that the other person doesn’t have health insurance doesn’t affect the friend because health insurance companies do not have a policy whereby the company is obligated to pay the expenses of a victim that their insurer passed their sickness on to. Evidently, paralleling the need for having car insurance as compared to having health insurance doesn’t quite match up.
Furthermore, there is the question of whether it is ethical for the healthy consumers of this plan to be responsible for covering the health costs of the sick consumers with this plan. Essentially, that is the reality for the young, healthy people who buy into the insurance offered under the Affordable Care Act. Generally, younger people are healthy which reduces the need for medical attentions; on the other hand, elders typically make more trips to the doctor and need more treatments per year. Therefore, any healthy consumer covered under the Affordable Care Act will just be pumping more money into the system which will be used to pay the medical expenses for the elderly with the same plan.
An article that appeared in the Wall Street Journal exemplifies the necessity for young people to buy into the Affordable Care Act: “Age is a crude actuarial proxy for health status, and merely 24% of enrollees are between ages 18 and 34. ObamaCare’s economics needs that to rise to about 40% to achieve a critical mass. Enrollment also skews heavily to people 55 to 64 years old, at 33%” (“The Young and ObamaCare-Less”). In order for this law to be a success, evidently, there must be more young enrollees than older enrollees so that the younger consumers can foot the medical bill that elders rack up. Obviously, this is not fair for the younger consumers.
Ever heard the expression, “quality is more important than quantity” ? Well, that is not the reality for the Affordable Care Act. There’s no denying that the desire to have every American citizen medically covered is a charismatic ideal; however, when it’s at the expense of receiving quality medical attention, then it becomes less idealistic and more daunting. Yet, the Affordable Care Act is creating a daunting affect for some American citizens. Firstly, more citizens becoming insured will raise the numbers of visits to the doctor’s office, which will also increase the wait time to see a doctor. A recent study conducted by Merritt Hawkins, an AMN Healthcare Company, showcased this cause-and-effect relationship.
In this study it was found that in states where a majority of residents had health insurance there was longer waiting periods to see a physician. Boston, one of the cities studied, had nearly all the residents covered and the average wait time was 45.4 days. This creates somewhat of an issue because access to medical attention is extremely important, especially for emergency situations. It’s doubtful that the implementation of the Affordable Care Act in American society will cause a chain-reaction in every major city whereby the waiting time to see a physician will skyrocket; however, they’re likely to increase. The problem with this is that it creates extreme irritation and impatience amongst patients. Furthermore, it forces those that have minor medical issues to wait in discomfort to see a physician. However, the act is only seeking affordable care, nobody ever said anything about quality of care.
Another problem in relation to the issue of quality care under the Affordable Care Act is the fact that numerous hospitals do not accept this insurance plan. Suppose that wouldn’t exactly qualify as an issue with the quality of care; more like the lack thereof. An investigation heeded by Watchdog.org, a non-profits news website, found that many top hospitals opted out of the Affordable Care Act and those that were within the network only accepted one or two carriers under the act. This creates a profound issue for consumers because they’re least likely to be informed on which hospitals are within the network that accepts the different insurances for the Affordable Care Act, so if they’re treated at an institution that doesn’t accept this form of insurance, they’ll be expected to come out of pocket with the cost.
Unfortunately, the issue of having health insurance that isn’t accepted at certain medical facilities is harming those that need it the most, specifically, cancer patients. Treatment for cancer is extremely expensive. Forgetting for a second the steep cost of the actual treatments for cancer, the drugs for this illness alone is enough to place financial burdens on victims. Even so, the cost of cancer drugs continues to rise rashly. In fact, an article that appeared in the New York Times reported on the insane increase that these drugs has seen since in a matter of a decade: “The typical new cancer drug coming on the market a decade ago cost about $4,500 per month (in 2012 dollars); since 2010 the median price has been around $10,000.
Two of the new cancer drugs cost more than $35,000 each per month of treatment” (Bach, Saltz &Lee). This is an extreme and dramatic rise in a matter of 10 years. But it gets worst. The articles goes on to describe the financial troubles cancer victims faced due to the expensiveness of the drugs: “In 2006, one-quarter of cancer patients reported that they had used up all or most of their savings paying for care; a study last year reported that 2 percent of cancer patients were driven into bankruptcy by their illness and its treatment. One in 10 cancer patients now reports spending more than $18,000 out of pocket on care.” (Bach, Saltz &Lee). The cost of cancer is financially burdensome, and that burden gets even heavier seeing as though many top cancer treatment facilities do not accept a number of the insurance plans offered under the Affordable Care Act.
Associated Press, a multinational nonprofit news agency, conducted a coast-to-coast survey to figure out what the future of cancer patients looked like under the Affordable Care Act looked like, here is what they found: “In all, only four of 19 nationally recognized comprehensive cancer centers that responded to AP’s survey said patients have access through all the insurance companies in their state exchange.” Sadly, cancer victims can expect to continue paying out-of-pocket expenses for cancer treatments when enrolling in the Affordable Care Act.
To be clear, this paper is not to say that the Patient Protection and Affordable Care Act is entirely unprofitable and bad for the American people, but there are some pretty bad things with it. As with most things in life, there are pros and cons and this act is certainly no exception to that. Though the Affordable Care Act has numerous respectable things encompassed within it, there are also some unforgiveable things about it, which were all discussed in the paper. Being if this act didn’t create an effect by which business owners result to such extreme measures to meet the demands of this law, if it wasn’t a mandate but rather a heavily suggested option for the American people and if it did not create such undesirable problems in terms of quality care, this might actually be a wholly good act for the American people.
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