Affordable Care Act: Analyzing the Impact of Repeal & Replacement

This report provides a comprehensive review and analysis of the proposed repeal and replacement of the Affordable Care Act (ACA). It delves into the key aspects of the proposed legislation, including its impact on healthcare coverage, access to treatment, and the financial stability of the healthcare system. The report also examines the potential effects on nursing practice, patient care, and communities, highlighting concerns about the loss of coverage for millions of Americans and the resulting strain on healthcare providers. Furthermore, it discusses the role of federal subsidies and Medicaid expansion in supporting healthcare services and the potential consequences of their removal. The analysis incorporates insights from various sources, including government reports, news articles, and academic research, to provide a balanced perspective on the complexities of healthcare reform and its implications for the future of healthcare in the United States. Desklib offers more resources for students.

Running Head: AFFORDABLE CARE ACT ‘REPEAL & REPLACE’-REVIEW & ANALYSIS
AFFORDABLE CARE ACT ‘REPEAL & REPLACE’-REVIEW & ANALYSIS
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1AFFORDABLE CARE ACT ‘REPEAL & REPLACE’-REVIEW & ANALYSIS
Introduction:
The Patient Safety and Health Care Act, commonly known as the Affordable Care Act
(ACA) or colloquially regarded as Obama care (Siskin et al., 2017), is a statutory legislation of
the United States passed by the 111th Congress of the United States and signed into law on 23
March 2010 by President Barack Obama. The bill has introduced a series of changes to payment
processes aimed at reducing healthcare expenses and increasing efficiency. After the reform fell
into force, total healthcare cost growth decreased, particularly rates for employer-based
insurance policies. Trump and other Republicans (Jacobs, 2017) have promised to dismantle
Obama care to expand it. On January 20, 2017, President Trump passed legislation (McCarthy,
2017) saying Obamacare's pressure will be lifted while the government passes toward abrogation
to substitution. The paper below discusses and reviews the effects of the repealing and replacing
the Affordable Care Act (ACA). Additionally the paper also discusses the health care issues
included in the proposed bill and ways with which it influences nursing practice or nursing care
as well as how it will potentially impact the health care system, patients and communities.
Discussion:
Legislation or the Proposed Bill passed for repealing & replacing the ACA:
The House Republican leadership revealed a concise proposal to overhaul the Affordable
Care Act on March 6, 2017. It maintains several provisions of the Affordable Care Act, but
combines ACT's payment program with tax credits and publicly supported provision of Medicaid
with a block grant framework for states depending on the type and amount of patients covered.
The New York Times mentions in their article (Hoffman & Goodnough, 2019) that the

2AFFORDABLE CARE ACT ‘REPEAL & REPLACE’-REVIEW & ANALYSIS
conservative opponents like Rand Paul described the proposal as "Obamacare Thin" and
proceeded to support complete elimination, although other Republicans like Cory Gardner from
states that had approved Medicaid extension voiced doubt over how the proposed program would
properly finance Medicaid patients 'programs. One section of the bill was approved by the
United States House Committee on Ways and Means on March 9, 2017, during an all-night
session. The United States House Committee on Energy and Commerce has endorsed the second
section of the bill by a party-line vote by March 9.
Key aspects of the Legislation or Bill and the Areas of Health Care
Addressed:
The Congressional Budget Office issued its report on the plan on March 13. It forecasted
a rise of 24 million uninsured by 2028, with savings of $337 billion over ten years. In 2018,
much of the loss will be triggered both explicitly and implicitly by the removal of the fines under
the federal requirement (Ku et al,. 2017). By 2016, the CBO predicts that the total price paying
for health benefits will be decreased by about 10%. It stems from higher premiums for older
patients and decreased benefits that are projected to raise the percentage of younger individuals
in the population and decrease the percentage of older people. The bill (Jost, 2017) was
authorized on 16 March 2017 by the House Budget Committee 19 to 17. On 4 May 2017, the
U.S. House of Representatives voted to amend the Consumer Safety and Affordable Care Act
and enact the American Health Care Act by a slim vote of 217 to 213, referring the measure to
the Senate for deliberation. The Senate has suggested that it would draft its own version of the
legislation, rather than rely on the House edition.
On 7 March 2017 Pete Sessions introduced an innovative resolution to amend and restore
the "World's Best Healthcare Initiative 2017" Consumer Safety and Affordable Care Act. The

3AFFORDABLE CARE ACT ‘REPEAL & REPLACE’-REVIEW & ANALYSIS
new version of the legislation replaces the federal requirement of the ACA, which also punished
those lacking health care. In fact, it retains other elements of the ACA by maintaining medical
protections for pre-existing illnesses, requiring minors to stay in the health system of their
parents until they turn 26 years old, and banning insurance providers from imposing lifelong
spending caps.
Health Care Issue addressed in the proposed bill and its influence on Nursing Care
and the Health System:
The latest proposal to replace the Affordable Care Act (ACA) — unveiled by a coalition
of influential conservators and conservative organizations on June 19 — would have significant
harmful effects on health insurance coverage (Coombs, 2019), access to treatment, wellness and
financial security as the reform bills of last year. Currently, as a consequence of the ACA's
extension of Medicaid to low-income individuals, about 12 million people in 31 states and the
District of Columbia are insured, while around 10 million people in all states receive assistance
from the ACA's premium tax incentives while cost-sharing cuts to compensate for individual
insurance care. The latest reform bill will abolish these services entirely. The proposed proposal
will replace a range of ACA patient safety initiatives (French et al., 2016), which are extremely
important for those with pre-existing health conditions. The proposal leaves unclear whether the
ACA's bans on limiting benefits or paying higher rates depending on health status could still be
repealed by states (Nadash et al., 2018), stating not whether such clauses should be removed nor
whether they should stay in effect. 12 million individuals in 31 states and the District of
Columbia are protected by the ACA's extension of Medicaid to low-income families, and about
10 million individuals in all states seek aid from the ACA's premium tax incentives and cost-

4AFFORDABLE CARE ACT ‘REPEAL & REPLACE’-REVIEW & ANALYSIS
sharing cuts for individual market coverage. The current reform bill would abolish such services
entirely, and would substitute them with a state block grant.
Democrats have already taken action to abolish crucial sections of the Affordable Care
Act without, obviously, a contingency program. These are two main aspects of the Affordable
Care Act, government tax incentives used to subsidize insurance rates and Medicaid extension
initiatives. Essentially, federal subsidies under these two programs flow to employers and health
insurance facilities, ensuring they've had enough resources to increase their medical services. To
better handle the influx of newly covered people, it became important to recruit more nurses
(Fornili, 2017), physicians and other health-care staff. Stats from the Bureau of Labor Statistics
indicate that in 2016, the healthcare sector gained an average of 35,000 workers each month,
reflecting about 20 percent of the additional positions that were created last year. If Americans
remove the above two protections, the number of uninsured people could increase, contributing
to higher uncompensated cost of treatment for health care providers. The Congressional Budget
Office (CBO) estimates that dismantling the ACA would leave millions of Americans without
insurance. Despite more outstanding expenses and heightened customer hospital debt,
employment shortages in hospital and amongst nurses, look imminent. The federal budget cuts
present a challenge to the healthcare system. Cutting government subsidies to hospitals and
medical care services will have a domino-like impact through the US economy as a whole.
Effects will not only impact jobs, but also economic growth (Ku et al., 2017), as well as state and
municipal taxes.
Conclusion:
The Republican Congress and the Trump administration's rise in 2017 offer a significant new
framework for researching health care and federalism. This essay discusses how complexities of

5AFFORDABLE CARE ACT ‘REPEAL & REPLACE’-REVIEW & ANALYSIS
federalism worked out in reform legislative politics and substitutes the position of the
intergovernmental group with special focus (Thompson et al., 2018). Virtually any of the repeal-and-
replace measures should have dramatically strengthened the state's power to influence health care
policies while substantially weakening it by rising federal funds. The ACA's Medicare reforms have
played a significant part in improving the budgetary stability of Medicare for the future, thereby
offsetting some of the expenses of the ACA's service extensions while even offering certain new
advantages for individuals with Medicare. Throughout addition, reductions are made by raising fees
to suppliers, such as clinics and skilled nursing establishments. Congressional legislation to eliminate
the ACA tends to be imminent but it is not currently clear whether Congress will eliminate the ACA
in its entirety or maintain certain provisions. Medicare spending per patient has risen more steadily
than private health insurance expense as a consequence of the Medicare changes contained in the
ACA; rates and cost-sharing for certain Medicare-covered programs are smaller than they would
have been under the ACA; proposed improvements to the payment and distribution framework are
being introduced and tested; and the Medicare Trust Fund has acquired additional years funding
Total elimination of the ACA Medicaid regulations will boost fees to hospitals and other health
insurance facilities and Medicare Advantage programs, possibly to result in increased costs,
deductibles and cost share for Medicare-covered benefits charged by those under Medicare.

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References:
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Coombs, B. (2019). Health insurer stocks fall after Trump administration seeks overturn of
Affordable Care Act. Retrieved 11 April 2020, from
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seeks-aca-overturn.html
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about the potential repeal of the Affordable Care Act. Journal of addictions
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Protection and Affordable Care Act (ACA): a systematic review and presentation of early
research findings. Health services research, 51(5), 1735-1771. doi.org/10.1111/1475-
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7AFFORDABLE CARE ACT ‘REPEAL & REPLACE’-REVIEW & ANALYSIS
Jacobs, B. (2017). Republicans look poised for three-part plan to repeal and replace Obamacare.
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