The Affordable Care Act and Racial Health Disparities policy analysis

The Affordable Care Act and Racial Health Disparities policy analysis Introduction Affordable Care Act (ACA), passed in 2010 is one of the most profound changes to happen in U.S. health care. It was meant to further open access to affordable coverage, enhance quality of care, and better health outcomes inequities. It may be possible to reduce racial health disparities, especially in African Americans, an aspect that has its significance as one of the social justice implications that the intervention has. However, African Americans have traditionally had greater rates of chronic illness, shorter life expectancy, and had less access to care than White Americans. The current critical analysis accesses the ACA under the social justice profile and reviews the progress, objectives, efficacy, viability, and limitations of this policy. The strategic implications of the ACA with regard to the values identified in the National Association of Social Workers (NASW) Code of Ethics are also discussed, and the extent to which the policy promotes equity among the marginalized groups is explained. Policy development and historical Background ACA is a product of the years of the argument on the necessity of universal or increased health care coverage. Before its enactment, almost half of the Americans did not have insurance, and African Americans became one of the worst hit groups of people because of the system inequities in terms of work and income, and housing (Kaiser Family Foundation [KFF], 2021). President Barack Obama signed the legislation into law that came with a lot of congressional debate and partisan fracture. Its enactment was an outgrowth of the acute nature of the 2008 financial crisis that made millions of Americans vulnerable, as well as ongoing pressure calling for civil rights on health care access. The policy implementation was conditioned by legal and political problems. Interestingly, the 2012 verdict (National Federation of Independent Business v) on the Supreme Court allowed numerous companies in the United States to pay limited tax rates. Sebelius kept the majority of measures but made the expansion of Medicaid non-required by the states. This ruling greatly affected the scope of the ACA to lower the health inequities between races since most states with substantial African American populations rejected the expansion. Goals and Programs of the ACA The ACA was aimed at three main objectives, which included increasing access, improving quality, and reducing the costs. These objectives were achieved by making a few key provisions. Expanded Medicaid included persons with income rates as high as 138 percent of the federal poverty level, and directly targeted low-income populations, of which African Americans were included (Bailey et al., 2021). Health Insurance Marketplace has also made subsidized plans available to people to cover themselves privately, and those with preexisting conditions gained the opportunity as they could no longer be discriminated against. Also, the law required coverage of preventive services, attempted to enhance the primary care coverage, and offered financing of community health centers. In terms of social justice, such provisions lie in the endeavor to embrace dignity, equity, and the right to gain access to health care as reflected in the NASW Code of Ethics (NASW, 2021). The ACA also tried to remove ingrained inequalities in the health system by targeting systemic barriers and making things more equitable. Effectiveness of the ACA for African Americans The ACA has shown quantifiable results to have enhanced access to health care by the African Americans. Among the African Americans, the uninsured rate decreased by 19.9 to 11.7 between 2010 to 2016 with the rate reduction being one of the biggest coverage gains among racial and ethnic groups (KFF, 2022). Some disparities have been reduced with increased access to preventive care services that include cancer screenings and vaccination care. Moreover, Medicaid expansion has been associated with better maternal health among African American females, who face an overwhelming prevalence of maternal deaths (Daw et al., 2020). With these successes there still exist challenges. With states that decided not to expand Medicaid, African Americans are still disproportionally represented in this coverage gap, as millions go uninsured. Affordability and provider availability remain a barrier to even people covered. Alternatively, such low access to care can be associated with narrow insurance networks and high out-of-pocket cost coverage (Artiga & Orgera, 2019). Although the ACA has increased the social functioning of the African Americans due to increased access and decreased the vulnerability to finances, it is dissimilar and dependent on how the states adopt it. Bearing regular practice in mind, the ACA offers guidelines toward nondiscrimination and equity establishment based on ethical grounds. Nonetheless, the coverage gaps that still exist portray the areas of failing to fulfill ethical standards of justice and equality. Viability of the ACA The feasibility of the ACA can be estimated politically, economically and administratively. The ACA has endured political opponents especially by the conservative policymakers. The fact it is on such a precarious political base is evidenced by the struggles to repeal or undermine the law, as seen with the elimination of the individual mandate penalty in 2017. Yet, there is continued political viability as polling continues to demonstrate bipartisan consensus when it comes to major provisions namely protection of preexisting conditions (Pew Research Center, 2021). The ACA has been fairly affordable economically. Added federal spending was experienced through the Medicaid expansion and subsidies though some of it was countered by decreased uncompensated care and health outcome. Research findings reveal that the areas of expansion increased with more financial stability of hospitals and a reduced cost of uninsured care (Bailey et al., 2021). Administratively, the ACA rollout was not without its problems, namely in the technical failures of HealthCare.gov during its first years and uneven state-by-state rollout. With increasing enrollment system and outreach bars, the law has over time become workable. Complicated as it is, the ACA is administratively manageable, and reducing its complexity and increasing accessibility should continue to be a priority. Policy Constraints There are a number of limitations that restrict the role of the ACA in completely resolving the racial disparities in health. The most important one is the voluntary aspect of Medicaid expansion that has resulted in geographical disparity of coverage. The states that have higher numbers of African Americans and especially in the south have rejected expansion disproportionately leaving millions of people uninsured (Artiga et al., 2020). Other limitations are on the affordability levels where even with the subsidies, premiums and set deductibles are still high in relation to income levels among the low-income families. The problem of political polarization remains one of the potential threats to stability because such frequent policy changes put both providers and consumers under the threat of uncertainty. New issues like the COVID-19 pandemic have also pointed out flaws in the capacity of ACA to act swiftly in response during health crises. Although the ACA has set the stage in the right direction, these limitations are a handicap to its complete achievement of equality. Conclusion and Forward-Looking Reflection ACA has played a significant role in decreasing the health disparities of race especially among the African American by increasing access, enhancing quality, and incorporating equity in the health policy. Its achievements can be seen in decreased rates of uninsured and increased usage of preventive care. However, structural and political obstacles limit its performance resulting in the lack of coverage of many African Americans being uninsured or having inadequate coverage. Going into the future, reforms are to be based on strengthening the ACA instead of destroying it. Further expansion of Medicaid to every state, greater subsidies to minimize affordability gaps and an improvement of community based health programs is vital. These kinds of reforms would also make the U.S. health policy more aligned with the NASW Code of Ethics in respect to promoting justice, dignity, and equitable access. Although the ACA is an unmatched success, the unfinished business of the ACA reminds policy-makers and health equity advocates that their work does not end with a piece of legislation.   References Artiga, S., & Orgera, K. (2019). Key facts on health and health care by race and ethnicity. Kaiser Family Foundation. https://www.kff.org Artiga, S., Hill, L., & Orgera, K. (2020). Medicaid expansion and the uninsured: A look at remaining uninsured by race and ethnicity. Kaiser Family Foundation. https://www.kff.org Bailey, S. R., O’Malley, J., Gold, R., Heintzman, J., Likumahuwa, S., & DeVoe, J. E. (2021). Receipt of preventive services among insured adults: How race, ethnicity, and income matter. American Journal of Preventive Medicine, 60(2), 234–242. https://doi.org/10.1016/j.amepre.2020.09.014 Daw, J. R., Hatfield, L. A., Swartz, K., & Sommers, B. D. (2020). Women in the coverage gap: The Affordable Care Act and maternal health disparities. Health Affairs, 39(5), 793–801. https://doi.org/10.1377/hlthaff.2019.01461 Kaiser Family Foundation. (2021). Key facts about the uninsured population. https://www.kff.org Kaiser Family Foundation. (2022). Health coverage by race and ethnicity, 2010–2021. https://www.kff.org National Association of Social Workers. (2021). Code of ethics of the National Association of Social Workers. https://www.socialworkers.org