The Patient Protection and Affordable Care Act, also known as the Affordable Care Act or “ACA” for short, is a healthcare reform law that was unveiled in March 2010. The primary objective of the ACA is to increase access to health insurance for a larger number of U.S. citizens. Because of this, the ACA mandates that every U.S. citizen and legal resident must have health insurance. To achieve its goal, the government is planning to expand the Medicaid program, which is the primary program for healthcare coverage serving people of lower income, to expand coverage for all adults whose income falls below 138% of the federal poverty level.      

Chronic diseases, which are ongoing health conditions that have lasted at least one year, are consistently affecting growing numbers of America, and are the leading causes of death in the United States. About 45% of Americans suffer from at least one chronic illness. Thus, chronic care is currently one of the biggest costs in healthcare, which claims 90% of the $4.1 trillion of the healthcare budget for people with chronic and mental conditions. People 50 years old and older with at least one chronic disease are projected to increase by 99.5% from 2020 to 2050, totaling at 142.66 million by 2050, which might affect health insurance and health funding as a whole. People with chronic diseases need long-term care, treatment, and resources, which means that the costs of healthcare are large to begin with. Because it is predicted that people with chronic conditions will rise in the following years, it is also predicted that the costs of healthcare will continue to rise as a response. These high costs could either make health funds raise their prices or place a greater financial burden on people with chronic diseases. This is where the ACA comes into play. The ACA’s goal of expanding health insurance access for all Americans raises the question of how it would impact individuals with chronic diseases.  

Advocates champion the ACA for three reasons:

1. Affordable healthcare is considered a right. One of the primary arguments put forth by ACA advocates is the belief that affordable healthcare is not merely a privilege but a fundamental right that should be accessible to all individuals. This ethical standpoint aligns with the principles of social justice, as it emphasizes the importance of ensuring healthcare access for everyone. By aiming to provide more access to health insurance and healthcare for all, the ACA plays an important role of promoting justice within health, which includes a fair distribution of healthcare resources to ensure that society flourishes as a whole. Consequently, this understanding implies that individuals with chronic diseases and illnesses should receive enhanced insurance benefits to adequately address their healthcare needs and facilitate proper care and treatment. 

2. The ACA helps with preventative measures for individual conditions. It provides free preventative measures, contributing to better health outcomes and cost savings in the long run. For example, it offers a range of vaccines to both children and adults, a considerable number of screenings, including several types of cancer and chronic conditions, and behavioral screening. This ensures that individuals are able to receive immunizations and screenings which are crucial in preventing the spread of diseases and safeguarding public health. Furthermore, the ACA addresses the financial challenges associated with chronic disease management. Under the ACA, insurance plans are required to cover a wide range of prescription medication for chronic conditions, services related to chronic disease management (check-ups, consultations with healthcare providers, and therapy), and a reduction in hospitalization costs. By requiring insurance plans to cover health benefits, the ACA helps individuals with chronic conditions manage their conditions and prevent complications or exacerbations. 

3. The ACA helped lower the costs of healthcare. The Patient’s Bill of Rights, which is an interim final regulation announced about six months after the Affordable Care Act, ensures that some financial barriers towards getting healthcare will be removed. A study found that 64% of the sample was satisfied with the impact of the Patient’s Bill of Rights. Supporters of the ACA believe that this Bill of Right has helped a lot of people (children, pregnant women, and people with disabilities) by protecting patients’ coverage for pre-existing conditions, protecting the choice for doctors, and ending lifetime limits on the care that a patient may receive. 

Those opposing the ACA are against this for three reasons:

1. Critics of the ACA believe that mandating nation-wide coverage might not be feasible from both an organization and financial standpoint. There are multiple challenges to universal healthcare, including a heavier burden on insurance companies for providing funds for the previously uninsured or the government to provide lower costs for healthcare and physical and technological changes in the healthcare system. With chronic diseases, a growth in the demand for healthcare is inevitable, which means that as more people get insured, healthcare workers will receive more burden in their line of work as the demand for healthcare continues to grow. Moreover, the cost of healthcare will continue to increase and that burden will fall onto taxpayers. Opponents of this plan believe that it might not be the most efficient in terms of manpower and financial burdens. 

2. Trust among American citizens and the government is low, leading to skepticism and disbelief in the ACA’s effectiveness. Critics of the ACA believe that the government should have minimal involvement in healthcare. The opposition’s reasoning for this is the belief that the government is doing too little to address the issues of concern for several groups, including middle-income people, retirees, rural residents, and suburbanites. Middle-income people are especially burdened because the inflation of costs associated with health insurances are increasing faster than their income. Retirees are also burdened by the rapid inflation of healthcare costs. Due to not actively earning income, they are worried that the ACA might lead to cuts in their Medicare benefits or increased costs for supplemental coverage, adding to their financial insecurity. 

3. People opposing the ACA argue that healthcare should be based on personal financial responsibility. The argument is that individuals who have not made sufficient efforts to finance their own healthcare should not receive the same level of support as those who have made greater financial contributions. People against the ACA think that some individuals may not be deserving of healthcare benefits if they have not demonstrated adequate effort or responsibility in managing their own healthcare expenses. However, oppositions do make exceptions for individuals with disabilities or pre-existing conditions. They recognize that certain people face circumstances beyond their control that may prevent them from independently financing their healthcare needs, which leads to the acknowledgment that these people need social support and safety nets to ensure that they have access to the necessary healthcare services.