Southern California is made up of ten counties in the southern part of the state of California. The area, otherwise abbreviated as SoCal is proof of the importance of health reforms in changing the fortunes of Americans. The area is highly populated at more than 22 million people forming 60% of the entire California population. The problem of high population is particularly challenging in the administration of high quality healthcare. In addition, about 5.7 million people in California were living in poverty with a majority being in Southern California (Lowrey, 2012). Moreover, the cost of living is among the highest in the US making most of the needs inaccessible to the poor families.
The challenges facing the state are partly solved through the enactment of the Affordable Care Act (ACA) of 2010 which covers the wider United States. Development of the Affordable Care Act was necessitated by the problems that had engulfed the healthcare care system in the country. California was among the states that felt the negative effects of the system that prevailed initially. There was no fair treatment coming from health care providers as at that time. Health care insurance was not affordable and accessible to many Americans. There was a lot of discrimination with regards to gender and other prevalent issues. Aspects of medical underwriting, benefits cap, exclusion due to pre-existing conditions and coverage exclusions also gained prominence during this period. This paper is an analysis of the policy in place to address healthcare problems as well as the implementation of the policy and its success in improving the general level of healthcare in Southern California. In this undertaking, the paper will review literature in gaining an understanding of the nature of the problem and the success of the policy problem. Further, the motivations behind the enactment of the policy will also be used in exploring the implication of the policy on the lives of the people. Particularly, the link between the policy and the solution of the problems identified will be established and recommendations given.
Health Care Problem
The level of healthcare within a particular state is determined through the access to the different types of healthcare service providers in time to address the healthcare problem. In this regard, the existence of health insurance is a critical aspect in the development and sustenance of this access. In fact, research has shown that people with health insurance are much more likely to benefit from preventive services including regular checks and immunizations. All these benefits contribute towards the reduction in the severity of the illness as well as the costs of treatment. The importance of health insurance in a community is also visible through the support of larger healthcare infrastructure translating into higher job creation and the improvement in the amount of taxes collected within the community. California performs fairly well in terms of healthcare access but is faced with challenges in environmental health. Surprisingly, Southern California is worst hit as it takes up the bigger share of the problems. These challenges have the capacity to affect the normal operation of an entire state thus resulting in huge losses in the process. Although the state ranks at position seventeen in terms of health, there are disparities between various classes. The access to healthcare is also limited among the blacks thus inhibiting early detection of the problems and the subsequent treatment of the ailments. Eventually, the state is left behind in terms of economic development as its population becomes weaker in the face of diseases and ailments.
The problems of healthcare before the enactment of the ACA were far greater in Southern California as analyzed through a number of factors. For instance, the life expectancy in the state stands at 77 years compared to the national life expectancy of 78 years. Clearly, the problem in healthcare cannot be underestimated as the infant mortality rates are also higher than the national averages. The access to healthcare as well as health insurance coverage is also lower in the state of California posing increased challenges in healthcare provision. The state was ranked at number 16 in access to healthcare among its patients (Kaiser, 2015). Perhaps the problem of poor access to healthcare is attributable to the low number of physicians within Southern California. Most of the counties within the state are designated as experiencing shortages in the number of health professionals as well as the level of healthcare provided. The cost of these healthcare problems cannot also be underestimated or assumed for their long term implications on the success of the state. The cost of the uninsured population within the state was arrived at anywhere between 3.0 and 5.1 billion dollars before the enactment of the ACA (Rak et al, 2013). This figure results from the increased loss of lives from shorter life spans as well as poorer health relative to other states. In most organizations with less than fifty employees, health insurance is least likely to be offered to the staff. In Southern California, about 60% of the employers had less than 50 employees therefore limiting a significant number of employees from health insurance (Rak et al, 2013). Also, a significant number of these organizations had employees not exceeding 20 thus limiting the prospects of future health insurance provision for the staff. In 2013, a significant percentage of about 16% of the entire Southern California have no single form of health insurance (Rak et al, 2013).
Regardless of the magnitude of the problem of healthcare in Southern California, there are ready solutions that when implemented can result into a healthier state. Following the adoption of the Affordable Care Act, the state has witnessed incredible progress in the improvement of healthcare as more people have access to healthcare services (Sommers et al, 2013). The origin of the problem can be traced to the increase in population in the region as well as the limitation in the number of insured people straining health care service providers in the process. The problem of healthcare is therefore not a permanent problem and can be addressed through reasonable measures. The use of regulations and the encouragement of people to register for health insurance can help in the alleviation and solution of the problem within the state. More so, the problem, although more pronounced in Southern California also affects other states and counties within the country. The best approach to the solution of the problem facing the state of Southern California should be holistic to include both private and public institutions. The government should take responsibility and provide better health access to the people through increased physicians in public hospital. The private sector can also help by providing affordable health insurance as well as healthcare in the private health care centers. However, if a single party was to be chosen in trying to solve the problem, the government is more suitable. This is because it has more resources hence making it possible to reach out to as many people as possible. If the issue of the health care was left solely to the private sector, the problem would even accelerate. This is because it would be more commercialized hence making it more problematic for the less fortunate to access better health services.
In addressing the challenges facing the country in terms of healthcare provision and access, the government developed the Affordable Care Act in 2010. Primarily, the goals of the policy included the improvement in the number of Americans with access to health insurance as well as a reduction in the cost of health care. Also, the policy intended to increase the quality of healthcare provided to patients within the country (Koh & Sebelius, 2010). As a member state of the larger United States, Southern California is affected by the provisions in the Act and must abide by the same. Although the development of the policy was done at the national level through the Congress, its implementation is largely at the state and county level. The difference in development and implementation bodies is attributed to the fact that regulations made by the country are applicable in all the states. However, the provision of healthcare is a devolved function and is implemented at the state level. In this regard, therefore, there exist discrepancies in the different levels of implementations.
As with other congress regulations, public participation was highly encouraged during the process of development. The formulation involved the input of health professionals, insurance providers and the general public in striking a balance. The main beneficiaries of the policy are the American people and specifically those in Southern California as they can now access healthcare easily. However, the provision in the policy also benefits the insurance providers as they require everyone to have access to health insurance. Moreover, professionals stand to benefit through increased employment opportunities as the policy directs that states employ more professionals to cater for the healthcare needs of the people. The development of the policy was motivated by the need to have better healthcare among the American people (Rak et al, 2013). It is not surprising therefore that the policy was formulated at the Congress level of the national government reflecting the level of importance attached to the healthcare needs of the people. The formulation was, however, free from any international influence save for the different treaties that the country has signed.
The implementation of the Affordable Care Act is a complex and intricate process involving the input of different stakeholders. The implementation of the policy relies on the instruments of the states including prosecution powers and tax credits. For instance, the policy provides tax credits to organizations that provide health insurance to their employees despite having lower than 25 employees in their team. The Act further prohibits insurance agencies from discriminating new clients based on their wages. The gap created by retired employees before reaching the eligible age of Medicare is bridged through encouragement of early retiree reinsurance programs (Dayaratna, 2012). Still, the policy requires an extension of the coverage dependants up to the age of 26 therefore increasing the number of people covered. Breaking these provisions may lead to prosecution in a court of law. The implementation of the policy is done at the state level through the different institutions established. For instance, each of the states has a health department that is responsible for ensuring and checking compliance with the regulations.
It is true that policies have failed at the implementation stage due to the problem of bureaucracy (Heineman, 2001). The government has its interest in any implementation and may slow down the process of implementation altogether. In this policy, bureaucracy played a leading role in determining the implementation of the policy. However, the requirement that due processes be followed and the delays experienced in the execution of statutory tasks resulted in poor implementation. Indeed, some of the states had not implemented all the provisions of the policy in 2014 owing to hurdles occasioned by the concept of bureaucracy. The process of implementing the Affordable Care Act is not simple but one that requires huge resource allocations to gain considerable success. The cost of the implementation cannot be attained through a single figure as the implementation is a continuous process. For instance, the tax credits offered to small businesses providing health insurance to employees are huge and accumulate over time. Also, the health sector accounts for billions of dollars annually. The number of people served by the Act is large and includes every American citizen with an interest in quality health care.
Results of the Policy
The results of the policy implementation can be summarized through the increased quality of healthcare in areas such as Southern California. The improved percentage of persons accessing better healthcare as well as the number of people with health insurance depicts the success of the policy implementation (Kaiser, 2015). The implementation of the policy was highly effective despite facing challenges in different states. The policy has resulted in increased quality of health care in Southern California as well as the access to healthcare. Today, the percentage of people with access to health insurance has risen owing to the provisions of the policy. The policy has its share fair of limitations including the practicability of some of its provisions. For instance, the implementation of the provision regarding the attainment of health insurance by all citizens is not easy. In addition, the act does not guarantee quality healthcare through implementation but must rely on other policies in ensuring the same is achieved. The policy could be improved through a number of recommendations. The policy should be complimented by other policies in each of the states to increase effectiveness. This provision is necessary since some of the regulations are not applicable in all the states. In addition, more focus should be made on the provision of quality healthcare other than focusing on forcing citizens and insurance providers to comply with the provisions. These recommendations can improve the effectiveness of the Act when incorporated into the implementation of the policy.
The Affordable Care Act is one of the most important policies in the United States. Particularly, the counties in Southern California have benefitted greatly from the implementation of the Act. Today, the state and the country in general has experienced success in the healthcare sector through improved quality as well as increased access to health insurance. The Act is also instrumental in the reduction of health care costs as well as the increase in access to health care services (Rak et al, 2013). The policy was an important aspect in turning around the health prospects of Southern California, an area that previously had poor statistics in health care provision and access. The act has managed to take care of the increasing population by requiring that insurance providers increase the age of dependants to 26 years amongst other measures. Having the ability to tackle health care issues goes a long way into improving people’s life. When the cost burden is reduced, people can use the available funds in solving other issues in their lives. Healthy individuals also have a better prospect of working hard in order to improve their lives. Despite the benefits that come with the Affordable Care Act, there are limitations involved too. Among them is that taxes are going up due to the Act, people can be fined for not having insurance covers and some businesses are reducing employees’ hours to avoid covering them. However, despite the policy having its share of limitations, it remains largely successful and beneficial to the country. In addition, the policy has succeeded in effectively serving a large proportion of the people.
Dayaratna, K. D. (2012). Studies show: Medicaid patients have worse access and outcomes than the privately insured. The Heritage Foundation Backgrounder, 2740.
Heineman, R. A. (2001). The world of the policy analyst: Rationality, values, and politics. New York [u.a.: Chatham House Publishers.
Kaiser, H. (2015). The California Health Care Landscape. Retrieved November 02, 2016, from http://kff.org/health-reform/fact-sheet/the-california-health-care-landscape/
Koh, H. K., & Sebelius, K. G. (2010). Promoting prevention through the affordable care act. New England Journal of Medicine, 363(14), 1296-1299.
Lowrey, A., & Pear, R. (2012). Doctor shortage likely to worsen with health law. The New York Times, 29.
Rak, S., & Janis Coffin DO, F. A. A. F. P. (2013). Affordable care act. The Journal of medical practice management: MPM, 28(5), 317.
Sommers, B. D., Buchmueller, T., Decker, S. L., Carey, C., & Kronick, R. (2013). The Affordable Care Act has led to significant gains in health insurance and access to care for young adults. Health affairs, 32(1), 165-174.
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