NUR133 Assessment Task 3 Reflective Journal This task will introduce

The original version of the Affordable Care Act (ACA) included a mandate for all citizens to obtain health insurance to offset the financial burden of sicker, more costly members to insurance companies, thus increasing access to more citizens. Before the ACA, insurance companies could deny coverage or charge much more expensive premiums for probable high-cost members, exclude coverage for preexisting conditions, or not cover specific highly utilized and expensive benefits. As a result, many citizens who needed access to healthcare were excluded. The ACA was a public health policy law that removed many of those barriers. As with all forms of insurance, the financial risk is spread among a large population, with those using fewer and less expensive resources offsetting the cost of those using more and expensive resources. We see this in the car insurance industry. Those who did not have a car accident in a given year help pay for those that did. This same logic was applied to the ACA, where younger and healthier people with few healthcare needs and expenses would be required to purchase health insurance to offset the cost of older and sicker citizens. After the ACA passed, the National Federation of Independent Businesses, a special interest group, challenged the individual mandate’s constitutionality. The U.S. Supreme Court ruled that the mandate was constitutional as Congress has the power to tax citizens. Congress then passed the Tax Cuts and Jobs Act, which eliminated the individual mandate in December 2017 and became effective in January 2019. As a result of this new law, the ACA was modified. This was a significant change to the original policy and had a ripple effect throughout the healthcare industry. Discuss how a different special interest group, like the National Federation of Independent Businesses, can use the rulemaking process to change a public health policy.

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