Introduction
The Affordable Care Act is a platform introduced by the U.S government to reduce the effects of uninsured or lack of insurance health covers. The Act aims at helping the medically uninsured in the U.S. by lowering the medical costs. The policy performs through a legislative component introduced by the government that utilizes governmental funds by helping the uninsured individuals in acquiring health activities (Kovner and Knickman 2011). The Act has helped many citizens in the country to acquire health services despite having different income levels. According to statistics, the Act has led to a fall in the uninsured rates in the country (Jones, Bradley and Oberlander 2014). The Act was implemented and took effect as its efforts were seen in the past five years. For instance, the uninsured rate has fallen from 12.9% to 11.4% in 2015 (Jones, Bradley and Oberlander 2014). The Affordable Care Act was placed into action to help the government in accomplishing their proposed idea by helping the population in affording the medical covers and insurance (Kuezi-Nke 2003). For instance, the Act was in search of the middle-income families in the way of helping them attain health covers as well as expanding the Medicaid program. The program would help the poorest families to acquire health services regardless of their incomes. Therefore, this report discusses the policy-making and implementation and the introduction of the Affordable Care Act as a measure of improving the Uninsured rates.
Theories and Models of Health Policies
Different policy models; namely, The Hall et al. (1975), Kingdon(1985), Downs (1972), and Sabatier and Jenkins-Smith (1999) help towards the implementation and discussion of the Affordable Care Act. The Hall et al. (1975) was a method employed by the government in helping the population affording the health care services. The model implied that the government would cater for the cost of capital and salary services while the fees contributed by the patients would cater for the development and running of the hospital facility. Similarly, the Kingdon (1984) states the importance of garbage can model. The model indicates that a problem might be solved by could be solved by utilizing new techniques that were not previously used. Down (1972) introduced a model of an environmental issue by issuing an attention cycle model that incorporated the views of the public on family issues. Additionally, Sabatier and Jenkins-Smith (1999) articulated the issue and the policy of Advocacy Coalition Framework that would help in the implementation of health policies.
The Hall et al. (1975) Model
The Hall et al. (1975) model was put in place to ascertain the importance of the government in the implementation of health policies. The model suggested that the government and specifically the health care system management would recommend an issue affecting the healthcare system and it would be made a policy if it passes the justification from the laws. Similarly, the same issue would be made legal or made a health policy after being feasible towards the hands of the healthcare management (Jones, Bradley and Oberlander 2014). The policy requires support from various institutions as well as from other health personalities. For instance, the Medicaid and Obamacare models and policies were implemented after being recognized with importance from almost every citizen in the United States. Similarly, the Affordable Care Act was put in place after being first analyzed, tested, and accepted by a majority vote in the government’s healthcare legislation (Kocher and Adashi 2011). The same Act was introduced to the public by the government and received support by being one of the best policies that favored the lives of the poor as well as the most population in the American culture.
The Hall et al. (1975) model allows a public opinion to offer support towards any proposed document or policy. The uninsured rates have been decreasing year by year with the introduction of the Affordable Care Act as well as other policies such as Obamacare and the Medicaid, which have tried to reduce the healthcare disparities (Kocher, Emanuel and DeParle2010). The policy is widely accepted by almost every corner of the state due to its importance. The Act has changed people’s lives with the increase of health care facilities, an increase in the number of health practitioners, a rise in the facility technology, salary increment in the healthcare staffs, and other aspects of healthcare development. Therefore, the legitimacy and the legality of the policy are widely accepted in the United States.
The Hall et al. 1975 model also suggests that the Affordable Care Act and the uninsured rates policy were introduced in the country since it was potentially effectual towards the American people. Doty, Rasmussen and Collins (2014) claim that the life of a common American citizen was in danger in the past compared to the current situation. People used to cater for their hospital bills straight from their pockets. However, the government saw the importance of changing the situation by introducing a way of helping the citizens in acquiring an affordable strategy that would help in minimizing the risks associated with the health issues. For instance, most people could not afford private emergency hospitals as the bills are always exaggerated. Similarly, the public hospitals could not have sufficient care due to poor management (Smith and Medalia 2014). Therefore, the policy was feasible and had the potential to be implemented since most health practitioners saw the need for making the lives of American citizen better.
Summary analysis of Hall Theory
| Stream | Ensuring the reduction of the uninsured rates through the implementation of the Affordable Care Act |
| Legitimacy | -Legal actions aimed at promoting the healthcare system -Introduction of Medicaid and Medicare through the ObamaCare system -The introduction and implementation of the law of Affordable Care Act |
| Feasibility | -The resources to be used in the fight against the rising Uninsured rates -The government increasing the number of insurance agencies that should provide covers to a large amount of population -Introducing insurance coverage in the employment system where employers should help their employees access insurance covers |
| Support | -The acceptance of the ACA by the population -Employers helping the government achieve the aim of increasing insured rates -Hospitals and healthcare facilities accepting the change by welcoming the idea of insurance payments |
The Kingdon(1995) Theory
Another model discusses the importance of the Affordable Care Act and the Uninsured rates policy. The model of Kingdon(1995), also known as The Windows Theory, was put in place by a theorist known as Kingdon, who suggested that policy would be placed in action after passing three stages. The stages include independent streams, which are problem stream, alternative stream, and a political stream. However, the model does not articulate the process of involving the government in the betterment of the health policy. The windows theory also known as Kingdon theory is based on a process that starts with identifying a problem (Jenkins-Smith 1988). The problem is analyzed and articulated towards a level that would benefit the public. The government officials in the United States viewed the insurance rates as a problem before the implementation of the Affordable Care Act (Krueger and Kuziemko 2013). The problem was that the rates of the uninsured individuals kept rising and rising as the health care system become expensive.
From the step of realizing a problem, the model explains the need for an alternative where the policy makers should adopt before implementing the proposed policy. For instance, the United States government health officials saw the need for the Affordable Care Act as a platform that would change the course of the health care delivery (Krueger and Kuziemko 2013). The alternative for the solution might have helped since it included the use of funds to increase the productivity of health care facilities. Health practitioners would have been increased to raise the number of healthcare services in the public hospitals.
The last step in the Kingdon model is the political stream where the government is involved in the decision making as well as the implementation of the policy (Kingdon 1984). The United States government through the legislation proceeded to introduce the debate through the law-making chamber (Stout and Stevens 2000). The outcome was the introduction of the Affordable Care Act that was to reduce the healthcare disparities and the rate of uninsured individuals.
Summary Analysis of Kingdon Theory
| Stream | Application of ACA in an effort of reducing the effects of Uninsured rates |
| Problem stream | -Increased rates of uninsured -High costs of health care towards the poor and the elderly -Lack of knowledge concerning the insurance education |
| Policy or alternative Stream | -The government had discussed the effects of the rising uninsured rates mostly towards the elderly and the people living in the poverty level. The alternative of offering insurance covers would be offering free healthcare system to the disadvantaged group. |
| Political Stream | The government introduced Medicare and Medicaid programs through the ObamaCare system as well as introducing the Affordable Care Act. |
Analysis, Application, and Discussion
Kingdon Theory
Problem Stream
The Kingdon theory would focus in ascertaining the problem facing the Uninsured Rate health policy which would be done by perusing the available health article dated from the beginning of the healthcare implementation in the United States (Kusi-Ampofo et al. 2015). Similarly, the information could be obtained from governmental websites that lay concern in the healthcare delivery to the public. For instance, the problem in the healthcare system was that the population uncovered by any available health insurance kept rising with the increase of unaffordable health care (Mortensen 2010). The previous system seen in the United States was that people could not afford healthcare services due to its high costs. Additionally, statistics showed that the elderly and the poor people had the highest percentage of the uninsured rates.
The first survey was conducted in 1988 by the Current Population Survey (CPS). The survey obtained information from households interviewing every member of the society of their knowledge of the current insurance covers (Pump 2011). The report claimed that many individuals had less or no knowledge of any insurance covers meaning that it was hard to acquire one. For instance, many employees could not respond to any available insurance covers despite employers providing a platform for an affordable health insurance. However, the rate of unemployment had played a role in the misconception of uninsured rates. Employers were asked by the government to provide employer-based insurance covers which the employees were obliged to pay for through their salaries. Therefore, only a small percentage of the population had access to the proposed employer-based insurance covers despite the existence of other forms of insurance covers such as Medicaid, Medicare, and privately-purchased insurance covers.
National Health Interview Survey (NHIS) was another statistical data platform focusing on obtaining the information regarding the uninsured rates in the United States. Although the survey group dates back to the mid-twentieth century, the group was reinvented in 1997 with the aim of reviewing the problem facing the government in the rise of uninsured rates (Stone 1989). The survey was aimed at interviewing the entire population if possible (Downs 1996). The group managed to obtain relevant information that proved that the health insurance coverage had improved from the previous decade. Many people had access to any insurance program. For instance, the Medicaid and the Medicare programs had managed to penetrate into the interior of the country helping as many people as possible in the attainment of health insurance covers. However, Hofer, Abraham and Moscovice (2011) showed that the ratio of the insured and the uninsured had a large difference and the government was supposed to implement a strategy to minimize the disparity. The recent survey conducted by the group (NHIS) produced data obtained in 2014 showing that the rate of the uninsured elderly population had fallen to 13.3% proving that the society had started having the knowledge of the insurance programs (Schoen et al. 2011).
The Medical Expenditure Panel Survey was another group of surveyors introduced in 1996 to articulate the evidence in the insurance programs in the United States. The group conducted a door-to-door analysis collecting data on the knowledge of insurance covers. Similarly, the survey group managed to interview employers, healthcare facilities, and the insurance program institutions (Collins et al. 2012). The group aimed at knowing the rates of payment offered by the insurance institution as well as the fees payable to the healthcare facilities. Therefore, the information obtained was deemed to have an effect of realizing the reason behind the rising percentage of uninsured rates (Collins and Nicholson 2010). Additionally, another group “Gallup-Healthways Well-Being Index” was formed to conduct a phone call interviews obtaining information to estimate the rates of the insured and the uninsured. The group managed almost 1000 phone calls which provided the required data of the insurance programs. Sommers and Kronick (2012) shows that the interviewed group ranged from 7500 adults between 18 and 64 years as well as 2400 children under the age of 18 years.
Policy/Alternative Stream
The policy of the Uninsured rates was seen to have challenges in its implementation and the United States Government need a strategy that would reduce the health disparities in their population. Therefore, the lawmakers and policy implementers introduced the Affordable Care Act with the aim of helping the citizens acquire equitable health services regardless of their financial income (Collins, Rasmussen and Doty 2014). The Kingdon theory had suggested that every policy should be followed by an alternative in the effort of policy implementation. However, the Act was introduced late bearing in mind that the Uninsured rates policy was there before the millennium. According to Sommers et al. (2012), the Affordable Care Act has been seen to help the government as well as the population in the provision of an affordable healthcare system. The Act suggests a strategy that would reduce the percentage in the ratio of insured and the uninsured.
Political Stream
The law of the United States considers that the Affordable Care Act was a strategy that would implement the Uninsured rates policy. The Act was introduced in 2010 and started to take action with the prose that the insured families would be eligible and cater for their children until they reach an age of 26 years (Ku et al. 2011). The strategy would reduce having youths without the insurance coverage because they would be eligible to their parents’ insurance covers before they start paying taxes. Similarly, the law expanded the Medicaid coverage by decreasing the range of providing insurance coverage to the population below the income of 138% in the poverty level. Mulligan (2013) claimed that most of the States n the United States had implemented the requirement of expanding the Medicaid that covered most of the population in the Federal Poverty Level (FPL). Therefore, the political stream has contributed to the implementation and the improvement of the Affordable Care Act as well as the reduction in the percentage of the Uninsured Rates. Learning the Kingdon’s theory has helped in the realization of the process involved in the implementation and improvement of the Uninsured Rates in the U.S through the introduction of the Affordable Care Act and the ObamaCare programs.
The Hall Theory
Legitimacy
Legitimacy is the legal attribute where the government plays a major role in the implementation of the health policy. Similarly, the law provides the steps to be followed in by the policy makers as well as the health care management in the improvement and reduction of the uninsured rates (Rosenbaum 2011). The Hall et al. (1975) theory suggests that the government should place laws protecting the less disadvantaged such as the federal poverty level individuals, the children, and the aged. Some of the laws in the Act propose that the medical insurance covers through Medicaid and the ObamaCare should increase their coverage to almost every individual in the United States.
Feasibility
The feasibility attribute of the Hall theory covers the availability of resources that should be used in the implementation of the Uninsured Rates Policy (Long et al. 2014). The Act should as well indicate their capability in the fight for the reduction of uninsured population in the United States. Bharel et al. 2013) showed that the U.S government had laid down the requirements proposed to the health care providers, the insurance agencies and the health ministry that would help the population in bridging the gap between the insured and the uninsured.
Support
The public and the government have shown the support for the health policy. For instance, the United States had recorded an improvement in the response since the implementation of the health policy (Sommers and Kronick 2012). The public has also responded positively to the implementation of the health policy and the Affordable Care Act. Therefore, the use of the Hall et al. (1975) model could help in the implementation and improvement of health policies and the betterment of healthcare services in the United States.
Conclusion
The United States healthcare department had recorded a healthcare service disparity in the sector of insurance programs. The history of health care services showed that people could not afford healthcare insurance covers due to various reasons. However, the government had introduced measures aimed at improving the health care services but was faced with the problem of an increasing rate of uninsured percentage. Similarly, the government lacked a clear strategy that would help reduce the gap between the insured and the uninsured. Therefore, the introduction of the newest policy named as Uninsured Rates and Affordable Care Act has helped the government overcome the challenge of having a large uninsured population. Additionally, the policy implementation has been a success using theories and models, which articulate the procedures of identifying the problem, analyzing the obstacles, and laying down strategies that would help in the policy implementation. The use of Hall theory and the Kingdon’s theory has helped the government in achieving what was missing from the beginning.
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