This paper will focus on Texas’ approach on the Affordable Care Act (ACA) commonly known as Obamacare. From a nurse practitioner’s point of view, a further discussion on some strengths and flaws of as well as the approaches’ impact on stakeholders. The ACA was a legislation healthcare reform signed into practice by President Barack Obama in 2010 with provisions aimed to for everyone to be able to purchase health insurance especially those within and below the federal poverty level. “The ACA gave states the opportunity to further eliminate disparities between high- and low- income populations by expanding public coverage, subsidizing the purchase of private insurance, setting minimum standards for benefits, and regulating …out- of- pocket expenses” (Nickitas, Middaugh, & Aries, 2016). As with other legislative acts, this one has raised concerns within states not leaving out Texas.
One can say the ACA was enacted with a positive goal/outcome in mind though it has it flaws and strengths in its draft and each state’s implementation. Texas’ approach certainly has its shortcomings and few benefits. The flexibility of respecting or rejecting certain ACA provisions by states limited the positive impact of the act on consumers. One cannot dispute the notion that, Texas’ approach to the ACA have some limitations and entitlements.
Some strengths of the state’s approach are that, tax credits were used to subsidize its citizens to aid with insurance that led to more insured citizens compare to the past. Also, regulating insurers adherence to the set standard of coverage benefit by the state from insurers and forbidding of denial on base of pre-existing conditions, there have led to some increase in insurance enrollment and coverage in the state.
As expected, Texas’ ACA approach has some negative consequences on its citizens. The states’ focus is profit making thus it selecting benefit packages and regulating doesn’t meet the needs of the people. Non-expansion of Medicaid leaves the citizens in need of it most without insurance. “ In Texas and Florida alone, nearly 3 million low-income adults will remain uninsured as a result of their state’s decision not to expand Medicaid” (Adepoju, Preston, & Gonzales, 2015, pp. S665-S667). Texas’ slack on promoting and supporting the ACA results in not focusing on the healthier workplace provision thus serving as a breeding ground for unhealthy and unproductive population that will have a negative impact on the economy. Furthermore, due to the unavailability of enrollment assistance aid programs and refraining community support efforts to assist citizens with enrollment left many uninsured which further deprive the state covers from the revenues it would have made. It as well suffers from unpaid healthcare cost services healthcare facilities incur from uninsured individuals.
The state’s approach on the ACA has both some positive and negative impacts on the stakeholders ( patients, healthcare professionals, insurance and pharmaceutical companies and the government). In Texas, one can be tempted to say providers are at the wining end while consumers are at the losing side.
The state benefited from grants provided for healthcare improvement initiatives to ensure a healthcare system for provision of better quality and standard of care. According to Chat and Glied (2018), “States received funding to create and implement a state health improvement plan…that targets the preventable drivers of poor health in the state and a plan to integrate public health, community-based, and behavioral health services” initiatives decreased the state spending in compensation to healthcare facilities and indirectly boosts its economy. The leniency and flexibility of some provisions benefited the state, insurance and pharmaceutical companies for as marketing agents, they regulate prices, have control advantage over taxes, deductibles, and co-pays.
Some positive impacts from the consumer’s stand point is the alternative Medicaid expansion eligibility criteria of extended benefits and the tax credits provision though it doesn’t have a huge coverage impact to accessibility. Its advantage in the healthcare arena is from its restructuring of the healthcare system in its open recognition and incorporation of health professionals/providers.
Texas’ decision not to expand its Medicaid program like some states as required by the ACA has some negative impacts on its citizens as it handicaps many. Absence of assistance programs enacted by the ACA for the low-income have led to their inability to buy insurance . Per Sommers (2016, “Texas decision not to expand Medicaid is leaving millions of poor adults worse off than in comparison states in terms of coverage, household finances, and ability to obtain necessary medical care”. employer-sponsored coverage is beneficial to a minute population so those working with small business owners don’t have that opportunity. There is also low applicant and enrollment rates attributed to knowledge deficiency, unawareness and lack of assistance.
To amend the loopholes in the ACA, a reevaluation and amendment in areas of provision flexibility and options by the federal government. “ The federal program provided states with general guidance about eligibility for services …implementation of the guidelines was to be determined by the states” (Nickitas, Middaugh, & Aries, 2016). In should enforced implementation of guidelines rather than just providing guidance for states to determine/decide their implementation. Most ACA provisions are consumer friendly thus making states respecting it and holding them accountable is a way forward to achieve them. The plight of the low-income citizens is rarely considered by state policy-makers, so if having healthcare insurance is to be made a priority, legislators votes should not be an optional.
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