Negative Aspects of Affordable Care Act Extension


The Affordable Care Act (ACA) is a bill ratified in 2010 to regulate the terms and conditions of healthcare services with a focus on health insurance. It is believed that the ACA has optimized the American healthcare system substantially and has increased the access of many citizens to qualified medical and nursing services. There is an alternative to extend the act to cover undocumented workers, thereby broadening the range of insurance coverage. However, this decision is associated with a number of negative aspects that are critical reasons to reconsider such a point of view.

Tax Burden

One of the potential negative implications of the expansion of the ACA in this direction is increasing the burden on ordinary taxpayers. According to Dickman et al. (2017), the ACA is unique in that wealthy citizens benefit from it, while middle- and low-income people may spend more than they acquire. The authors argue that billions of dollars spent on Medicare are transferred annually, and for many citizens, these costs are not comparable to potential benefits (Dickman et al., 2017). In other words, this is not beneficial for people to have more social groups involved in the ACA’s reach due to additional costs spent on healthcare insurance. Undocumented workers are not a privileged category of the population. Consequently, their inclusion in the Medicare program will be accompanied by additional costs coming from the budget and, accordingly, from citizens’ taxes. Therefore, the decision to expand the ACA is directly associated with the tax burden on many people and entails ambiguous results.

The burden on the Economy

When discussing the potential harm of expanding the ACA’s coverage to provide health insurance for undocumented workers, one should also consider a significant burden on the national economy. As Boozary et al. (2019) note, according to the act, insurance premiums are to be sufficient to cover comprehensive healthcare services. Nevertheless, the inclusion of a new category of citizens in the range of these payments is fraught with a financial burden on the budget. Undocumented workers do not have the official confirmation of their employment, and control over the legitimacy of using medical services becomes much more difficult. Moreover, the national budget needs to be revised to introduce an additional item of expenditure since the designated category of citizens will not be able to participate in the tax collection system comprehensively. This means that the economy will be weakened due to such an initiative, and in addition to tighter tax conditions for the population, new spending will be added within the framework of the state treasury.

Limited Healthcare Staff

Although, from an ethical standpoint, expanding coverage may be a positive prospect, from a practical point of view, this decision is controversial due to limited medical staff. Healthcare employees involved in patient care under the ACA program will face a burden and increased workload if a new category is involved. Hall et al. (2019) confirm that this problem exists and state that limited provider networks can be a constraint on skilled care because labor shortages cannot be addressed by skyrocketing jobs. New applications from citizens will need to be included in the regime that exists now, which, in turn, will affect healthcare employees’ physical condition and job satisfaction. In addition, staff will need to optimize their work schedules to check more patients and, at the same time, not reduce productivity due to more responsibilities and increased work hours. Therefore, the impact of expanding the coverage of the ACA is directly related to the issue of limited medical personnel providing qualified services.

The Lack of Health Guarantees

Another problem to take into account follows from the previous one: the expansion of the ACA coverage does not guarantee high-quality medical care, which is largely due to the overload of the medical staff. The more patients need to be examined; the less likely the examinations will be thorough and careful. Moreover, the lack of adequate compensation for the extra workload may explain physicians’ and nurses’ potential reluctance to exert as much effort as possible. Moreover, according to Center et al. (2017), “insurance does not guarantee access to affordable health care” (p. 118). Even with the formal approval to participate in the ACA, undocumented workers may not receive the services they want. Healthcare cannot be strengthened if the key initiative is to increase workload rather than optimize the resource base. Thus, the expansion of the ACA’s coverage does not provide the target citizens or healthcare in general with a guarantee that the quality of care will be improved.


The decision to potentially expand the ACA’s coverage is associated with a number of negative implications, particularly the tax burden on ordinary citizens, economic challenges, the lack of medical personnel, and inadequate quality of care and treatment. For undocumented workers, free access to physicians’ and nurses’ services is not a guarantee, even if the amendments to the law are officially adopted. Optimizing the healthcare system involves revising the resource base rather than expanding responsibilities and burdens on a number of stakeholders.


Boozary, A. S., Feyman, Y., Reinhardt, U. E., & Jha, A. K. (2019). The association between hospital concentration and insurance premiums in ACA marketplaces. Health Affairs, 38(4), 668-674. Web.

Center, H., Woods, C. A., Manchikanti, L., & Purdue Pharma, L. P. (2017). A critical analysis of Obamacare: Affordable care or insurance for many and coverage for few. Pain Physician, 20, 111-138.

Dickman, S. L., Himmelstein, D. U., & Woolhandler, S. (2017). Inequality and the health-care system in the USA. The Lancet, 389(10077), 1431-1441. Web.

Hall, J. P., Kurth, N. K., Gimm, G., & Smith, S. (2019). Perspectives of adults with disabilities on access to health care after the ACA: Qualitative findings. Disability and Health Journal, 12(3), 350-358. Web.

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DemoEssays. "Negative Aspects of Affordable Care Act Extension." October 26, 2022.