Reference no: EM133260471

Please respond to this post. One citation is need. APA format. It should be at the end of the sentence & end of post. 300 word is enough.

The affordable Care Act (ACA) was passed and implemented in 2010, however, the ACA was not fully implemented until four years later in 2014. The implementation of the ACA had the goal of extending healthcare coverage to the 32 million uninsured in the US. It sought out to bring such a change by expanding the Medicaid program and adding new structures to support the individual and small-group health markets. (National Academies of Sciences et al., 2018) In years prior an individual lacking in insurance was not necessarily without care. This, in large, was due to the passage and implementation of the EMTALA (Emergency Medical Treatment and Labor Act), where someone that was uninsured was able to present to an Emergency Department and be treated. Though the EMTALA guarantees an uninsured individual an avenue to be treated, it puts increasing strain on EDs due to the number of patients that are presenting as well as putting a financial burden on those EDs, due to the mandate being unfunded and only partially addressed through Medicaid disproportionate share hospital payments. (National Academies of Sciences et al., 2018)

The goal of the ACA was to expand access by building on the existing financing system. It sought out to expand Medicaid and private insurance, by mandating changes in insurance regulation and provider payment methods (Gaffney & McCormick, 2017, p1446). The ACA expansion of Medicaid included all citizens with incomes up to 138% of the federal poverty level being able to qualify. It was also instrumental in mandating uninsured citizens to purchase private insurance, and in some instances, offered a subsidy if the individual's income was between 100% to 400% of the poverty level. After the enactment of the ACA there was an online insurance exchange or marketplace where individuals would be able to purchase regulated, subsidized, and standardized plans. Within the individual mandate, "it was designed to compel healthier people to purchase insurance so as to balance the risk pool and lower premiums for everyone (National Academies of Sciences et al., 2018)."

In their article, Gaffney & McCormick (2017), state that the ACA has halved the number of Americans without coverage. However, they also point out that although the number without insurance is smaller, those health-care inequalities that the ACA sought to close remain in some populations (p1442). There remain financial barriers that are seen for some with high copays and deductibles. In terms of expansion of Medicaid, the ACA improved access for millions, however, in 19 states the expansion was opted out and "limitations in the Medicaid program relegate many enrollees to a lower tier of access (Gaffney & McCormick, 2017, p1442)." The landscape for the ACA is unknown. It is an idea that is without fault. McGee & Breslin (2020), state that there are two fronts with the ACA, on one side is a complete dismantling of the current structure and implementing a "Medicare for all" or the idea of "build-on-what's-working (p4)."