Healthcare Delivery After Affordable Care Act

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Table of Contents

Research Background
Problem Statement
Methodology
Discussion
Recommendations
References

Research Background

American healthcare system is the eighth largest in the world. An average American spends most of its income on health care immediately after food and housing. Given the share of capital invested in the healthcare, it is important to carefully analyze present healthcare conditions and impact of ongoing healthcare policy. In order to meet the changing requirements, the USA’s traditional physician-dominated healthcare system has undergone tremendous changes from time to time due to open-market competitions, technological changes, and recent advances.

Patients have reported dissatisfaction with the quality of time and amount of care received from the practitioners in hospitals. In this respect, the Affordable Care Act (ACA) was brought as a major changer to organizational structure and adjust insurance cover to improve healthcare. Nevertheless, hospitals across USA have been reporting impact in their prior functioning. This work aims to analyze the impact of the Affordable Care Act 2010 on the USA health care organization and delivery in hospitals.

Problem Statement

In the USA, the complex structure and delivery system makes it difficult to analyze the impact of ACA on present issues of healthcare in hospitals. The Medicaid revenue shows increasing profit for hospitals and increasing insurance cover for the wider population (Cunningham, Rudowitz, Young, Garfield, & Foutz, 2016). However, published research works show that ACA has reduced hospitalization and impacted non-for-profit hospitals working style. This work discusses positive and negative impacts of the ACA and analyzes its impact on the hospitals using information gathered from secondary sources.

Problem

Hospitals are reporting the ACA has increased healthcare demand and revenue. Now, due to the complexity of USA’s healthcare system, new problems are often created while solving the previous problems. For example, healthcare insurance has been given major reforms in the United States. However, due to increasing revenues from the patients, the act has reduced compensation to Medicaid Disproportionate Share Hospital (DSH) (Cunningham, Garfield, & Rudowitz, 2015). This has impacted hospitals which serve large number of uninsured and Medicaid patients. It should be noted that many not-for-profit hospitals focus on giving care to underprivileged patients. Now, if ACA act implements lower uncompensated care costs- these non-for-profit hospitals and Disproportionate Share Hospitals (DSH) will ensure huge impact on their revenue. Healthcare sector is labor intensive with the periodic requirement to cope technological changes.

ACA primarily focuses on primary care and reduces hospitalization cases. For example, the Patient Protection and Affordable Care Act (ACA) conducted a pilot project to check commercial viability of Medicare (Barlas, 2014). This program encourages care home health facility with physician closely monitoring patients to minimize hospital admissions. This has reduced hospital admissions by 6 percent, according to recent report published by the Care First of Maryland.

Providers of the healthcare form an important part and determine the quality of service. Major problems associated with the healthcare practitioners include financial issues, operational issues, clinicians’ knowledge issues, belief and attitude issues. In addition, the structural changes are also associated with the quality of healthcare being delivered. Over last few decades, increasing interest has been shown to improve the quality of healthcare services. However, much needs to be done to disseminate real world problems and solve new problems being faced by traditional hospitals.

Methodology

This work aims at investigating present trends and problems associated with the Affordable Care Act 2010. Two methods were employed to determine the impact of Affordable Care Act 2010 namely media review and secondary data sources. First, this study looked at major findings and reports on the Affordable Care Act 2010. Second, data were derived from the published literature to support the conclusion and derive realistic results. An extensive discussion on the impact of Affordable Care Act 2010 is presented in the following sections.

In addition, this essay focuses on identification of major problems associated with the traditional hospitals such as non-for-profit hospitals. In this respect, a number of media contents were reviewed and analyzed. Some of the major problems discussed in this work are healthcare cost, state expenses, antitrust cases and other structural problems associated with the hospitals. Therefore, this study discusses and analyzes impact of Affordable Care Act 2010 on hospitals and problems associated with present practice in the USA.

Discussion

Major Controversies

The Affordable Care Act 2010 has brought change to all the aspects of healthcare starting from delivery to insurance. Major highlights of the Act are given below

The act ensures every American has healthcare insurance,
A number of regulatory control on the present healthcare practice of medicine,
A subsidy system to pay for the healthcare insurance, and
New requirements for the healthcare insurance industry.

While, the act has positively impacted the present medical practices in the USA, but there is a concern on future changes. In the present state, it is very difficult to alter or repeal the act and this can create problems in adjusting the Act to address future problems.

USA’s healthcare system presently faces a number of structural and functional issues (Gamble, 2015). For example, a number of non-profitable hospitals performing as per the traditional system were expected to make a profit from the present medical policy. A report from the year 2014 state operating margin of non-profitable hospitals has remained same. Another controversy reported came from the Blue Cross.

Over 37 companies sued the Blue Cross Blue Shield Association for higher insurance price and lower reimbursement. This also reflects that its consolidation has increased insurance price and reduced reimbursement. Another major problem is associated with the state budget. State governments are facing increasing number of healthcare responsibilities and medical expenditure. The present situation is expected to worsen given the shifting financial burden to the State budget.

Analysis

Overall the ACA had a positive impact on the healthcare sector. It has increased access of healthcare to wider population, it has also increased hospitals’ revenue, and provided insurance to wider population. However, the benefits are higher for profit making hospitals and lower for non-for-profit making hospitals. ACA does not compensate for charity-health care. In fact, the number of hospitals providing charity health care has decreased after ACA implementation. In addition, the gap between the health care investment to provide medical care and return has decreased by 31.9 percent. This decrease in profit and operation cost is because the state government has reduced the reimbursements to hospitals for providing charity health care.

Data from the Ascension hospitals show that revenue from self-paying patients has reduced by 63.2%. This implies that more patients are looking to support their hospital bills with Medicaid (Jiang et al., 2016). This has increased burden of states across USA. Recently, Anthony Terigni the CEO of Ascension stated that he is looking forward to increasing support from the newly elected US government towards increasing the insurance cover and provide 100% affordable hospital care (Lambert, 2017). This clearly indicates that changing political interest can impact functioning of ACA. It should be noted that At. Louis-based Ascension is USA’s largest hospital with 20 billion USD revenue. Since, ACA has reduced compensation to charity care, it looks forward to more reforms to support its traditional objective.

At present ACA covers 20 million Americans across 31 states (Barkholz, 2016). Hospitals are findings it difficult to understand the how ACA can be repealed if required. Despite few limitations, the Affordable Care Act 2010 has positively impacted the healthcare conditions in the USA. For example, low-income groups and their families have been positively impacted with the spread of Medicaid. Medicaid benefits are expected to rise positively in coming years. In addition, the Affordable Care Act 2010 links the Social Security Act in its section 1115, allowing the financial waiver to the needy. Special focus was paid to senior citizen and childcare.

For example, the act targeted childless adults who don’t have dependents, but in their old age struggle to find the traditional insurance. The demerit of the present act is that it does not provide any other alternative to challenge or replace the recommended reforms (Sommers, Kenney, & Epstein, 2014). Another drawback being this act has put the burden on states for implementing the project. In this respect, it is recommended that federal government should pay special attention to address immediate financial problems.

In addition, a provision should be made to improve present act to incorporate future challenges. Therefore, it can be concluded that the Affordable Care Act 2010 has overall had a positive impact on healthcare system and organization in the US. Nevertheless, there are areas of improvement which will ensure the success of this act in improving US healthcare sector.

Recommendations

First, the number of insurance enrollments should be increased to cover wider population and benefit underprivileged patients, who seek care in non-for-profit hospitals. In recent year efforts have been made to provide Medicaid to lower income groups under the ACA. However, no attention has been given to non-profitable hospitals, which are not making a profit as suggested by the policy maker. On the other hand, private player and institutions are able to work profitability under the Affordable Care Act.

Therefore, there is an immediate need to address performance issues related to non-profitable hospitals, who are major providers of healthcare to underprivileged patients. In addition, smaller and individual group of physician find it difficult to cover healthcare requirements of increasing population with Medicare in place, government needs to include the benefits foe the small group of physicians too.

References

Barkholz, D. (2016). Hospitals fret over financial impact of ACA repeal. Web.

Barlas, S. (2014). Hospitals Struggle With ACA Challenges: More Regulatory Changes Are in the Offing in 2015. Pharmacy and Therapeutics, 39(9), 627.

Cunningham, P., Garfield, R., & Rudowitz, R. (2015). How are hospitals faring under the Affordable Care Act? Early experiences from Ascension Health. Kaiser Family Foundation, 30.

Cunningham, P., Rudowitz, R., Young, K., Garfield, R., & Foutz, J. (2016). Understanding Medicaid Hospital Payments and the Impact of Recent Policy Changes. Kaiser Family Foundation.

Gamble, S. B. M. (2015). The 8 biggest healthcare issues in 2015 so far. Web.

Jiang, H. J., Boutwell, A. E., Maxwell, J., Bourgoin, A., Regenstein, M., & Andres, E. (2016). Understanding patient, provider, and system factors related to Medicaid readmissions. The Joint Commission Journal on Quality and Patient Safety, 42(3), 115-121.

Lambert, J. M. (2017). Burdens Encountered By the Uninsured in the Search for Hospital Care: Are Tax-Exempt Hospitals Fulfilling Their Charitable Obligations? Hinckley Journal of Politics, 6.

Sommers, B. D., Kenney, G. M., & Epstein, A. M. (2014). New evidence on the Affordable Care Act: coverage impacts of early Medicaid expansions. Health affairs, 33(1), 78-87.

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