Patient Protection and Affordable Care Act

As a way for the government of the United States of America to avoid the massive burden of financing healthcare, it made an official call to the citizens and the legal residents of the United States share in the contribution for its financing. Each resident and citizen of America had to pay for this financing.  Because it was an official call, those who failed to remit their contributions were subjected to a penalty in terms of cash. There were debates on the constitutionality of this official call, the proposers of ACA arguing that it was constitutionally right for the government to call for the citizens, to contribute and that it was constitutional for the government to put in place measures to ensure that the proposed requirement by the government was followed to the later. Those who were against the proposal, on the other hand, argued that it was not constitutionally right to force people to buy something and that this was a violation of the human rights and which provides freedom o choice on what to consume and what not to consume depending on the conditions set. For instance, in America, most states were under the federal government, which had made this proposal to the citizens, to secure a medical insurance cover to assist in financing medication[1]. At first, there was no enforcement, and people were only requested to secure the medical insurance cover, there was no penalty for anyone who didn’t obtain this insurance. It was later discovered that there was much negligence in the adherence of these citizens to the number of those who didn’t adhere to this request was high as compared to those who agreed to take theinsurance according to the government request. The negligence caught the attention of policymakers, and there rose the need to put in place an enforcement measure, which was a penalty on everyone who didn’t take and play the insurance.

Policymakers experienced a change in the pattern, a tremendous increase in the number of insured as co pared to the uninsured. However, this policy used to work against the poor at first as those who lived below or close to the poverty line experienced constraints in paying for the insurance cover. The government took the initiative of changing this condition by increasing the burden on the rich and lowering the load on the poor. The government did this through an increase in the taxes on the rich, and using these taxes realized to subsidize the poor.There was also the introduction of new health insurance coverage and especially for the rich. The new covers were deemed to have better provision as opposed to the earlier sheet, which included every single American citizen and any other legal residents. The rich opted tobuy this new insurance cover, which was seen to provide quality services under it. The cover was a little bit expensive, and therefore the cash collected from this unique cover made it possible to finance the poor in their medical cover[2]. Therefore it was possible for every citizen to acquire this cover from the poor to the rich, and refusal to get covered was considered negligence.

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It should be considered that there was were cases of exemption. This means that some American citizens and legal residents of America were taken out of the bracket of those who were expected to secure an insurance cover. Therefore, the penalty did not apply to them. Their condition had to be considered carefully before adding them to the exempted list. The person who gets into the exemption list needed to qualify for this position, and in most cases, it was based on the financial situation of an individual. If an individual lived under the poverty line and had some other underlying financial constraints, then it would be so inconvenient to ask them to pay the penalty if they didn’t have this insurance cover. To avoid favor and biasness on a particular group of people, the work of scrutinizing the people legible for this position was tasked with the IRS office, and applications passed through this office. Those exempted were those with minimum essential health insurance coverage.

The trend was that between 2014 and 2018, there was a penalty for those who didn’t have ta insurance cover and those who were on in the exemption list. The sentence was in terms of tax that was included in the finances collected from the insured, serving as booster fund. However, it was short-lived, and therefore the penalty measures ended in the year 2019, where there was no way the federal government would continue to tax those who didn’t have the cover. There were reforms in the individual mandate and on ACA as a whole, impacting on its other parts[3]. Some states within the USAimposed their penalty and taxes on those who didn’t adhere to the request of insurance.

The insurance was different among different ages in that those with over 30 years of age were required to purchase catastrophic health insurance as opposed to those below the age of 30 years, which were supposed to buy individual mandate insurance.Thereforethe above discussion was all about below thirty persons. Catastrophic insurance cover was abit expensive and more comprehensive in its coverage as opposed to the mere individual mandate cover.

During tax return filing, the tax included in the total; for instance, if you failed to remit your 2017 insurance cover funds, it is evident that when filing your returns in 2018, the tax was included. However, this trend ended in 2019, with no more charges on the income returns of those who didn’t comply. It was not a trend that swept all over American states, but rather, it was effected in some states, leaving others with this practice and not the federal government’s tax but rather the tax by the state governments. To state, for instance, DC, jersey, and Massachusetts, after the wiping away of the tax penalties, they introduced their sanctions of the non-complaints, therefore, forcing them to pay to the insurance coverage just like the federal government did.

There was a repeal on the individual for the federal penalty and hence its elimination. Some states with the united states, however, felt it hard to accept the fact band thus had to find a mechanism to cover for the lost revenue for the medical insurance covers. Some installed their mandate cover at the state level, institutionalizing it at this state level to collect funds for their medical insurance. However, they had different approaches. For instance, some sought to follow what the federal governments had started, that is to start an insurance plan for individuals to finance their health and setting the penalties if one failed to adhere to these set rules, I mean if one was unable to remit their insurance subscription they were liable a tax[4]. However, other states installed such a kind of health insurance but failed to put measures in place to enforce compliance by its state citizens. This was the start of their failure as they were not in a position to ensure control over their system. The system that existed without an enforcement mechanism was considered a toothless system. It is the nature of humanity in most of its aspects that without control many things are likely to go astray and this is precisely the scenario that occurred in these states, the system experienced many non-compliant cases and the funds collected were not able to support the system hence the need to reform the system or letting it fall. Those who have created their state insurance, with an enforcement mechanism, were successful in their venture, and their failure was not attributed to lack of funds but rather o other factors.

The individual insurance act was a part of the controversial affordable care act after the congress enactment and debate where the opponents argued that it wasn’t right for the citizens to be penalized for not buying something. It was considered so irrational for the federal government to enact a law that would force the citizens and the legal residents of the United States of America to pay an insurance cover, and the failure to do so attracts a significant penalty. Although it was considered an effective way of ensuring that citizen concerned collaborated, it was also regarded as irrational, especially to those who experienced difficulties in paying it.

The opponents, therefore, after viewing it unconstitutional, went up to the supreme court to protest against this act by the federal government to both force individuals to purchase an insurance cover and to use a penalty for those who didn’t comply with it. After hearing the case, it was decided that tax on noncompliance was a tax on those who went without insurance cover, and hence the government had the right to impose a tax on these people. They considered this tax constitutional and that the opponents had no legal right to oppose it or to challenge the government’s practice.This seemed to favor the federal government’s actions and gave them the go-ahead to continue forcing the citizens to practice this practice on itkeep getting more of the citizens to enroll in this practice.

This decision by the Supreme Court is deciding that penalties by the federal government on the non-adherencedidn’t satisfythe needs of the opponents. Therefore they went on to more attempts at stopping it as soon as they could[5]. All they sought was a declaration that the imposition of taxes was not constitutional and that the practice ought to stop. From the Supreme Court, they went on to oppose the whole ACA, arguing that its different elements were unconstitutional. Therefore there was a need to overturn the whole of ACA and not only the individual mandate. This was because the individual mandate was considered to be inseparable from the large ACA and that if needed to reach a reformat personal reform, they needed to look at other elements of ACA and the ACA in general. A change in ACA would, therefore, include the individual mandate, which is one of its controversial parts.

28th December 2020 saw the declaration of a court order for the ACA to be overturned, and the individual mandate taken low to zero. This was a significant turning point in favor of the opponents of the individual mandate. The argument following this ruling was that the ACA had most of their elements which were not constitutional. The penalties were not anymore applicable to those who didn’t comply with the individual mandate. Those who went through 2018 without their medical insurance cover, and upon filing their returns in 2019, didn’t get the penalty for noncompliance. It was, therefore, and proper lifting of sanctions, and from this time up todate, there are no penalties as a result of failure to comply.

An appeal to this was taken but didn’t pick, as trumps administration failed to support the call. The administration despised the request on the ground that it was scorned on the grounds that it had disastrous effects on the American people with the preexisting medical condition, and therefore its need to overturn the whole ACA.An appeal was made but failed immediately when judges from the 5th circuit courts of appeal agreed with the lower court in Dec 2019. It considered the individual mandate unconstitutional. The two appeal failures rendered the individual mandated chanceless to success; it was evident that the constitutional provisions didn’t support it in any way. Because the federal penalties were banished, there was a need to leave it or adopt the different measures. Some states in the United States, are still practicing individual mandate on medical insurance, some using enforcement methods and other just without enforcement mechanisms only relying on the goodwill of the people and their willingness to pay[6]. The delays caused in the court system led to uncertainties in the insurers and the American republic. However, there was a negative attitude towards the individual mandate. Therefore the judgment by the courts to decline the appeals worked in favor of the general public. However, the debate has not ended. Therefore the Supreme Court is still considering the case from the lower court. It may be resolved in 2020. Taking either side, meaning that there can be support for the individual mandate or decline in the practice.

The individual mandate is also called shared responsibility payment and is a system that the government requests the individuals or citizens to make contributions to the medical insurance company. The government, before the introduction on the individual mandate, the government used to finance all the medical requirements in the country, and it was seen to have laid a very significant burden on the government. The government has many sectors to take care of, and therefore it was ethical to delegate some of its duties to different authorities. Thus, the government came up with a policy to involve the public in the financing of their health. They used health to finance to make this happen, and used a penalty for those who didn’t comply. This was seen as an incentive to the public to comply to avoid the sanctions imposed.

Evaluation is therefore required to know the bestway of providing healthcare servicesto the public. In this connection, the provision of health services by the government or the self-financing by the contribution of individuals towards insurance companies are the two different ways of financing HealthCare in a country. However, according to the public policies, it was economical and more convenient to provide healthcare services to the public[7]. The conservatives held that there wasn’t a need for reform in the provision of healthcare. However, there was a different group that proposed changes to end this adopted individual mandate. The success of this reform was not 100%. Therefore there were some incidences in which the governments of some states didn’t leave the individual mandate and continued to practice it at their state level, some of them with enforcement mechanisms and others withno enforcement mechanisms whatsoever. However, this is opposed to the propositions of the legal provisions which require that these kind of insurances on healthcare are unconstitutional and constitutional regulations prohibit the exercise of this enforcement measures of penalty.

America has so far been reforming in the over the years. 2018 saw the reform and 2019 and 2020 are the years in which a lack of penalties and enforcement. Therefore the government policies encouraged and proposed an embedment of the PPACA retaining most of its more popular provisions. Still, in the latter, it would be disastrous for both the cost of insurance and the number of people covered by the insurance. The cost increases tremendously for the poor, and the number of people included decreased.

The government, however, put in place policies to balance the inequality between the poor and the rich in the United States of America concerning the individual mandate. After the reforms, a positive change was witnessed with more people acquiring the cover, and the medical cover cost decreased. This was because of the pulling of funds.




Hackmann, M.B., Kolstad, J.T., and Kowalski, A.E., 2015. Adverse selection and an individual mandate: When theory meets practice. American Economic Review105(3), pp.1030-66.

Goodson, J.D., 2010. Patient Protection and Affordable Care Act: promise and peril for primary care. Annals of Internal Medicine152(11), pp.742-744.

Conklin, A., Morris, Z., and Nolte, E., 2015. What is the evidence base for public involvement in healthcare policy?: results of a systematic scoping review. Health Expectations18(2), pp.153-165.

Freeman, M., Gruber, J., and Sommers, B.D., 2017. Premium subsidies, the mandate, and Medicaid expansion: Coverage effects of the Affordable Care Act. Journal of Health Economics53, pp.72-86.

Hackmann, M.B., Kolstad, J.T., and Kowalski, A.E., 2015. Adverse selection and an individual mandate: When theory meets practice. American Economic Review105(3), pp.1030-66.


[1]Goodson, J.D., 2010. Patient Protection and Affordable Care Act: promise and peril for primary care. Annals of Internal Medicine152(11), pp.742-744.


[2]Frean, M., Gruber, J. and Sommers, B.D., 2017. Premium subsidies, the mandate, and Medicaid expansion: Coverage effects of the Affordable Care Act. Journal of Health Economics53, pp.72-86.


[3]Hackmann, M.B., Kolstad, J.T. and Kowalski, A.E., 2015. Adverse selection and an individual mandate: When theory meets practice. American Economic Review105(3), pp.1030-66.


[4]Hackmann, M.B., Kolstad, J.T. and Kowalski, A.E., 2015. Adverse selection and an individual mandate: When theory meets practice. American Economic Review105(3), pp.1030-66.


[5]Goodson, J.D., 2010. Patient Protection and Affordable Care Act: promise and peril for primary care. Annals of Internal Medicine152(11), pp.742-744.


[6]Hackmann, M.B., Kolstad, J.T. and Kowalski, A.E., 2015. Adverse selection and an individual mandate: When theory meets practice. American Economic Review105(3), pp.1030-66.


[7]Conklin, A., Morris, Z. and Nolte, E., 2015. What is the evidence base for public involvement in healthcare policy?: results of a systematic scoping review. Health Expectations18(2), pp.153-165.


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