Aca Healthcare Reform and Stakeholders


The implementation of the Affordable Care Act (ACA), also known as Obamacare, is a crucial reform process in modern history. This program, launched at the beginning of the second decade of the 21st century, has changed the existing paradigm in American healthcare institutions (Gaffney & McCormick, 2017). One way or another, ACA inevitably affected all groups of the population. That is why it is crucial to conduct a study on the topic of what stakeholder groups this health care reform impacted financially. It is also necessary to analyze the financial climate that formed during and after the implementation of the ACA. The purpose of this paper is to differentiate diverse ACA impacted stakeholder groups and explore their financial situation, as well as benefits and drawbacks on each of them.

Differentiation of ACA Impacted Stakeholders

Small Employers

In a study of multiple scientific sources, several impacted stakeholder categories were identified, one of which is small employers. It is due to this reform concerns primarily the financial distribution of cash, both consumers and producers of healthcare services. According to Corlette et al. (2017), “the Affordable Care Act (ACA) ushered in dramatic changes for small employers and the market where these employers purchase coverage” (p. 2). It is also worth mentioning that the term small employer means businesses and enterprises with personnel of fewer than fifty employees (Corlette et al., 2017). This category of stakeholders is significant because about a quarter of the whole full-time workforce in the United States is employed in this sector of the economy.

Farmworker Communities

Farmworker communities turned out to be those who also were significantly influenced by ACA. According to researchers, one of Obamacare’s fundamental goals was to ensure access to health services for rural populations (Guild et al., 2016). It is no secret that agricultural workers who mainly live in rural areas are more prone to health problems such as chronic diseases and bad habits (Stanhope & Lancaster, 2017). Unlike urban residents, they are much less likely to participate in activities related to life promotion and disease prevention (Stanhope & Lancaster, 2017). That is why this group of stakeholders was identified and included in this work.


It is essential to mention that a considerable part of them in the United States are represented by immigrants from numerous countries, mainly of the Latin American region. This is partly why, and for several other reasons, one more broad category of stakeholders on whose position the ACA has influenced are immigrants. These reasons are the general low socioeconomic status of immigrants as well as a noticeable drop in health indicators that correlate with the amount of time spent in the United States (Reynolds et al., 2016). It is worth noting that the goal of the ACA in the topic of the immigrant population was to maximize access to a health institution and services (Bustamante et al., 2019). This reform has also changed the financial conditions for all stakeholders that were described above.

Financial Effect of ACA Implementation

Small Employers

Regarding the stakeholder group of small employers, ACA has had a more significant impact on the financial conditions for acquiring and providing insurance and coverage, as well as the healthcare market. Researchers note that “some employers, especially those with fewer than 10 employees (called “micro-groups”), dropped coverage at least in part because affordable individual coverage had become available in the marketplaces” (Corlette et al., 2017, p. 3). It means that ACA has affected not only small employers but also other active participants in the healthcare market, namely insurance companies, and brokers, thereby changing the paradigm in this economic sphere. It was achieved by the abolition of several market restrictions and the establishment of a monetary minimum in favor of both employers and employees.

Farmworker Communities

To address the issue of access to healthcare services for farmworker communities, ACA has adopted a direct financing strategy. According to Guild et al., “the ACA designated $11 billion to community health centers to expand their services” (2016, p. 7). This massive funding made it possible to open new clinics, expand medical personnel, update and reorganize databases, and simplify several bureaucratic and administrative processes. In addition to municipal and structural reorganizations, an extensive program of in-person assisters was launched with the help of this funding (Guild et al., 2016). The task of in-person assisters is to educate farmworkers regarding health insurance and the United States health care institution, as well as help to get involved in Obamacare.


For immigrants, ACA changed the norms and rules of insurance service and utilization depending on the level of poverty and income earned. In more detail, it means that country-born, legal, and naturalized immigrants receive either “Medicaid coverage up to 138%” or “subsidies in the private health insurance exchanges (HIE)” (Bustamante et al., 2019). Several healthcare institutional problems of various ethnic minorities in the United States were resolved through such structural innovations. The implementation of the ACA also caused a significant increase in the number of insured immigrants among all indicators, such as gender, age category, socioeconomic status, and area of residence.

Benefits and Drawbacks of ACA for Stakeholders

Small Employers

To summarize the various data regarding the impact of ACA on small employers, it can be stated that there are objective, interconnected benefits, and drawbacks. On the one hand, this reform has significantly contributed to both the development of the healthcare market and simplified the entry threshold for small businesses (Corlette et al., 2017). On the other hand, this was followed by the refusal of small entrepreneurs from group health plans (Corlette et al., 2017). It is also worth noting the increased cost of insurance payments, namely premiums, especially in markets with a high hospital concentration (Boozary et al., 2019). In addition, the system of individual healthcare marketplaces has shown visible instability due to the subsequent cancellation of some ACA measures after the 2016 elections.

Farmworker Communities

The ACA also has its successes and failures and the field of farmworker communities. One of the positive benefits, is worth highlighting the expansion of the healthcare infrastructure and the improvement of services, especially “behavioral and oral health” (Guild et al., 2016, p. 75). In addition, for those who purchase medical insurance on marketplaces, the state provides various tax reductions (Guild et al., 2016). However, these exemptions apply only to farmworker communities of the local population as well as legal and documented immigrants (Guild et al., 2016). Some logistic problems are still relevant, especially in the field of technological equipment and state and foreign documentation.


The situation with the ACA and the immigrant stakeholder society, like the entire United States policy towards immigrants, is very controversial. That is why some unique points should be described. For example, research results show that with the introduction of ACA, “uninsured rates for U.S. immigrants were reduced significantly” (Bustamante et al., 2019, p. 216). A clear drawback of the Obamacare program is the five-year waiting period for Medicaid insurance, which applies to all categories of immigrants (Bustamante et al., 2019). A general review of all scientific sources indicates that many stakeholders and other population groups are not sure about the ACA, in particular, due to the political situation in the United States.


This paper explores how ACA implementation has affected various stakeholder groups. There are three identified population groups, such as small employers, farmworker communities, and immigrants. During the study, the author found that the economic measures taken during the ACA reform affected the topic of insurance in all three categories. Financing-related institutional changes were seen in stakeholder groups of farmworker communities and immigrants. The benefits and disadvantages of ACA implementation for each of the three stakeholders were also analyzed.

Regarding small employers, the positive points are the development of the healthcare market and the simplification of market enrollment. The flaws are the refusal of small entrepreneurs from group health plans and the increased cost of insurance payments. From the farmworker communities’ perspective, benefits are the expansion of the healthcare infrastructure, the improvement of services, and tax reductions. However, there are also disadvantages, such as classification and logistic problems. An increase in the numbers of insured people and the five-year waiting period for Medicaid are clear benefits and drawbacks for immigrant stakeholders. Further research is needed to study more financial correlations between ACA and other stakeholder categories.


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.

Bustamante, A. V., Chen, J., McKenna, R. M., & Ortega, A. N. (2019). Health care access and utilization among US immigrants before and after the Affordable Care Act. Journal of Immigrant and Minority Health, 21(2), 211-218.

Corlette, S., Hoadley, J., Lucia, K., & Palanker, D. (2017). Small business health insurance and the ACA: Views from the market 2017. Web.

Gaffney, A., & McCormick, D. (2017). The Affordable Care Act: Implications for healthcare equity. The Lancet, 389(10077), 1442-1452.

Guild, A., Richards, C., & Ruiz, V. (2016). Out of sight, out of mind: The implementation and impact of the Affordable Care Act in US farmworker communities. Journal of Health Care for the Poor and Underserved, 27(4), 73-82.

Reynolds, M. M., Chernenko, A., & Read, J. N. G. (2016). Region of origin diversity in immigrant health: Moving beyond the Mexican case. Social Science & Medicine, 166, 102-109.

Stanhope, M., & Lancaster, J. (2017). Foundations for population health in community/Public health nursing – E-book. Lexington, KY: Elsevier Health Sciences.

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NursingBird. "Aca Healthcare Reform and Stakeholders." February 22, 2022.