Affordable Care Act 2010

Posted on: 10th May 2023


To prepare:

Select a health care policy and a policy analysis framework to utilize for this Assignment. You may use the policy and framework you identified in this week’s Discussion or change your selection.

To complete:

Write an 8- to 10-page analysis paper (including references) in which you succinctly address the following:

Part 1: Define the policy issue.

How is the issue affecting the policy arena?

What are the current politics of the issue?

At what level in the policy making process is the issue?

Part 2: Apply a policy analysis framework to explore the issue using the following contexts:






Theoretical underpinnings of the policy

Include in this section:

Who are the stakeholders of interest?

Is there a nursing policy/position statement on this health care issue? If so, who developed it?

Part 3: Policy options/solutions

What are the policy options/solutions for addressing the issue? Include at least three levels of options/solutions: no change; partial change; radical change or maximum change.

What are the theoretical underpinnings of the policy options/solutions?

What are the health advocacy aspects and leadership requirements of each option?

How does each option/solution provide an opportunity or need for inter-professional collaboration?

What are the pros and cons of each suggested change? Include the cost benefits, effectiveness, and efficiency of each option along with the utility and feasibility of each option.

Part 4: Building Consensus

Outline a plan for building consensus around your recommended option/solution for solving the policy issue.

Part 5: References

Limit your references so this section is no more than 2 pages.

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Affordable Care Act 2010

Policy Definition

According to Chavez et al. (2018), the Affordable Care Act (ACA), or simply Obamacare, is a recent policy initiative by the Obama administration to reform the healthcare industry. The Affordable Care Act (ACA), also called the health reform bill, H.R. 3590 or PPACA (Patient Protection and Affordable Care Act), was enacted on March 23, 2010. Passed by Congress in late 2009, the Act contains both provisions designed to expand health insurance coverage and improve existing coverage of many groups in the United States. The ACA 2010 is a piece of federal legislation that overhauled many aspects of the healthcare system in the United States. It was meant to increase healthcare affordability and reduce the extent of medical expenses while increasing access to affordable health insurance by reducing or eliminating limits on pre-existing conditions and annual deductibles and introducing new insurance rules and regulations. The Affordable Care Act (ACA) is an excellent political topic for speeches and pro-con debate, particularly in the 2010 Congressional Midterms (Daw and Sommers, 2019). The ACA has many political implications for election years and beyond. Since implementing the 2010 Affordable Care Act, there has been vigorous debate about this landmark piece of legislation. While more Americans are covered now than before it was adopted, many feel that the benefits don't go far enough or that this type of health care is an intrusion into personal freedoms. For example, some people have criticized the ACA for not including a public option as an insurance provider on exchanges and for subsidies not available to those with over 400% of federal poverty levels. The issue over the Affordable Care Act is about health care reform. It's been addressed by congress since 2009. It has been amended several times since its first introduction. This paper seeks to discuss the policy framework’s theoretical underpinnings and build a consensus regarding the progress and solutions to the Affordable Care Act 2010, specifically in providing equal and cheap health care services to the citizens.

Policy Framework

In this case, it is also significant to apply a policy analysis framework to explore the Affordable Care Act (ACA) 2010 issue using the following contexts: ethical, legal, economic, and political. The ethical context is used to model how justice, fairness, equality and responsibility are relevant to this problem.


Social justice requires that every person access healthcare services regardless of race, gender, or creed. Social factors are variables in one's life that affect their health status. These factors include income, education level, and employment status. The ACA was passed with a clear mandate from a socially liberal citizenry. The policy promotes universal access to health care via a framework of personal responsibility and state involvement. Personal responsibility rests in the citizens’ hands; they must purchase insurance or pay a fine. The state will be responsible for regulating this system by implementing federal standards for healthcare plans, including what types of coverage they must include and how much they can charge. Moreover, the social context of the ACA has two sides: how it affects society as a whole and how it affects individuals. In terms of population health, the ACA seeks to increase access to preventative care for all Americans, reduce costs for those with common health problems, improve quality of care, and increase healthcare delivery efficiency.


One could argue that the ACA raises several concerns from an ethical perspective. Some contend that it is unethical because it requires Americans to participate in commerce as part of their civic duty. This may compel some citizens to purchase insurance that does not fit their needs simply to avoid paying a fine. The ACA is a very controversial policy issue because of its ethical dimensions. By insisting upon universal coverage for all Americans, regardless of any preexisting conditions or lack of employment, it is violating the tenets of many major religions as well as strict interpretations of the U.S. Constitution. One question that arises is whether or not it is legal for the government to force citizens to purchase products or services they do not want? Another ethical issue that arises is whether or not it is fair for the government to force citizens who have done nothing wrong and are not at fault for their situation to purchase health insurance (MacCallum-Bridges, and Margerison, 2020). Those opposed may argue that it is their constitutional right not to buy health insurance if they choose not to, and therefore forcing them violates their civil liberties.


The legal context explains how the ACA was created and why it was created. The Act was introduced as an attempt by President Obama and his administration to ensure that all Americans had affordable healthcare. They wanted to ensure that all Americans received health coverage, and they also wanted to ensure that all Americans received healthcare of a high standard. Because of how America works, the ACA needed to be introduced in a bill that would allow the President to pass the legislation through congress. The United States Congress enacted the ACA on March 23rd, 2010, with an overwhelming majority vote: 219-212 ( Nipp et al., 2018). The main legal issues surrounding the ACA are its Constitutionality, whether it can be applied to states that did not adopt it themselves and whether it is an unfunded mandate on state governments. In June 2012, the Supreme Court struck down the individual mandate that would require all Americans to purchase health insurance coverage or pay a tax penalty for not doing so; however, they upheld all other provisions of the ACA.


The Historical Context explores how healthcare policy has changed within the U.S throughout history. The ACA is a very controversial piece of legislation because it is changing healthcare policy from its previously based system into one where every American can access health care at a higher level than before; this is incredibly progressive as it works against the previous models of healthcare policy which have been used for many years in the U.S (Olfson et al., 2018). This model of healthcare policy is known as socialized medicine and is often opposed by those who believe in free-market economics, meaning that private companies should not have any involvement with government funding or services.


The Affordable Care Act 2010 is a federal statute that has been in effect since 2010, aiming to improve access to health care for all Americans by increasing its affordability and reducing its dependency on the private health insurance system. The law includes several provisions, including expanding Medicaid eligibility, instituting penalties for those who do not have health insurance, providing incentives for businesses to provide health care benefits to employees, requiring businesses with more than 50 employees to provide health care coverage, and establishing state-based health insurance exchanges (Mahal et al., 2020). There are also several taxes on the wealthy and the medical industry included in the law. It is important to note here that critics of the Affordable Care Act argue that it is not affordable since there are many taxes on the citizens for it to work.

Theoretical Underpinnings

The Affordable Care Act 2010 impacts individuals, families, businesses, health insurances and hospitals. These are the main stakeholders of interest in this area. The ACA aims to promote access to affordable health insurance, improve the quality of care, and ensure that those who do not have health insurance can get the medical care they need. Moreover, The Care Act was designed to expand health insurance for people who were not offered coverage through their employer and could not afford it, for unemployed people and those with low incomes, uninsured children and teenagers, elderly persons, and disabled persons. The Affordable Care Act strives to provide the uninsured with the opportunity to purchase good health insurance at a reasonable price (Mahal et al., 2020). From employers to individuals and the uninsured, everyone stands to gain when more Americans can secure quality health care coverage. However, there are some concerns about implementing the law and its impact on the stakeholders.

Policy Options

The following are the policy options available when addressing the Affordable Care Act 2010. These policy options affect insurance companies, health care providers and employers. The current law is to keep the Affordable Care Act 2010. A second option would be to repeal the Affordable Care Act 2010 as a whole, a radical change (ADA et al., 2019). The third option would be to only partially repeal certain parts of the law, such as allowing children up to age twenty-six years old to stay on their parents’ insurance or no longer requiring expensive preventative care such as mammograms.

No change

No change is when the Affordable Care Act 2010 does not happen. This would greatly affect health advocacy and leadership skills because it would leave healthcare as it is now. This is not a good thing for anyone currently in the healthcare system. With this option, people are still left with high premiums, prescription drug prices, and no care to those who cannot afford a plan. There is more need for health advocacy and leadership skills in situations like this because the people would be fighting for their rights to affordable healthcare. Some critics of the ACA argue that it should be repealed entirely. Other critics, however, prefer to keep some aspects of the law in place while eliminating others (Chavez et al., 2018). Replacing a tax with a penalty is one example of this approach. Keep in mind that even if Congress repeals all or part of the ACA, some states might continue to implement its provisions. Nevertheless, this option has its one disadvantage in that this means keeping everything as it is now until there is a major reason for the change. This could mean problems since there will not be any improvement of the Affordable Care Act 2010 soon.

Partial change

Partial change is when only some of the options within the Affordable Care Act 2010 are fulfilled. For example, employers must cover employees based on their income level or provide them with a subsidy to help pay for their insurance premiums if they have been with their company for at least three months. This partially changes the health advocacy aspects and leadership skills because it gives people some benefits of having healthcare but not all of them. People will still be fighting for what they need most: affordable insurance and lower-paying plans that fit. One example would be to allow Americans to keep their existing health coverage even if it doesn't meet ACA standards. Another would be to delay implementing key provisions like Medicaid expansion and tax subsidies until they can be implemented properly. Moreover, expanding Medicare to cover people under 45 would save money, increase efficiency and improve the quality of health insurance available (MacCallum-Bridges, and Margerison, 2020). Expanding Medicare to include everyone under 45 would not be feasible without first reforming Medicare to be sustainable for the long term. The current Medicare system will not remain financially viable if it is expanded beyond those currently eligible for coverage.

Radical or Maximum Change

The passage of the ACA fundamentally changed the health care system in America. The new law requires all citizens to have health insurance, provided by either an employer or the state. This is a radical change from how things were before. However, according to stakeholders, not all changes were for the better, who saw many issues with these new reforms. When looking at recommendations for change, it was difficult to distinguish between advocacy and leadership because they are so closely linked. It seems like leadership is required for advocacy to happen effectively and vice versa. Both are needed for successful reform implementation. The differences become clearer when looking at specific aspects of the legislation, like cost controls, prevention policies, choice and access, which are typically considered advocacy issues rather than leadership ones (Kaye, 2019). Consequently, the government should use its purchasing power to drive down costs by creating a unified, single-payer system that would take all Americans (including illegal immigrants) off private health insurance and put them on a government plan that negotiates rates with doctors and hospitals. As the ACA does now, it would also cover all Americans for basic medical services rather than just emergency services. However, this option would run into political and practical difficulties, especially in terms of funding.

Building Consensus

In this case, it would be vital to promote radical changes within the Affordable Care Act 2010. To build consensus around a solution that addresses the ACA's flaws and improves upon it, we will first need to understand what elements of the ACA are working well and which are not. We will then evaluate different policy options for improving upon the ACA's current structure. The ACA can transform the health system from one that treats patients when they become ill to one that focuses on keeping people well. This is a major paradigm shift, with many implications for providers, payers, and government agencies (Olfson et al., 2018). For instance, there are several ways that healthcare providers can improve patient care, reduce costs, and increase the current system’s efficiency. One way that is being implemented is the adoption of electronic health records. This is meant to help doctors keep accurate records and provide better patient care. Finally, it is significant to propose a specific reform that builds upon those positive elements within Obamacare while addressing its shortcomings.

In conclusion, the paper has discussed the policy framework, theoretical underpinnings and building a consensus regarding the progress and solutions to the Affordable Care Act 2010, specifically in providing equal and cheap health care services to the citizens. The Affordable Care Act 2010 is the first major healthcare reform ever passed in the United States. On March 23, 2010, President Obama signed it into law. It attempts to address the problems caused by uninsurance in the United States by fulfilling Americans' right to have health care and making costs more affordable. The Affordable Care Act 2010 is important for the rich and elder people and the young and healthy people who have to buy their health insurance. Additionally, as mentioned above, one of the goals of the ACA is to extend coverage to an additional 32 million uninsured Americans. The ACA also includes provisions that aim to reduce racial disparities in health care access, such as an extension of Medicaid eligibility to include those with incomes under 133 percent of the federal poverty level.



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Chavez, L. J., Kelleher, K. J., Matson, S. C., Wickizer, T. M., & Chisolm, D. J. (2018). Mental health and substance use care among young adults before and after Affordable Care Act (ACA) implementation: A rural and urban comparison. The Journal of Rural Health, 34(1), 42-47.

Daw, J. R., & Sommers, B. D. (2019). The Affordable Care Act and access to care for reproductive-aged and pregnant women in the United States, 2010–2016. American journal of public health, 109(4), 565-571.

Kaye, H. S. (2019). Disability-related disparities in healthcare access before (2008–2010) and after (2015–2017) the Affordable Care Act. American journal of public health, 109(7), 1015-1021.

MacCallum-Bridges, C. L., & Margerison, C. E. (2020). The Affordable Care Act contraception mandate & unintended pregnancy in women of reproductive age: an analysis of the National Survey of Family Growth, 2008–2010 v. 2013–2015. Contraception, 101(1), 34-39.

Mahal, A. R., Chavez, J., Yang, D. D., Kim, D. W., Cole, A. P., Hu, J. C., ... & Mahal, B. A. (2020). Early impact of the Affordable Care Act and Medicaid expansion on racial and socioeconomic disparities in cancer care. American journal of clinical oncology, 43(3), 163-167.

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Ramalingam, K., Ji, L., Pairawan, S., Molina, D. C., & Lum, S. S. (2021). Improvement in breast reconstruction disparities following Medicaid expansion under the affordable care act. Annals of Surgical Oncology, 28(10), 5558-5567.

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