PPACA Legislation: An Improvement or a Liability


1) Use your critical thinking skills to write a paper of 1200 words that responds to the question, “Is the PPACA legislation an improvement or a liability to our health care delivery system?” Use examples to illustrate your points and include pros and cons of the changes.

2) Refer to the assigned readings to incorporate specific examples and details into your paper.

3) Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

4) This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.

PPACA Legislation

The access to quality health care services is undoubtedly one of the factors that significantly increases the quality of life that many individuals across the USA, and the world, live (American Nurses Association, 2015). As such, it is imperative to ensure that people can receive high-quality and affordable health care services regardless of any barriers that may potentially hinder this such as income (Lee, Casalino, Fisher, & Wilensky, 2010).

It is for this reason that the PPACA, or Obamacare as it is commonly referred to, was structured as it is. It aimed to facilitate the provision of quality health care services at very low prices, and in the case of the very poor, virtually free of charge.

However, the reality of the matter has been extremely different from the expectations that it cultivated during its discussion and subsequent implementation. Although the PPACA has proven to have a number of valuable benefits, it is consistently plagued with serious challenges, essentially making it a liability more than an improvement of the health care delivery system.

One of the core advantages of Obamacare has been its established of federal and state health care exchanges where individuals can identify, compare, and select among a variety of insurance plans (Barker & DeNisco, 2016). This approach has done well to gift insurance buyers increased control insofar as selecting their plans is concerned. In this way, individuals, couples, and families can tailor their insurance plans to meet their needs, which is a significant development in the health care insurance industry in the USA.

Similarly, the PPACA has provided a set of 10 essential health care services that all insurance plans must provide in order to be deemed acceptable. These include mental health treatment, maternity and newborn care, and preventive visitations to name a few (CMS, 2010). In this way, the basic health care benefits are enshrined in all insurance plans regardless of the premium that one pays. For instance, expecting a child becomes a less worrisome activity when maternity care is essentially covered within the selected insurance plan, eliminating the need to purchase additional insurance.

Increased access to mental and behavioral health treatments have also been welcomed by insurance buyers as they can now enjoy more affordable treatment options for such services compared to the pre-PPACA era. It is also worth noting that the PPACA requires all citizens to have insurance for at least 9 months of the year (or to pay a tax instead) in addition to implementing a quality-of-care payment structure for physicians and hospitals as opposed to the previous quantity-of-care model (CMS, 2010). The combination of these services has significantly improved the quality, reliability, and delivery of health care services for those able to afford health insurance.

However, while some of these benefits are quite lucrative, the disadvantages of Obamacare have proven to be exponentially more catastrophic to insurance buyers across the USA. Perhaps one of the biggest disadvantages of the PPACA was its inability to legally mandate all states within the USA to expand their Medicaid coverage (Barker & DeNisco, 2016).

A Supreme Court ruling in the matter of state-expanded Medicaid coverage established that states were within their rights to opt out of expanding Medicaid coverage (Young, 2014). This development resulted in millions of individuals being uninsured and unable to afford health care services across the USA with the poor being the most affected.

Consequently, in states that have chosen not to expand Medicaid coverage, individuals earning annual wages considered to be below the poverty level (roughly $11500) do not receive any benefits from Medicaid (Young, 2014). This has left many of them unable to access health care services or dogged with exponentially high out-of-pocket costs whenever they seek services traditionally covered through Medicaid. This has left many American citizens stranded and hopeless insofar as health care services are concerned, and approximately 27 million non-elderly American citizens remain uninsured in 2016 (Dorsey, 2016).

It is also worth acknowledging the PPACA increased the deductible level for families from 7.5 percent to 10 percent (Amadeo, 2017). This increases health care costs for families. Similarly, families can now lose tax deductions for incurred medical costs that were uninsured. All these provisions work well to take more money from the pockets of insurance buyers, which is in essence a contradiction of the initial goals of the PPACA.

An alternative to buying insurance is to pay Obamacare taxes. However, these have been significantly controversial, with no concrete values of said taxes being prescribed. For instance, in 2016 the taxes rose to 2.5 percent of the adjusted gross income (Amadeo, 2017). Seeing as the minimum payment was $695 and the maximum payment is set as the cost of purchasing a bronze insurance plan, it becomes difficult for families to ascertain the amount of taxes they would pay on a yearly basis for opting out of purchasing an insurance plan (Amadeo, 2017).

In addition to these personal finance challenges, Obamacare has been touted by many experts as having the potential to increase the national debt by as much as $1.76 trillion (Amadeo, 2017). Initially, the PPACA was projected to make $143 billion in savings. These varying and vastly different financial assessments of Obamacare make it difficult to ascertain its true costs to the USA, and especially over the long-term.

Secondly, the PPACA now mandates Medicare to reimburse hospitals using a value-for-service or quality-of-care system as opposed to the previous fee-for-service approach (Shafrin, 2010). This provision of the act is specifically designed to help reduce the health care costs that consumers bear whenever they seek services in the long-term. The immediate implementation of this provision has created a tumultuous transition period for hospitals as they are forced to receive lower reimbursements from Medicare. In some cases, such financial strife is likely to affect the efficient operation of said health care institutions, thereby jeopardizing the very quality of care this provision looks to realize (Shafrin, 2010).

Along the same line, the PPACA now requires all doctors’ offices across the USA to computerize the medical records of their patients. While this in itself is direct and developmental, the development of 140000 codes from which doctors must choose when entering diagnosis data only looks to lengthen the adjustment period and reduce the efficiency of the health care delivery system (Amadeo, 2017).

Thirdly, health insurance and health care companies are required to pay more taxes in order to help cater for the benefits that Obamacare promises. For instance, pharmaceutical companies are projected to pay $84.8 billion more between the years 2013 and 2023 (Amadeo, 2017). These are all strategies aimed at closing the financial gap in Medicare Part D, commonly referred to as the doughnut hole. In the event that such additional expenses are passed onto the consumers, then drug costs are very likely to increase over the years, which is in itself also against the core goal of reducing health care costs that the PPACA was developed to realize.

Undoubtedly, the PPACA was developed with the best of intentions. It sought to reduce the costs of health care across the USA in addition to streamlining health care service delivery and increasing the efficiency of health care facilities.

However, as shown above, the fine print of the PPACA did little to robustly enforce the successful adoption of this policy. Similarly, the obstacles that have dogged this policy since its inception have made it difficult for the PPACA to successfully navigate its path and realize its intended mandates within the American society-an affordable and reliable health care system for all. Instead, these obstacles have transformed the PPACA into a national liability.     


Amadeo, K. (2017). Challenges Presented by ObamacareThe Balance. Retrieved from https://www.thebalance.com/what-is-wrong-with-obamacare-3306076

American Nurses Association (2015). Code of ethics for nurses with interpretive statements. Silver Springs, MD: Author.  

Barker, A. M. & DeNisco, S. M. (2016). Advanced practice nursing: Essential knowledge for the profession. Boston: Jones & Bartlett.

CMS. (2010). The Patient Protection and Affordable Care ActCms.gov. Retrieved from http://www.cms.gov/LegislativeUpdate/downloads/PPACA.pdf

Dorsey, J. (2016). How many people are still uninsured in 2016? Healthedeals.com. Retrieved from https://www.healthedeals.com/articles/who-are-the-remaining-uninsured-americans

Lee, T., Casalino, L., Fisher, E., & Wilensky, G. (2010). Creating accountable care organizations. New England Journal of Medicine363(15), e23. http://dx.doi.org/10.1056/nejmp1009040

Shafrin, J. (2010). What are accountable care organizations? Healthcare-economist.com. Retrieved from http://healthcare-economist.com/2010/01/26/what-are-accountable-care-organizations/

Young, J. (2014). Millions are now realizing they’re too poor for ObamacareHuffPost UK. Retrieved from https://www.huffingtonpost.com/2014/01/31/florida-medicaid-uninsured_n_4680566.html

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