The Affordable care act became law on March 23, 2010. The Act has five major aims. The first aim is to achieve near-universal coverage and to do so through shared responsibility among government, individuals, and employers. A second aim is to improve the fairness, quality, and affordability of health insurance coverage. A third aim is to improve health-care value, quality, and efficiency while reducing wasteful spending and making the health-care system more accountable to a diverse patient population. A fourth aim is to strengthen primary health-care access while bringing about longer-term changes in the availability of primary and preventive health care. A fifth and final aim is to make strategic investments in the public’s health, through both an expansion of clinical preventive care and community investments (Rosenbaum, 2011). The Affordable Care Act was comprised of many different foundations. This act was an almost universal guarantee that everyone would have not only access to health insurance coverage but it would be affordable. The number of uninsured American’s would be cut by more than half and result in 94% of Americans with health insurance coverage. Yet this would also increase Medicaid enrollment by 15 million beneficiaries and there are still would be 24 million people without health care coverage. So in reality their foundations of providing access of health care to all and making it affordable already isn’t plausible. The health care system in the United States is relatively unplanned and poorly coordinated. There is also no single coordinated integrated organization. That is why we are not the healthiest country even though we spend so much on health care. In our current health care system people don’t have a choice, we are forced to buy or be enrolled in a healthcare plan which we don’t want. Many have described the ACA as “insurance for many with coverage for few.” Some believe that the ACA might be more appropriately labeled the “Medicaid Expansion Act.” The President-elect at that time has described the problems he perceives with the ACA as; rapidly rising premiums and deductibles, narrow networks, and limits of coverage imposed by health insurance companies (Hirsh & Manchikanti, 2016). To finance this Act they made this a legal expectation that everyone living in the United States has to by law have health insurance coverage. This obligation was the only way to secure this act, and this burden was put on all U.S. taxpayers. If not you would be fined when you were doing your taxes at the end of the year. The system is relying on the taxpayers and the wealthy to help fund the rest of the people who can’t afford coverage and that is why they are mandated to buy into this system. People that have insurance are not even protected. The insured have to pay deductibles, monthly premiums, and copayments yet deductibles actually delay care because people can’t pay them. People with coverage through their employers should expect premium hikes of 5 percent or 6 percent next year, depending on where the employee lives and what adjustments a company makes. That’s double the forecast for inflation next year. And the rising rates may keep them from getting a raise, too. Employers often pay most of the bill for employee coverage, leaving them less money to increase salaries when rates rise (NBC News, 2016). The mechanisms for financing health care are more expensive care but high quality or low quality and less expensive care. Physicians are trained to treat, prevention is not taught and insurance companies are not paying for prevention. They make money off of treatment.Medical providers didn’t want Medicaid patients because of low reimbursements, more paperwork, and retroactive denials. The hospital could not deny care so they would provide the care but not get paid because of retroactive denials. We needed an integrated, effective, and less expensive health care system but that didn’t happen US Health care expenses are the highest in the world in 2013 it was 18% of GDP. These expenses have increased over the years with nationwide inflation and excess medial inflation. Medical expenses increased more than any other and we are just increasing the debt. What most people don’t realize is how costs are rising. One reason is that our system is in competition for the same resources which causes wasteful duplication and ineffective use of resources. It’s a complicated system that is on a treadmill going nowhere. Insurance premiums, which reflect spending on medicines, doctor visits, tests and hospital stays, have climbed 213 percent since 1999 for family coverage purchased through an employer, according to the Kaiser Family Foundation (Washington Post, 2016). There are many people who pay good money for their insurance but still cannot find a facility accepting new patients, or who accept their insurance, or they have to wait 3-4 months for an appointment. They then have to resort to going to an out of network provider which will charge them an out of pocket fee but they get to be seen hopefully a lot sooner. The insured are not well cared for or protected. Insurance companies are out for money and when you seek out care even though you paid your copay if the insurance company incurs any costs they will just increase your premium next year. With these insurance premiums and health care costs rising it’s affecting many American’s from the middle class to the poor. More American’s are having to get on Medicaid because they don’t make enough to have private insurance or their jobs keep their hours below 40 a week so they don’t have to offer them insurance. They struggle with same issues as people who are insured but they can’t afford to see someone out of network or pay the high out of pocket costs. This contributes to the increase in people using the ER as a point of care for their health needs, which is extremely expensive but they can’t get in to see someone. This is not an effective long term solution, it is in essence putting a band aid on the problem then sending the patient out again to have them only have return because they need care. There are lots of factors contributing to the price changes. Premiums are going up in some areas because insurance companies are dropping out of the market, leaving consumers with fewer options. Some insurance companies are raising rates because the premiums they charged initially were too low to cover the costs they faced, causing them to lose money, said Cynthia Cox, associate director of health reform and private insurance for the Kaiser Family Foundation (Washington Post, 2016). The hospital will also incur the costs of caring for these people especially those who aren’t insured or can’t pay the huge hospital bill even if they have insurance. Then hospitals will have to increase rates to offset these costs they have incurred. Not to mention increase in costs causing inflation because more people are having to get on Medicaid. Which in turn affects tax payers because we pay for Medicaid. As I have mentioned no one is protected and we are all on a treadmill going nowhere with this system. While the plan of providing American’s access to quality healthcare that is affordable sounded like a great idea, but in reality is not feasible. Unaffordable healthcare is a huge barrier facing many people but even on the other end they still will face more barriers in being able to receive care. People are running into barriers such as; insurance denials, places not accepting new patients, or the places that are out of pocket because insurance does not cover them are too expensive for people. Without getting the proper care their health issues just escalate. Advocacy is important for these types of issues because this imposes costs on or denies services to people in need. We needed an integrated, effective, and less expensive health care system but that didn’t happen and that attributes to the high costs which affects the delivery of health care Healthcare is an enormous system and the implementation and execution of their goals they set out to reach would be unrealistic and unobtainable. I think in creating any sort of change you have to set boundaries of what can and can’t be realistically done. Providing low costs, better access, and quality care our healthcare delivery system logistically is not feasible because these three entities are interrelated. Providing access to quality healthcare is not going to be free or cheap so the element of cost is affected because now costs have to rise to support the changes in the other two entities. It is a catch 22, if you want access to quality healthcare than costs will rise, if you make healthcare affordable by cutting costs then access quality healthcare or even access to healthcare in general will be negatively affected. This is why the system isn’t functioning as expected. Scaling down the problems to more manageable in size and initiating small-scale changes can improve factors to help you achieve your goals. This way is simpler, decreases demands, and there is less play between cause and effect. To improve our health care our system we need to be more integrated, so we can bring about effective less expensive health care.