Week 7: Medicaid and the Affordable Care Act as Examples of Public Policy Implementation

As discussed last week the government is how the public sector provides services for the general public/population as needed. As previously defined, the public sector of an economy is the sector responsible for providing public services (investorwords.com, 2015). The Patient Protection and Affordable Care Act (PPACA) also known as the Affordable Care Act (ACA) was created to reform the health insurance industry and entire health care system (obamacarefacts.com, n.d). The purpose of the ACA policy is to make sure that all Americans have healthcare coverage though it may inadvertently causing some to be unable to continue to gain coverage for their health care insurance needs from their employer, thereby causing more people to need aid from the government. This ultimately puts a burden on the Medicaid. Eligibility for Medicaid is currently that individuals who make approximately 133% or less of the federal poverty level may qualify for coverage, including adults with dependent children (U.S. Department of Health and Human Services, 2014) which fall into categories such as a certain age, pregnant women, parents of Medicaid-eligible children who meet certain income requirements, and low-income seniors to mention a few and it is up to each state to define the details of each category. For example, in New York State, there is a program called the Medicaid Buy-in Program for Working People with Disabilities where on the website one of the requirements to be eligible is to be engaged in paid work either on a full or part-time basis. Neither full-time nor part-time employment are defined by this website or any other I could find. Hines (2012) had reported that Wal-Mart was attempting to lower costs by taking advantage of the, then, fairly new ACA policy.

Garfield, Damico, Stephens and Rouhani (2014) explained in a report that most people who fall into the coverage gap will not be able to afford ACA coverage without assistance though they work full or part-time but below the poverty line. Remember full and part-time work are still not being defined. These authors speculate that this portion of the population will still remain uninsured even after the ACA is fully implemented due to out-of-pocket costs and ineligibility for cost-sharing subsidies for Marketplace coverage. Ultimately reverting the burden to Medicaid. Another article reports that even though employees who do not qualify for insurance through their employers due to employment status (“full-time” or not) would qualify for Medicaid or be eligible to use tax credits at marketplace exchanges for coverage, with employers not facing a penalty, this could be expensive for employers in states that do not accept the Medicaid expansion option because the employers would then have to pay a higher shared responsibility payment for employees who use tax credits for health care coverage (Hope, 2013).


Garfield, R., Damico, A., Stephens, J. & Rouhani, S. (2014). The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid – An Update. Retrieved from http://kff.org/health-reform/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid-an-update/

Healthcare.Gov. (n.d.). Medicaid and CHIP coverage. Retrieved from: https://www.healthcare.gov/medicaid-chip/getting-medicaid-chip/

Hines, A. (2012). Walmart’s New Health Care Policy Shifts Burden to Medicaid, Obamacare

Retrieved from http://www.huffingtonpost.com/2012/12/01/walmart-health-care-policy-medicaid-obamacare_n_2220152.html

Hope, C. (2013). New Study Finds Failure to Expand Medicaid Could be Costly for Employers. Retrieved from http://ccf.georgetown.edu/all/new-study-finds-failure-to-expand-medicaid-would-hurt-employers/

U.S. Department of Health and Human Services. (2014). How the health care law is making a difference for the people of Arizona. Retrieved from: http://www.hhs.gov/healthcare/facts/bystate/az.html

WebFinance, Inc. (2015). Public Sector: Definition. Retrieved fromhttp://www.investorwords.com/3947/public_sector.html


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