Impact of Affordable Care Act on North Carolinas Uninsured Population – Health System Example

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"Impact of Affordable Care Act on North Carolina’ s Uninsured Population" is a marvelous example of a paper on the health system. The Affordable Care Act of 2010 (ACA) was the most aggressive health care reform during the first two years of President Obama’ s administration. One of the main elements of the ACA is an expansion of the state’ s Medicaid program.   Medicaid growth is intended to provide a continuum of reasonable health care coverage to the underprivileged group of people not covered prior to the ACA’ s enactment. The state of North Carolina complied with the provisions of the ACA; the eligibility to acquire Medicaid has been revised by increasing the federal poverty line threshold, which in turn has enabled more people to acquire Medicaid benefits.

  The ACA extended its health care coverage to children from six to eighteen years of age, working parents, non-working parents, and childless adults (Milstead, 2013).   Expansion of Coverage and Economic Projection When the ACA was signed into law, some states protested against it and challenged its constitutionality at the Federal Supreme Court.   The Supreme Court upheld the constitutionality of the ACA.

  However, the Supreme Court excluded one provision of the law and left the expansion of Medicaid benefits for each state to decide individually (North Carolina Institute of Medicine, 2013).   North Carolina complied with the ACA and developed its Medicaid program for the community. The new ACA expanded Medicaid coverage mostly to adults with income up to 138 percent of the federal poverty level.   The federal government will subsidize 100 percent of the state’ s Medicaid development for the first three years of the newly eligible group, and gradually decrease its subsidy to 90 percent of the program’ s cost by 2020.  By the fiscal year 2021, the shortfall will be recouped with the prescription drug rebates estimated at $193 million and $60.7 million in additional tax revenue (NCIM, 2013).

  This predicted income can be utilized for the promotion of public health by the ACA’ s community-focused prevention and wellness programs. North Carolina’ s Medicaid expansion created an increase in expenditure for the healthcare industry.   In an analysis conducted by Regional Economic Model, Inc. (REMI), the influx of federal funding for the development of the ACA was anticipated to stimulate the economy with its projected 25,000 job creation by 2016 and sustained job growth up to 18,000 by 2021.  This federal funding will generate an additional $1.3 to $1.7 billion in State Domestic Product (SDP) (NCIM, 2013).   Another study showed that the expansion of Medicaid programs to rural communities will generate an increase in job openings in the healthcare system in response to its federal funding provisions (Smith, 2013).   The ACA extends its funding to the rural areas to provide people with high-quality care. Impact on the affected population The ACA provides a credible solution to improve population health, access to medical service, and quality health care (Silberman, Cansler, Goodwin, Yorkery, Alexander-Bratcher, & Schiro, 2011).

The Carolina Institute of Medicine acknowledges the transformation of the state’ s Medicaid program as a positive step as it has helped expand health coverage to both children and adults (North Carolina Institute of Medicine, 2013).   The newly covered individual under the plan will be able to gain access to health care and will have positive health outcomes (NCIM, 2013).   The ACA supports the routine use of primary medical care (Goodson, 2010).   Primary care helps develop a patient-centered approach to health; members have their own personal health plan that is tailored to their individualistic needs.   Primary care physicians know what is best for their clients because of the development of a stable relationship between them.   Patients that are followed up by primary care physicians have better medication management and adjustment because prescription medications are properly supervised.   Another benefit of having primary care is that the patients’ health records are kept in one location, which means easy access to clinical information whenever needed for collaborative care.   Primary care delivery is known to have a better outcome because of its engaged and coordinated practice (Collins, Piper, & Owens, 2013).   The ACA funds wellness and civic health infrastructures.

Its $11.6 million grant is directed at improving the state of public health (Silberman et al. , 2011).   Although the Medicaid development can not cover every citizen of North Carolina because of some restrictions, the ACA has provided provisions in strengthening its community health outreach by reinforcing the state’ s health care Safety Net.   The health care Safety Net is a community-based clinic with providers who serve patients that cannot afford health care.

  The ACA earmarked $9.5 billion to North Carolina’ s Safety Net allocated over a period of five years.   These developments of the State’ s Safety Net will not only help the uninsured citizenry but also the people who are underinsured as well as other undocumented individuals or families that need healthcare (Silberman et al. , 2011).   The ACA supports preventive care services for the community such as valuable screening exams including HIV, obesity, and tobacco use.   HIV screening has been proven to have a positive effect on patients who are aware of their diseases.   Statistical data shows that people who are aware of their HIV status have a low proclivity to be involved in risky sexual behavior (Wagner, Yanyu, & Sood, 2014).   This research also shows that 18 percent of the HIV-infected people in the US are unaware of this infection, and that half of the HIV infections are transmitted from the “ unaware group. ” The ACA offers health incentive projects to the at-risk population such as the obese and the smokers so as to reduce the development of chronic debilitating disorders.

These health incentives come with strict adherence to healthcare programs like smokers going for smoking cessation and obese clients attending a weight loss program or a counseling program (Madison, Schmidt, & Volpp, 2013).   The ACA coordinates with the state’ s department of health in its community-based approach to prevent and reduce childhood obesity.   Public and private schools are encouraged to provide students with access to healthy meals and physical activity programs.   A case study held in the state of Washington showed a reduction in student obesity when the school promoted healthy eating habits and encouraged physical activity among its students (Kern, Chan, Fleming, & Krieger, 2014).

  While the ACA endorses these mandates, another study presented by the Annals of Family Medicine shows that a greater percentage of the ACA’ s newly enrolled individuals have a lower incidence of obesity and depression, and that infusion of healthy individuals with the insured population increases the revenue for the healthcare system without causing any deficit of the services (Chang & Davis, 2013). Another preventive service enacted by the ACA is Preventive health services for women; there were no specific initiatives for precautionary health services for women before the ACA’ s enactment.   The Institute of Medicine (IOM, 2011) established guidelines for the implementation of specific services directed at the improvement of women’ s health.

Recommendations for the females aged 10 to 65 years are as follows: STD counseling, Annual well-woman visit, Domestic violence screening, Annual HIV screening and counseling, HPV testing and cervical cancer screening, Lactation consulting and free breast pump rental, Gestational diabetes screening during pregnancy Full coverage of contraceptives, sterilization, and reproductive counseling. The implementation of the ACA is designed to encourage healthcare standards that are tailored towards the promotion and maintenance of women’ s health.

(Gee, 2012) Conclusion North Carolina’ s participation in its current Medicaid development will not only increase health care spending in the state but also stimulate the economy by creating more jobs.   This Medicaid growth would increase the number of health insured populace as well as have a positive effect on the community in terms of health care promotion and maintenance. The addition of newly eligible young people in the Medicaid program will eventually help the state’ s economy through their contribution to their healthcare plans in the future.   Since the majority of the health plan beneficiaries are young and healthy, their contribution to the healthcare system will continue for a long time.

These newly qualified health consumers will have access to primary healthcare and thus become salubrious members of society.


Chang, T., & Davis, M. (2013). Potential adult Medicaid beneficiaries under the patient protection and affordable care act compared with current adult Medicaid beneficiaries. Annals of Family Medicine, 11(5), 406-411. DOI: 10.1370/AFM.1553

Collins, S., Piper, K. B. K., & Owens, G. M. (2013). The opportunity for health plans to improve quality and reduce cost by embracing primary care. American Health & Drug Benefits, 6(1), 1-7.

Gee, R. E. (2012). Preventive services for women under the affordable care act. Obstetrics & Gynecology, 120(1), 12-14. DOI: 10.1097/AOG.0b013e31825bd604

Goodson, J. D. (2010). Patient Protection and Affordable Care Act: promise and peril for primary care. Annals of Internal Medicine, 152(11), 742-744. DOI: 10.1059/0003-4819-152-11-201006010-00249

Kern, E., Chan, N. L., Fleming, D. W., & Krieger, J. W. (2014). Declines in student obesity prevalence associated with a prevention initiative - King County, Washington, 2012. MMWR: Morbidity & Mortality Weekly Report, 63(7), 155-157.

Madison, K., Schmidt, H., & Volpp, K. G. (2013). Smoking, obesity, health insurance, and health incentives in the affordable care act. JAMA: Journal of the American Medical Association, 310(2), 143-144. DOI: 10.1001/jama.2013.7617

Milstead, J. R. (2013). Health policy and politics: A nurse’s guide ( Laureate Education, Inc., Custom ed.) Sudbury, MA: Jones and Barlett Publishers.

North Carolina Institute of Medicine (2013). Examining the impact of the patient protection and affordable care act. Retrieved from

Siberman, P., Cansler, L. M., Goodwin, W., Yokery, B., Alexander-Bratcher, K., Schiro, S. (2011). Implementation of the Affordable Care Act in North Carolina. North Carolina Medical Journal. Retrieved from

Smith, J. (2013). Examination of the relative importance of hospital employment in non-metropolitan counties using location quotients. Rural & Remote Health, 13(3), 1-10.

Wagner, Z., Yanyu, W., & Sood, N. (2014). The Affordable Care Act May Increase The Number Of People Getting Tested For HIV By Nearly 500,000 By 2017. Health Affairs, 33(3), 378-385. DOI: 10.1377/hlthaff.2013.0996

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