Public Health Reforms

Public Health Reforms

The current state of public health in the USA offers a reason for hope for a better tomorrow. That is the case given the overall improvement in various aspects of public health. The great public health accomplishments of the 20th and 21st centuries like eradication of smallpox via vaccination and reduction of road accidents by 40% are just a tip of the iceberg of what public health has managed to achieve over the years. Despite these achievements over the years, there is still more that public health needs to address for the overall improvement of the health and lives of Americans. A case in point of this kind of urgency is evident in the extent of health care disparities that have paralyzed the wellbeing of various cultural groups living in the USA. For instance, Noonan, Velasco-Mondragon, and Wagner, (2016) observe that the African-Americans are still victims of inequality. Such is the case given that the vast majority of this population languishes in poverty and thereby lacks access to quality healthcare services as the other American citizens. As such, the African-Americans are victims of cardiovascular diseases, diabetes, violence and substance abuse. Unfortunately, this should not be the case, and thus there is a need for a rethink of the current public health legislations that prescribe the pathway to follow. A befitting example of such legislation is the Affordable Care Act.

In light of the current state of public health in the USA, this discussion targets to review a portion of the Affordable Care Act, present its strengths along with its weaknesses and propose ways of improving it.

Review of Affordable Care Act

The Affordable Care Act (ACA) came into existence in 2010 through the proposition of the then president, Obama. Its main aim as legislation was to attain near-universal if not full coverage. Other targets for this Act included improvement of equity, quality, and affordability of health insurance coverage, bettering of the value, efficiency, and quality of health care through the reduction of the health care spending wastage. Strengthening the primary health care access and effecting changes that will incorporate long-term care services in the current primary and preventive health care was another aim of this Act. Lastly, it targeted at making strategic investments in the general population’s health via the expansion of both the community and clinical preventive care investments (Rosenbaum, 2011).

A section of the ACA that is worth analysis is that of health insurance coverage. Such is the case given the implications it has on the well-being of the American citizen. For instance, on the positive side, this plan of ACA will lead to health insurance coverage of an estimated 94% of the American population. The ramification of such coverage is increased access to the health care services for a further 31million USA citizen that were uninsured before this Act (Rosenbaum, 2011).

Notable strengths of this plan include its potential to reduce the number of persons within the USA with no health insurance coverage. That is the case given that since its initiation as a plan, the number of uninsured people has decreased by 31 million. A figure of this kind is significant since it marks a big step towards the 94% coverage that ACA is aiming at after its full implementation. Besides, ACA has made it possible to bridge the gap of drug coverage the ‘doughnut-hole’ effect that allows a 50% discount for individuals that are unable to afford the same for prescription medications. Another plus point for ACA is its ability to expand the Medicaid eligibility to American under the age of 65 years with incomes amounting to 133% of the federal poverty level. Finally, ACA also has the benefit of inclusion of persons with preexisting conditions like Asthma in the health insurance coverage, which was not the case before ACA implementation (Rosenbaum, 2011). Evidently, with such strengths, it is undeniable that ACA is the best for the USA citizens. However, the plan is not spotless given that it has some deficiencies.

A befitting example of the plan’s weakness is its dependence on the taxpayers’ money, which may be inconvenient given that an individual may decide not to file his/her returns and instead pay the fine. Such a possibility is not good for the plan since there will be no enough finances for the health insurance coverage plan. Secondly, its punitive measure known as the individual mandate in which one ought to have insurance or risk facing a penalty is not a good way of going about issues of this kind (Jost & Pollack, 2015). Additionally, the family glitch phenomenon is another weakness associated with ACA. The family glitch phenomenon curtails individual workers’ eligibility to new marketplaces financial help if they are receiving employer-sponsored coverage. However, the employer-sponsored coverage is not enough to cover the family of an employee let alone him/herself alone (Jost & Pollack, 2015). Lastly, the plan has the disadvantage of creating room for employees who are just above the poverty line to reduce their working hours so that they can be eligible for the health insurance coverage for persons with income below the 133% of federal poverty line. With such disadvantages, it is beyond doubt that ACA needs remedies that will ensure it achieves its intended purpose in an effective and efficient way.

Proposal for Affordable Care Act Improvement

Central to the bettering of ACA are several strategies that are worth noting. One standard approach that the government should use is giving more flexibility to working parents as well as employers. Such flexibility will see the workers gain more access to new marketplaces. The ramification of this measure will be the fixation of the family glitch associated with ACA (Jost &Pollack, 2015). Consequently, there will be affordable health coverage for all low-income workers.

Besides, improvement of the consumers’ experience is also instrumental in increasing the number of Americans enrolled in an insurance coverage plan of any kind. An improvement of the users’ experience is attainable through encouraging marketplace competition. Such competition will ensure that consumers benefit from their ability to choose from a wide range of plans that are inevitable with increased competition. Also, the users’ experience will improve through the provision of low premiums, which is inevitable in competitive marketplaces. Small charges for premiums will inevitably improve the consumers’ experience since according to studies most people use various insurance plans because of the low cost of the premiums (Jost & Pollack, 2015).

Lastly, offering guidance for coverage selection is another viable strategy that can improve the health insurance coverage plan. That is the case given that with such information, the consumers can make decisions on which plans best suit them. Moreover, such a strategy will ensure empowerment of uninsured adults that are eligible for financial help to enroll in the scheme. According to Jost and Pollack, (2015) a high proportion of uninsured persons eligible for financial aid lacked information about the subsidies and new marketplaces. As such, offering guidance will help bridge this gap and enhance health insurance coverage for all Americans.


In summary, this paper aimed at establishing the current state of public health in the USA, reviewing the Affordable Care Act and proposing ways of bettering this Act. The same has duly been accomplished since it is clear that the USA public health sector has much more concerns to address given the fair share of public health issues existent in the USA. A case in point is the health care disparity that has made persons from minority groups to suffer diseases that are readily preventable with equal and early access to care. Moreover, on the review of the Affordable Care Act, it is apparent that it comes with merits and demerits. For example, whereas ACA opens up to the possibility of enhancing access to health care services for all cultural groups through health insurance coverage, it also makes health care services inaccessible for families of low socio-economic status given their inability to pay for the premiums. In light of these areas of improvements, the discussion offers a proposal on how to better this Act. The proposal entails providing flexibility to individual workers, which will have them access new marketplaces. That said, it is indeed evident from the discussion that public health reforms are of essence especially in the cited areas. However, failure to do so will only increase the pains instead of the gains of the current public health initiatives. As such, public health professionals should be at the forefront of pushing for this much-needed change.


Jost, T. & Pollack, H. (2015). Key Proposals to Strengthen the Affordable Care Act. The Century Foundation. Retrieved from

Noonan, A., Velasco-Mondragon, H., & Wagner, F. (2016). Improving the health of African Americans in the USA: an overdue opportunity for social justice. Public Health Reviews37(1).

Rosenbaum, S. (2011). The Patient Protection and Affordable Care Act: implications for public health policy and practice. Public health reports126(1), 130-135.