Category: Affordable Care Act

Provisions of Affordable Care Act that Impact Healthcare Consumption

The ACA provisions aim at ensuring provisions of quality and affordable healthcare to all Americans. Some of the ACA provisions will alter the quantity of healthcare consumed. The first part of the essay is going to show how these provisions will alter the quantity of consumed healthcare.

Under the quality and affordable healthcare for all Americans, there is immediate action to expand and preserve coverage.

This provision allows citizens to identify affordable insurance coverage options hence enabling many Americans to access healthcare services, thereby increasing the quantity of healthcare consumed; for instance, the formation of a temporary program that covers early retirees under this initiative increases the number of health insurance policies.

Moreover, the provision on the role of public programs increases Medicaid coverage to low income earners and children. Clearly, this provision increases the quantity of healthcare that the Americans will consume.

The hospital readmission reduction initiative, which is under the provision of improving the efficiency of healthcare, is a move towards ensuring that majority of the Americans can afford the re-admission costs; for example, the payments for bone density tests assist both the healthcare providers and patients.

In addition, development of new patient care models increases the quantity of healthcare consumed; many patients can be served at a go and even decide on the care model the health providers should accord them.

Additionally, the provision to extend healthcare protections and services to rural areas enhances community participation in healthcare programs such as preventing chronic diseases thus increasing the quantity of healthcare consumed directly.

There is also the provision that aims at improving access to innovative medical therapies and community assistance program. These two provisions work hand in hand towards providing services to the underserved community.

Notably, the class program is an insurance benefit program for individuals with functional limitations in the society. The discussed provisions of the ACA clearly will alter the quantity of healthcare that Americans will consume after full implementation of the act.

Effects of these Provisions on Expenditures and Health

The second part of this essay is going to analyze the effects of the above provisions on expenditures and health. The provision to expand and conserve coverage options among the Americans will lower expenditure on healthcare services. This is because people will be free to choose the coverage that they can afford.

On the other hand, the insurance firms will record increased revenues, which will be from the many American who had never been insured before. The qualified health plan will improve the health conditions of the citizens.

For example, low income earners who could not afford Medicaid are able to access quality, and affordable healthcare; in this sense, their health conditions improve.

The provision for improving access to innovative medical therapies obviously improves the health of the citizens, even though it implies increased expenditure to acquire such services. The current disease complications require innovative medical practices that are under the ACA.

The provision on the role of public programs assures improvements in Medicaid services, simplification of Medicaid enrolment and enhanced support for children and low income earners. Undoubtedly, this provision will improve the health of the citizens through their engagement in healthcare programs.

However, the simplification of the Medicaid enrolment process increases the cost of healthcare in the end, even though the patients do not have a direct feeling of the cost. The ACA initiative aims at revolutionizing the entire American health system in order to provide quality and affordable healthcare to the citizens.

Even though it has benefits, there are hidden costs that accompany the initiative which raise expenditures on health; for instance, the tax levied on employers, annual fee for branded importers and manufacturers and increased premiums on insurance covers.

Therefore, ACA has effects on both the expenditures and health status of the Americans.

At the current moment, the Affordable Care Act (ACA) faces many legislative challenges and threatens healthcare coverage affordability, enrolment levels, and the overall stability of the non-group insurance market. This market serves a highly diverse population comprised of self-employed and unemployed individuals, early retirees, and those workers who do not have access to employer-sponsored insurance. It is clear that this population includes both healthy people and people with serious chronic diseases.

As Blumberg and Holahan (2017) state, the main problem with the ACA is that before its enactment, insurance was more affordable for healthy individuals, but a lot of people with health problems were often denied coverage by insurers or received limited benefits. Considering this, it is essential to analyze how the inclusion of high-risk population in the insurance program affects the level of enrolment and coverage costs in the non-group market.

Table G.1: Distribution of Non-Group coverage, Includes High-Risk Pool, by Age.

As the results of percentage change calculations presented in Table G.1 demonstrate, the age group of people aged 35-44 has the highest increase in the number of covered lives – 142,4%. According to Kennedy, Wood, and Frieden (2017), this age group of working adults with chronic conditions and disabilities was exposed to the largest number of disparities before the ACA. Thus, the increase in the enrolment level can be defined by a decrease in those disparities as a larger portion of the at-risk population in this age group obtained better access to coverage.

Nevertheless, considering that the percentage change in the same age group excluding the at-risk poll (Table G.2) is equated to 164%, it is possible to say that a significant number of healthy individuals aged 35-44 will likely find the coverage under new ACA conditions unattractive as they will have to pay more for the same amount of benefits and services.

When it comes to costs, the largest increase is observed in the group aged 55 and more (68,1%). Such a rise can be associated with general greater healthcare expenditures in older populations defined by the need to manage comorbidities, impairments, and the overall death proximity (Hazra, Rudisill, & Gulliford, 2017). However, when comparing this cost increase with the results of the same age group presented in Table G.2, it becomes clear that the inclusion of high-risk population makes the percentage change less steep, meaning that older individuals with chronic conditions can bear fewer coverage expenditures under the ACA.

Table G.2: Distribution of Non-Group Coverage, Excluding High-Risk Pool, by Age.

To sum up the analysis findings, it is appropriate to note that the ACA helps deal with disparities to which vulnerable populations were exposed in the non-group coverage market. At the same time, when people with chronic conditions are provided with greater access to coverage, insurers find it difficult to manage all expenses and, as a result, healthy individuals may suffer due to increased costs. Such a situation can have an unfavorable effect on the overall insurance program enrolment level. Policymakers should make some changes in legislation to stabilize the market and eliminate existing threats.

References

Blumberg, L. J., & Holahan, J. (2017). Stabilizing and strengthening ACA nongroup markets. Web.

Hazra, N. C., Rudisill, C., & Gulliford, M. C. (2017). Determinants of health care costs in the senior elderly: Age, comorbidity, impairment, or proximity to death? The European Journal of Health Economics, 19(6), 831-842.

Kennedy, J., Wood, E. G., & Frieden, L. (2017). Disparities in insurance coverage, health services use, and access following implementation of the affordable care act: a comparison of disabled and nondisabled working-age adults. Inquiry: A Journal of Medical Care Organization, Provision and Financing, 54, 46958017734031.

Introduction

The Affordable Care Act (also called Obamacare) was aimed at transforming the experiences of many patients and American citizens who lacked adequate healthcare resources. This policy managed to transform various aspects of the country’s healthcare sector, including insurance, Medicaid eligibility, and improved medical services. Using this Act, the personal discussion presented below identifies three key points that are of particular interest to me as a future advanced practice nurse (APN).

Key Points

Budget Reconciliation Process

Congress is currently proposing to repeal Obamacare through a process known as budget reconciliation. This move will have significant impacts on my roles and experiences as a future APN. The reason for this argument is that the decision will present both advantages and disadvantages. Blumberg, Buettgens, and Holahan (2016) believe that federal spending will reduce significantly, thereby making it possible for different institutions and agencies to focus on people’s health demands.

The move will also guide the government to focus on other key areas for the economy, including employment and infrastructure. However, challenges such as reduced insurance cover, loss of health funding, and poor health outcomes might occur. APNs will have to utilize their concepts and competencies if they are to provide high-quality health services. This means that there is a need to consider the disadvantages of repealing the Affordable Care Act (ACA).

Elderly Population

APNs should develop appropriate competencies and skills to meet the needs of the elderly. Recently, President Donald Trump decided to sign an executive order that empowers individuals to use short-term insurance for medical cover and association health plans (Bryan, 2017). This becomes the second point that is important to me as a future APN. The reason for this is that it presents both disadvantages and advantages.

The outstanding benefit is that the move will allow many healthy citizens to receive cheaper and affordable health services. It will also overcome most of the challenges associated with the ACA. However, the plan is capable of affecting the health outcomes of older persons and those with terminal conditions. The order will also create a scenario whereby sick individuals will require increased insurance costs for their conditions (Moffit, 2016). Insurers will also increase prices for their plans. APNs should be aware of these issues if they are to support all vulnerable citizens.

Overall Health Outcomes

The ACA was an Act that was aimed at increasing the number of persons who had access to health insurance cover. My third point from this law is the future overall health outcomes of all American citizens. Its main objective was to ensure that many citizens had access to high-quality health services. The law and every proposed amendment have the potential to support the medical demands of some individuals.

One unique benefit of such bills is that they will empower a small number of citizens by ensuring that they have access to medical care (Wilensky, 2017). The proposals will also make it possible for healthy persons to record positive medical outcomes. However, the latest amendments fail to consider the needs of every American citizen. This is true since they ignore the elderly, persons with terminal conditions, and minority groups. It will, therefore, be my duty to implement superior care delivery models in order to reduce this gap.

Conclusion

The above discussion has indicated that the ACA was a powerful law capable of addressing many citizens’ health needs. Each of the subsequent proposal or bill appears to present both positive and negative attributes that APNs should take seriously. Such an approach will transform the country’s health sector and empower more people to lead healthy lives.

References

Blumberg, L. J., Buettgens, M., & Holahan, J. (2016). Implications of partial repeal of the ACA through reconciliation. Urban Institute. Web.

Bryan, B. (2017). Trump just took a big step to unravel Obamacare. Business Insider. Web.

Moffit, R. (2016). Year six of the Affordable Care Act: Obamacare’s mounting problems. The Heritage Foundation. Web.

Wilensky, G. R. (2017). The future of the ACA and health care policy in the United States. Journal of the American Medical Association, 317(1), 21-22. Web.

There are several policies that can have profound implications for the implementation of such programs as Medicaid, Medicare, and CHIP. Overall, much attention should be paid to the implications of the Patient Protection and Affordable Care Act which can influence the work of various medical institutions.

This legislative act is aimed at increasing the availability of healthcare services to people who can have different income levels. This law can be regarded as the basis of healthcare reform. In the long term, it can affect the lives of parents and children. It is possible to say that the reform of healthcare can significantly influence such a program as CHIP or the Children’s Health Insurance Program. This is the main question that should be discussed more closely.

It should be noted that this program is intended for low-income families with children (Ubokudom, 2012). This policy will require medical organizations to provide more support for this social group. In particular, one should speak about the provision of various preventative health services (Ubokudom, 2012).

For instance, it is important to mention obesity screening, vaccinations, as well as psychological counseling. In turn, this healthcare reform has made these services more affordable. Therefore, it will be possible to identify possible healthcare problems at an early stage. Therefore, medical workers will be able to reduce a great number of healthcare risks. This is one of the points that can be made.

Additionally, according to this reform, the coverage will be provided to the majority of children who are uninsured due to some reasons (Kirp, 2011., p. 194). Therefore, this policy can alleviate the financial burden carried by various families facing some economic problems (Kirp, 2011., p. 194).

This is one of the details that can be distinguished. Apart from that, the provisions of the Patient Protection and Affordable Care Act imply that this program will be continued at least to 2019. Therefore, this information can be of great importance to parents, especially those people who cannot afford medical services.

Nevertheless, this policy can also affect the work of hospital administrators. In particular, these professionals should find ways of making the best use of available financial resources that will be available to them. Additionally, medical organizations should be ready for the increased inflow of patients.

This is one of the challenges that should not be overlooked by the board of trustees. Certainly, the implementation of this healthcare reform can have even greater implications for other programs such as Medicare or Medicaid. Nevertheless, the importance of CHIP should not be overlooked because this assistance can be urgently needed by thousands of families representing different social groups. This is one of the aspects that should be taken into account by the board of trustees.

On the whole, this discussion indicates that the adoption of the Patient Protection and Affordable Care Act can significantly impact the experiences of parents and children. They will have access to a wider range of medical services.

Additionally, healthcare administrators should make sure that they can allocate resources in an appropriate way; otherwise, increased funding may not bring any substantial benefits. This task is critical for improving the experiences of patients. These are the main details that can be singled out. The board of trustees should make use of this information while implementing the healthcare reform.

Reference List

Kirp, D. (2011). Kids First: Five Big Ideas for Transforming Children’s Lives and America’s Future. New York, NY: PublicAffairs.

Ubokudom, S. (2012). United States Health Care Policymaking: Ideological, Social and Cultural Differences and Major Influences. New York, NY: Springer Science & Business Media.

Small businesses are critical to the United States economy because they stimulate innovation and provide numerous employment opportunities. The objective of all business owners is to expand and make more profits while ensuring that their employees remain productive. Business owners use different methods to motivate their employees and increase their productivity. For instance, businesses can increase their employees’ wages and offer better health care.

However, the operational costs of running businesses significantly reduce the profit margins realized by many small companies. Although business owners seek ways to reduce their operational costs, the new Affordable Care Act increases the complications of running businesses. This submission will analyze how the Affordable Care Act affects American small businesses and will provide recommendations on how such businesses can maintain their profitability.

The Affordable Care Act lowers the profit margins of small businesses

The Affordable Care Act makes it almost compulsory for all businesses in the United States to offer health care coverage to all employees. The act offers provisions for businesses with less than fifty employees to offer health insurance exchanges and buy health insurance coverage. The Affordable Care Act demands all firms that hire above fifty workers to provide health care coverage to the workers, and this increases operational costs to small companies.

Businesses that do not offer healthcare coverage to their employees despite having more than fifty employees face stiff penalties that could significantly reduce their profit margins. The Affordable Care Act stipulates two types of penalties against businesses fail to provide the expected healthcare coverage.

Businesses that do not offer affordable health care coverage or fail to offer any healthcare coverage face a penalty of $2,000 per uninsured employee. However, the act exempts fines on the first thirty workers and employees who work on a part-time basis.

The Affordable Care Act prevents small businesses from expanding

The Affordable Care Act insists that all businesses with more than fifty employees offer health care coverage to their workers. Such a provision implies that hiring the fiftieth employee has costly financial repercussions to our business operations despite our interest in hiring more employees and expanding our company.

The financial implications of hiring additional workers complicate the future of our business and our ability to realize our mission of expanding our operations. The Affordable Care Act makes it difficult for our company to compete with our rivals, who have better financial resources.

The Affordable Care Act offers some benefits to small businesses

Although the Affordable Care Act increases the costs of doing business, it offers some advantages to small businesses. For instance, the Affordable Care Act offers a wide variety of healthcare coverage options for small businesses to choose from. The act’s insurance exchange option allows employees in small businesses to access health insurance.

The Affordable Care Act encourages employees in organizations offering health insurance to seek employment in small businesses and reduces the “job lock” phenomenon. Access to affordable health insurance was a significant issue among permanently employed workers in the past, but the Affordable Care Act makes health insurance accessible to most employees.

Recommendations

Although our company should adhere to the requirements of the Affordable Care Act, the company will not meet some of its objectives due to the increased costs of doing business. The company understands the importance of offering healthcare coverage to all our employees. However, the company is not yet well-established in the market despite its interest in expanding business operations across the state by opening multiple outlets. Consequently, the company should:

• Employ less than fifty employees on a permanent basis and others on a contract
• Sublet operations to affiliate companies as the business grows
• Open additional small businesses under different identities as the company’s operations grow

Introduction

The Patient Protection and Affordable Care Act, abbreviated as PPACA, was officially enacted into law on March 22, 2010, following President Barrack Obama’s assent of the respective act into law. The national health scheme, otherwise referred to as the Affordable Care Act (ACA), has remained controversial to many sections of the American society as support and opposition to its content continue to be voiced. One particular provision of the law that has drawn significant controversy is on dependants who are up to 26 years old remaining eligible to the insurance plan of their parents. Among the types of dependants benefiting from the provision include those who reside separately with their parents, those not listed as dependents on the tax return of their parents, as well as those who are non-students, and married individuals. This paper analyzes this provision on dependants and discusses its impacts, efficacy, implementation, and evaluation, while also providing recommendations at the close of discussions.

Description of the Law: History and Contemporary Situation

Prior to President Barrack Obama assenting to the PPACA into law, the USA lagged behind as the only first world country to have entered the 21st century without an existing national health insurance scheme. PPACA eventually became a culmination of a decade-old journey that involved legislative as well as political efforts to avail health insurance treatment for every American. At the onset of the journey, President Theodore Roosevelt in 1912 campaigned on the platform of making national health insurance a reality (Mauersberger, 2012). The American Association of Labor (AAL) in 1906 successfully campaigned for the introduction of a national health insurance program. The progressive group’s efforts during Roosevelt’s reign targeted to reform capitalism at the time, rather than aiming at abolishing it.

In 1912, a committee was formed by the progressive voices whose mandate involved looking at the social welfare of Americans. The committee met for the first time in 1913 to deliberate on the issue in a national conference. In 1915, the committee strictly focused on health insurance, which eventually saw it come up with a model bill. The bill had limited coverage for the working class, as well as other Americans whose annual earnings did not exceed $1,200. This also affected the dependants. An array of services were documented, including “the services offered by nurses, physicians, and hospitals, with other benefits including maternity benefits, sick pay, as well as $50 payment to cater for funeral expenses. Workers, the state, and employers were expected to share the costs involved” (Falk, 1977, p. 162).

There was a shift of focus on the health care scheme in the 1930s, with more attention going into ways of funding the program and increasing access to health care instead of focusing on making worker’s incomes stable. Workers’ medical costs began to elicit serious concerns, relegating to the periphery the concern on wage loss as a result of sickness.

In 1943, the Wagner Bill sought to introduce a national health insurance plan and shift attention from a previous proposal that sought for federal grants-in-aid. This bill was later popularly referred to as the Wagner-Murray-Dingel Bill. Part of the bill’s proposal was the formulation of compulsory national health insurance, together with a payroll tax (Falk, 1977). However, this bill was heavily criticized and opposed, with the Committee for the Nation’s Health being attacked on the basis that I.S. Falk, who was a significant policy analyst, acted as an agent linking up to the ILO and the US government. At the time, the International Labor Organization (ILO) was looked at as a remarkable political machine whose main agenda was to dominate world affairs.

The Wagner-Murray-Dingell Bill, nevertheless, failed to be approved by Congress, although there had been attempts for a record 14 years to reintroduce it. Its failure to see light at the end of the day saw America lose out an opportunity to establish national health insurance whose funding would have been compulsorily derived from payroll taxes.

Harry S. Truman’s ascension to power in 1945 saw his tenure being heavily characterized by unreserved support for a national health care scheme. His support for national health insurance, however, was met by renewed opposition efforts. The coinciding Cold War at the time provided the opposition with impetus as they successfully introduced the aspect of ‘socialized medicine’ to the whole debate, making it lose significant support. Truman had a different perspective on the national healthcare scheme. While previous administrations focused on covering only the employed in society, Truman proposed a healthcare scheme that covered all people in American society. His proposals equally dropped the aspect of funeral benefit, which had seen a similar effort flop during the progressive era under President Theodore Roosevelt.

The combined opposition of American Medical Association (AMA), the American Bar Association, the American Hospital Association, and the mainstream American press offered little room for the proposal’s survival (Gordon, 1997). In particular, the opposition sighted ‘socialism’ in the whole plan as the main reason for their failure to offer support.

There was the introduction of a new proposal by Aime Forand in 1958. The congressional representative pushed for the establishment of a medical cover for the elder Americans based on social security. This new proposal, too, received huge opposition as the AMA campaigned against it, terming any government insurance arrangement as a threatening patient-doctor relationship. However, this proposal survived most of the scathing attacks as it concentrated only on the aged. The grassroots support for this plan, for the first time in the health care history of the American society, pushed it into a national agenda. Nevertheless, this idea was rejected by the American Medical Association that, instead, brought up the “eldercare plan”. This was a plan that was wider in scope compared to Forand’s proposal, but it was supposed to be the voluntary based type of insurance.

There was a need to adjust the proposal that the government had presented to cover physician services. President Lyndon Baines Johnson signed into law the new proposal after private concessions and essential political compromises. This was part of his Great Society Legislation that saw an end to 20 years of congressional debate on the matter (Rothman, 1993).

The main battle for the passage of PPACA pitted Democrats against the Republicans in the latest proposal by President Barrack Obama on a national healthcare plan. In 2012, the opposition took the matter to The Supreme Court seeking to deliberate on its constitutionality. The Court’s ruling asserted that it was the state’s choice, rather than a requirement, to expand Medicaid (Andrews, 2012). The Court equally affirmed the requirement by law that individuals obtain coverage of health insurance. According to Pear and Herszenhorn (2010), the eventual passage of PPACA has been seen as a significant advance in the history of social justice in as far as the establishment of a Medicare and Social Security is concerned.

Initial Hypothesis

The PPACA healthcare program is a good law. The provision that allows dependants below the age of 26 to remain under the insurance plan of their parents fundamentally expands the number of young Americans who will be placed under health insurance. This group was largely at the risk of remaining uninsured because it is often difficult for this category of Americans to attain their own health insurance cover at the maximum age of 19, which is the limit for most healthcare plans beyond which they lose the dependent eligibility. It is a positive move for the government to uphold this law, given that 13 million out of the 47 million uninsured Americans fall within this age group (National Conference of State Legislatures, 2010). This is a significant size of the population, which if ignored, may mean a society suffering from health complications in the future. The USA has to ensure that her population is healthy for it to achieve its growth and development agenda. The extension of cover for dependents up to the 26th birthday, thus, perfectly assures a healthier future America.

Analysis of the Policy’s Efficacy

More young Americans within the 19-29 age brackets who previously were uninsured will benefit from health insurance coverage. In 2011 alone, estimates indicated that about 1.2 million young Americans were poised to enroll for coverage (Caralyn, 2010). This number is set to increase with each passing year as the new law gains its momentum. Quite a significant size of this population would have otherwise lived without a health insurance cover if PPACA was nonexistent. In particular, the expansion of the limit age beyond which an individual loses eligibility for cover as a dependent has played a critical role in increasing the number of Americans to be placed under a healthcare plan.

The new national healthcare program promotes uniformity without considering the age factor. This means that in terms of the insurance coverage provision on dependants, coverage may not be varied as a basis of a child’s age. The only exception, in this case, is where an individual is already over 26 years old — as of now, providing insurance to persons who are not more than 26 years old is not supposed to come with surcharges. The surcharges, however, can only apply to all children without considering their ages up to the maximum limit of 26. In the same breath, no variations of benefits are allowed for the dependants for as long as they are below 26 years of age.

PPACA took into consideration the “grandfathered health plans”, which involve all the plan years not exceeding January 1, 2014. This group of health schemes does not include adults who qualify to be covered under the employer-sponsored insurance cover. This does not include a parent’s group insurance cover. This category of health schemes is mandated to abide by the general requirements as from January 1, 2014.

However, there is a major setback on the age limit provision of 26 for the dependants. While employment-based coverage is on the increase, the likely scenario could be the fact that individuals are losing coverage by virtue of their work. This is suspected to be triggering the increased movement from employment-based coverage under the employee’s own name. Instead, individuals, especially those between 19 and 25 years of age are adopting employment-based coverage as dependants (Fronstin, 2012).

Equally, as a society, it is important for structures that enhance responsibility, particularly among young adults, to be implemented. Expanding dependants’ eligibility to cover individuals up to the age of 26 only succeeds in limiting responsiveness among young adults. There is a greater likelihood that a majority of the young adults will deliberately fail to work hard to attain health insurance coverage on their own.

The cost implications of PPACA as a result of the expansion of the age limit for dependants to 26 is enormous for the American economy. More funds are required to fund this program, given that the number of dependants who are not contributing to the scheme has increased (Gruber & Rundell, 2012). The tax bracket has to be expanded to enable the government to run the national health insurance program effectively. However, this is coming at a time when the American economy is not yet fully recovered from the aftermath of the global credit crisis that began in 2007. Most American taxpayers, thus, are left with limited disposable income to cater for their needs. In essence, these developments threaten to slow the economy’s rate of growth, where other important developmental aspects such as infrastructure may not receive adequate funding.

Implementation

The PPACA provisions on healthcare coverage to all dependents up to the age limit of 26 has resulted in substantial compliance challenges, particularly for the employers. There has been a substantial increase in group health plans enrolment because of this requirement. According to Smith, Gambrell, and Russell (2011), estimates for 2011 indicated up to 1.2 million adults intended to sign up for the program. This, in turn, points at the challenge that the employers face because of the newly expanded coverage. Industry groups now point at an increase of the average premium amounts that families are required to pay, to the tune of 3.4 percent.

With PPACA’s enactment into law in 2010, immediate provisions to be implemented include prohibiting lifetime benefit limits, as well as a host of other unreasonable annual limits. The extension of cover to include dependants who are below 26 years is mandatory. Employers and insurance providers are required to eliminate any pre-existing conditions that excluded children. Equally, employers and service providers are required to eliminate any waiting periods that existed earlier, and which exceeded the 90 days mark.

However, the implementation of PPACA has been made easier by the inclusion of grandfathered plans. PPACA’s implementation requires that other existing plans that offer dependent coverage must extend such coverage for individuals who are listed as dependants, who are below the age of 26. Grandfathered plans, thus, enjoy a leeway of excluding dependants who are adults, but who remain eligible for either their own employer-sponsored coverage or that of their spouse.

Evaluation

PPACA’s new provisions, which offer an expanded healthcare cover to dependants below the maximum age of 26, offer new options for consumers. This provision specifically protects consumers who already have private healthcare insurance plan. The new provision will also offer assistance to the government in its attempt to have more Americans placed under health insurance cover. A significant number of unemployed young adults, most of who have just cleared school and are not yet employed, will have the opportunity to benefit from a national health insurance plan. This, in turn, assures the country of a healthy population both presently and in the future. This is a perfect remedy for development.

The cost implications of PPACA have the potential of slowing economic growth in the USA. More beneficiaries who do not make a direct contribution to the scheme have been included in the program (Gruber & Rundell, 2012). This implies that the American taxpayer will have to increase individual contributions in order to cater for the increased number of beneficiaries. The additional contribution amount reduces the disposable income of most American families, which may end up affecting national development and economic growth. Negative economic growth may eventually erode the benefits intended by PPACA as few Americans will have the ability to afford health insurance coverage.

PPACA could lead to an overstretched medical infrastructure. The government has succeeded in providing an incentive to a huge number of Americans to gain health insurance coverage through the enactment of the law. However, there are no similar efforts to ensure that the health infrastructure is equally expanded.

Recommendation

PPACA’s successful implementation requires the establishment of Accountable Care Organizations. This will see a reduction in the failure of the episode-of-care payment-building to recognize chronic ailment nature. Eligibility for sharing savings payment will be achieved by establishing the Accountable Care Organization.

The government should focus more attention aimed at reducing inefficiencies and disparities that remain in PPACA. Construction of care delivery must be done in such a way that it not only treats acute events among the new patients. There is a need for the government to spearhead efforts aimed at addressing primary and secondary avoidance or prevention. This can be done through rewarding critical care management elements. It is important for policies and regulations to be formulated, which will specifically promote healthy competition as well as transparency.

Structural and fundamental reforms should be introduced in the healthcare sector to protect the country from facing cost implications of the new Act. There is a need for the government to review the fee-for-service reimbursement structure in order to enable providers to remain interested in value and not volume as is the case (Gruber & Rundell, 2012).

Conclusion

The USA has had a long history of efforts aimed at establishing a national healthcare plan. From the era of President Theodore Roosevelt, there have been consistent efforts by lawmakers and other stakeholders to ensure that the country establishes a formidable national health insurance program. However, these efforts have been met with opposition from political groups and players in the health sector. In 2010, President Barrack Obama led a spirited campaign that culminated in the eventual formation of the Patient Protection and Affordable Care Act (PPACA). Although the proposal received and continues to face stiffer resistance particularly from the Republican representatives, it was the first time the US government succeeded in setting up an elaborate national healthcare program. Parts of PPACA’s proposals require that healthcare insurance cover for parents be extended to their dependants below the age of 26. This requirement has increased the number of young Americans under healthcare insurance cover, as opposed to the past where quite a significant number of young adults between 19 and 29 years remained without health cover. PPACA ensures a healthier society, not only at the present but it also guarantees a healthier future.

References

Andrews, P. S. (2012). Health care reform. Web.

Caralyn, D. (2010). Extended dependent coverage likely to raise premiums, Say Feds. Web.

Falk, I.S. (1977). Proposals for national health insurance in the USA: Origins and evolution and some perspectives for the future. Milbank Memorial Fund Quarterly, Health and Society, 161-191. Web.

Fronstin, P. (2012). The impact of PPACA on employment-based health coverage of adult children to age 26. Employee Benefit Research Institute, 33(1), 64-69. Web.

Gordon, C. (1997). Why no national health insurance in the US? The limits of social provision in war and peace, 1941-1948. Journal of Policy History, 9(3), 277-310. Web.

Gruber, D., & Rundell, P. (2012). Restructuring and PPACA. American Bankruptcy Institute Journal, 31(8), 44-97. Web.

Mauersberger, B. (2012). Tracking employment-based health benefits in changing times. U.S. Bureau of Labor Statistics. Web.

National Conference of State Legislatures (2010). Covering young adults through their parent’s or guardian’s health policy. Web.

Pear, R., & Herszenhorn, D. M. (2010). Obama hails vote on health care as answering “the call of history”. The New York Times. Web.

Rothman, D. J. (1993). A century of failure: Health care reform in America. Journal of Health Politics, Policy and Law, 18(2), 1993-2009. Web.

Introduction

Providing affordable and reliable healthcare is one of the key goals of many nations. In the United States of America, the signing of the Patient Protection and Affordable Care Act, which is simply referred to as the Affordable Care Act (ACA), in 2010 was a crucial step towards the realization of this goal. The main purpose of the ACA was to enhance the quality of health care services and ensure that as many people as possible can have access to these services. Other goals of the ACA included introducing checks and balances to the insurance industry and reducing health care expenditure (French, Homer, Gumus, & Hickling, 2016). Consequently, several provisions were made to facilitate the realization of these objectives. Additionally, healthcare organizations were required to change some of their operations to align with the objectives of the ACA. The introduction of the ACA led to significant changes in the day-to-day operations of the health industry. The purpose of this paper is to address organizational preparation and strategic response to at least three provisions of the ACA.

Prevention of Hospital Acquired Infections

Section 3008 “Payment adjustment for conditions acquired in hospitals” under part 1 “Linking payment to quality outcomes under the Medicare Program” of Title III “Improving the quality and efficiency of health care” seeks to reduce payments to hospitals that report a high incidence of hospital-acquired infections (HAIs) (Office of the Legislative Council, 2010). Pay for performance was announced to motivate hospitals to invest in quality projects to enhance patient outcomes. The Medicare prevention of hospital-acquired infections program under the ACA has set up hospital payment for performance based on scores that consider the incidence of HAIs. Hospitals that record the lowest performance (the bottom quartile) have their revenues from Medicare reduced by 1%. Thus, the burden of costs implicated in quality improvement is borne mainly by health care providers, even though payers and patients also suffer the consequences. The purpose of the financial penalties is to enhance the quality of health care services by urging hospitals to factor the fiscal repercussions of poor quality in their investment decisions. The rationale of this provision was that if payers reimburse providers for the extra treatment costs that accrue from poor quality services, then there would be no motivation to enhance the quality of services.

Organizational Preparation

One of the major aspects of organizational preparation with respect to this provision is a focus on evidence-based research to find and implement recommendations to prevent hospital-acquired infections. It was noted that educating staff members and patients about hand hygiene were the first crucial step because most HAIs were a result of the transfer of infectious microbes from one person to another. Therefore, there was a need to invest in more comprehensive infection prevention programs and educate healthcare workers regarding the microbiologic facets of infectious bacteria, risk factors, identification, treatment, and prevention. Peer-to-peer learning also facilitated the exchange of information among health care workers.

Strategic Response

Following the intensive review of evidence-based recommendations to reduce HAIs, specific strategies have been identified. They include infection control practices such as using protective barriers like gloves, face masks, gowns, face shields, and protective eyewear to minimize the work-related spread of microbes from the health care worker to the patient and vice versa. Protective gear such as gloves should be changed each time a medical provider attends to a different patient. These precautions are to be taken, notwithstanding the infection status of a patient. Other strategies include identifying patients who are at a high of developing nosocomial infections, proper hand hygiene, and adhering to set standards meant to reduce HAIs such as catheter-associated urinary tract infections, catheter-associated bloodstream infections, and ventilator-associated pneumonia. Additional strategies that have been used in this regard include pinpointing the likely source of infectious microorganisms in specific situations, isolating affected patients, the selective use of prophylactic antibiotics if required, and surveillance.

Technological advances should also be embraced to reduce HAIs, for example, applying movable machines that use ultraviolet light to kill pathogenic bacteria and viruses. These machines supplement regular cleaning to guarantee sterility. It has been reported that the use of these machines has lowered the incidence of Clostridium difficult and Staphylococcus aureus significantly (Anderson et al., 2018). Furthermore, biosensors that combine bacteriophages and certain antibiotics have made it possible to identify antibiotic resistance in bacteria, thus enabling clinicians to use the most appropriate antibiotics for various conditions. Computer simulations that make use of real-time data from electronic emergency departments have been used to identify potentially communicable illnesses and predict their occurrence.

Hospital Readmissions Reduction Program

Section 3025 “Hospital readmissions reduction program” under part 3 “encouraging the development of new patient care models” of Title III “improving the quality and efficiency of health care” requires the Centers for Medicare and Medicaid (CMS) to cut down payments to inpatient prospective payment system (IPPS) hospitals with high rates of readmissions (Office of the Legislative Council, 2010). This move was informed by 2011 statistics indicating that 3.3 million patients had been readmitted to hospitals, thereby leading to the expenditure of $41.3 billion (Office of the Legislative Council, 2010). The Medicare Hospital Readmissions Reduction Program (HRRP) punishes acute-care hospitals that record-high rates of 30-day readmissions with respect to six major conditions: heart failure, heart attack, pneumonia, coronary artery bypass graft, chronic obstructive pulmonary disease (COPD), as well as elective hip and knee replacement. Affected hospitals were to receive a 1% deduction of their total Medicare reimbursements from 2012, which would increase to 2% in 2013 and 3% in 2014.

Organizational Preparation

The first step in addressing this provision is identifying patient populations at high risk of hospital readmission to facilitate targeted interventions. Uninsured patients and covered by Medicaid were more likely to be readmitted to the hospital due to preventable diseases compared to those with private insurance, particularly among maternal patients (Soley-Bori et al., 2015). In contrast, uninsured patients were less likely to be readmitted to hospitals than Medicaid patients. Patients with limited English proficiency are more likely to be readmitted than those who understand English (Seman et al., 2017). Therefore, healthcare organizations were compelled to invest in recruiting and training interpreters to circumvent such language barriers. Furthermore, sign language interpreters were also recruited to facilitate communication between health care providers and patients with hearing impairments.

Part of the organizational preparation to reduce hospital readmissions included implementing evidence-based strategies of maintaining patient wellbeing following discharge. It has been shown that adequate staffing of nurses can minimize preventable readmissions and emergency department visits. This observation was attributed to improved quality of discharge teaching as well as adequate preparation of patients for discharge. Adequate staffing allows nurses ample time to prepare patients for life outside the hospital.

Strategic Response

Reducing hospital readmissions involves many calculated moves, such as participation in incentive programs with health insurance firms that strive to minimize the problem. An example is a hospital-physician inducement program through a pay-for-performance model that urges several health care institutions to work together to cut down HAIs and readmissions. The key strategy used here is adhering to evidence-based recommendations for the treatment of surgical sites, pneumonia, heart attack, and heart failure.

A second strategy is making sure that patients book a follow-up after seven days of hospital discharge. This approach is supported by evidence showing that patients who received follow-up advice from their physicians within the first seven days of discharge had lower chances of being readmitted to the hospital (Jackson, Shahsahebi, Wedlake, & DuBard, 2015). Providing post-discharge care is an effective approach to cutting down readmissions. Healthcare organizations can enlist the help of home health aides or medical social services. A pilot study involving the use of home health care for patients with chronic illnesses resulted in better outcomes regarding hospital readmission rates than long-standing acute care hospital services.

Additional strategies being employed include providing transitional care to patients to ensure a seamless changeover from hospital to home care. Nurses play a vital role in this process, as shown by the findings of a systematic review highlighting the importance of nursing care in hospital transition (Jones et al., 2016). Consequently, many hospitals are entrusting nurses with leadership responsibilities, for example, clinical management or checking up on discharged patients at their homes. The value of patient education and effective communication cannot be undermined in preventing readmissions. Clear communication of post-discharge instructions ensures that patients adhere to instructions to maintain their health status while at home, thus eliminating the need to return to the hospital for specialized care. The teach-back method, where patients are asked to reiterate the instructions given to them to confirm their comprehension, is commonly used. Technology has also been used to keep an eye on chronically ill patients. For instance, telemonitoring devices have been helpful in keeping track of the progress of congestive heart failure patients following discharge.

Increasing Access to Clinical Preventive Services

This provision is found in Subtitle B under Title IV of the ACA. It stipulates that all new plans need to cover various preventive health services for various health complications without levying co-pay, deductibles, or coinsurance (Office of the Legislative Council, 2010). The role of preventive services is to enable the prompt detection of health problems that can be managed easily through timely treatment and empower the masses to make sound decisions regarding their health. Examples of health services covered are immunizations, screening tests, and counseling. Specific screenings encompass gestational diabetes, HIV, domestic violence, human papillomavirus, contraceptive counseling, breastfeeding support, and contraceptive counseling for women (Fox & Shaw, 2015).

Organizational Preparation

The ACA selected a number of organizations as sources of reliable guidelines that identify specific clinical preventive services and age groups of people who should receive them without deductibles or copays. Such organizations include the United States Preventive Services Task Force (USPSTF) and the Advisory Committee on Immunization Practices (ACIP). These entities consist of health experts who generate evidence-based guidelines for clinical services to preclude and control diseases. The Health Resources and Services Administration (HRSA), on the other hand, supports the recommendations suggested by the American Academy of Pediatrics Bright Futures program for children. Endorsed services for women are founded on the Institute of Medicine’s (2011) report titled Clinical Preventive Services for Women. ACA acknowledges services endorsed by these organizations. The statute also compels the adoption of new clinical recommendations from these organizations by non-grandfathered private plans at least a year following the issuance of the recommendation (Fox & Shaw, 2015).

Strategic Response

One challenge that remains despite the ACA’s recommendations is the adoption and use of preventive health services. Therefore, various organizations have conducted detailed studies to identify gaps and enhance the adoption of preventive services. For example, the Centers for Disease Control and Prevention (CDCD), in partnership with CMS and Agency for Healthcare Research and Quality (AHRQ), published an article “Enhancing the use of clinical preventive services among older adults: closing the gap” (CDC, 2011). The report accentuates critical inadequacies by revealing the number of adults above the age of 65 who do not receive the endorsed services. These findings emphasize the need to join clinical and community approaches that concentrate on underserved populations. Even though preventive services are conventionally offered in clinical settings, it is possible to deliver them within schools, worksites, homes, or residential treatment centers within the community. Therefore, community-based preclusion, policies, and programs are currently used to back clinical preventive services.

Conclusion

The ACA symbolizes the most important statutory change made in the US health care system for a long time. Many of the reforms proposed in the act have already led to significant changes in the organization and delivery of health care services. However, these changes have been made possible through organizational preparation and strategic responses. These observations show that any substantial change in the health care system requires deliberate planning and strategic execution.

References

Anderson, D. J., Moehring, R. W., Weber, D. J., Lewis, S. S., Chen, L. F., Schwab, J. C.,… Lokhnygina, Y. (2018). Effectiveness of targeted enhanced terminal room disinfection on hospital-wide acquisition and infection with multidrug-resistant organisms and Clostridium difficile: A secondary analysis of a multicentre cluster randomised controlled trial with crossover design (BETR Disinfection). The Lancet Infectious Diseases, 18(8), 845-853.

CDC. (2011). Enhancing use of clinical preventive services among older adults: Closing the gap. Web.

Fox, J. B., & Shaw, F. E. (2015). Clinical preventive services coverage and the Affordable Care Act. American Journal of Public Health, 105(1), e7-e10.

French, M. T., Homer, J., Gumus, G., & Hickling, L. (2016). Key provisions of the Patient Protection and Affordable Care Act (ACA): A systematic review and presentation of early research findings. Health Services Research, 51(5), 1735-1771.

Institute of Medicine. (2011). Clinical preventive services for women: Closing the gaps. The National Academies Press: Washington, DC.

Jackson, C., Shahsahebi, M., Wedlake, T., & DuBard, C. A. (2015). Timeliness of outpatient follow-up: An evidence-based approach for planning after hospital discharge. The Annals of Family Medicine, 13(2), 115-122.

Jones, C. E., Hollis, R. H., Wahl, T. S., Oriel, B. S., Itani, K. M., Morris, M. S., & Hawn, M. T. (2016). Transitional care interventions and hospital readmissions in surgical populations: A systematic review. The American Journal of Surgery, 212(2), 327-335.

Office of the Legislative Counsel. (2010). Compilation of Patient Protection and Affordable Care Act. Web.

Seman, M., Barrington-Brown, C., Simons, K., Cox, N., Wong, C., & Neil, C. (2017). The impact of limited English proficiency on hospital readmission rate in culturally and linguistically diverse patients hospitalised with acute heart failure. Heart, Lung and Circulation, 26, S150-S151.

Soley-Bori, M., Soria-Saucedo, R., Ryan, C. M., Schneider, J. C., Haynes, A. B., Gerrard, P.,… Kazis, L. E. (2015). Functional status and hospital readmissions using the medical expenditure panel survey. Journal of General Internal Medicine, 30(7), 965-972.

The Affordable Care Act is a bill that was supported by President Barack Obama as part of his health care agenda. His belief in universal healthcare for all led the president to see the shortcomings of the current healthcare laws and the need for further coverage expansion and a reassessment of the way insurance companies operate in terms of shouldering their clients healthcare needs and medical bills.

It was actually the fact that insurance companies were abusing the rights of their clients as patients that partially propelled the need for the Affordable Care Act. It was no secret that the insurance companies were acting like scam corporations before the Affordable Care Act, barely covering medical procedures, or outright rejecting the coverage of a patient just because he got sick. Some of them, even put a cap on insurance coverage per year of lifetime of the patients. All acts which were seen as insurance company abuse.

Another of the main reasons why there seemed to be a major need for the Affordable Care Act was because of the growing disparity in the healthcare coverage of the working people regardless of their race, ethnicity, or religion.

Healthcare studies at the time indicated that low income Americans, along with racial and ethnic minorities, barely had access to medical care, treatment options, and sometimes, did not even qualify for insurance coverage. The Affordable Care Act hoped to bridge that gap and offer coverage to those who would not usually qualify for regular insurance coverage for one reason or another.

Basically, the old era of healthcare should be viewed as the most incompetent and unsystematic method of national government healthcare delivery. It seemed to be slanted towards servicing the interests of the insurance companies alone while leaving its clients holding the empty bag of promises consisting of undelivered healthcare needs.

Although the Affordable Care Act sounds highly promising on paper, there have been quite a number of concerns raised regarding it by health practitioners, insurance companies, and politicians alike.

Senators and other politicians are afraid of the the government will have to increase spending in order to cover the insurance needs of more Americans while in turn, cutting the funding for Medicare to half of what its already measly budget is today. There are also increasing concerns that due to the larger insurance coverage for illnesses, it would translate into higher insurance premiums for members.

There were two key ideas that went into effect in 2010 for the Affordable Care Act. Both of which affected the insurance industry the most. The first of which is the removal of the ability of the insurance company to place a lifetime cap on essential benefits such as hospital confinement.

I would define this as an important key idea under this policy because not all illnesses can be considered as short term treatment cases. There are some which require extensive, expensive, and long term treatments which the patient normally does not manage to complete because their insurance coverage runs out before the treatment has a chance to actually have any effect on the patient.

Insurance companies also have this policy of not covering preexisting health conditions for most of its clients. Under the Affordable Care Act, insurers may also no longer prohibit preexisting medical conditions from being covered for its clients and their dependents under the age of 19.

An important factor to consider when you look at children who are born with congenital defects that can easily be treated if only insurance companies would open their pocketbooks and pay for the treatment or procedures. Instead of playing God like they seem to enjoy doing.

It is my personal opinion that mandating health care coverage via the insurance companies is not a good idea for the national public. Insurance coverage can only be effectively used by those who are gainfully employed and have the ability to cover the insurance premiums because of the cost sharing between the employer and the employee. Under that set-up, having insurance coverage is probably a good idea.

On the contrary, having the personal freedom to choose how to handle your own healthcare would allow the patient the freedom to get the best possible medical care he can afford with the knowledge that his treatment will not be cut midstream because his insurance suddenly ran out or the insurance company refused to cover it.

Basically, I view mandated healthcare coverage as a way of monopolizing the healthcare industry. By telling people that they need health insurance or they cannot get medical care, the insurance companies and their network doctors dictate how people can avail of medical services, by how much, and for how long.

Granted that the lifetime cap on medical coverage was removed by the Affordable Care Act, I find it hard to believe that the insurance companies and their legal think tanks will not find a way to get around that ruling. Health insurance companies are in this business for the money, not for the care of their clients.

In the end, the Affordable Care Act will allow people to opt out of insurance coverage if they wish, that is a good thing, because people will finally have the freedom to find the kind of health professional and services that feel right for them, and come ot a true understanding of what their healthcare will actually cost. All without having to settle because that is all their insurance could afford to cover.

Introduction

In an effort to reduce the number of US citizens that are not insured, the Affordable Care Act (ACA) provided for a mandatory Medicaid expansion program. The aim was to expand eligibility of low-income citizens to medical insurance. Under the ACA, the Medicaid expansion was geared at ensuring that adults earning below $16,242 per year in 2015 were eligible for Medicaid in all states (Rudowitz, Artiga & Musumeci, 2015). However, the Supreme Court ruling on the constitutionality of the Act prevented the mandatory expansion. Despite the ruling, 24 of the 29 states are in the process of the implementing the expansion as provided forth by the law. Five states have sought approval through waivers provided in Section 1115 (Rudowitz et al., 2015).

Other states such as New Hampshire requested CMS for approval to use an alternative model for premiums.

In accordance with Section 1115, five states are approved for the expansion of the Medicaid. The approved states include Iowa, Pennsylvania, Arkansas, Michigan and Indiana. The ACA allows the states to expand the Medicaid without adhering to federal rules. However, the states remain eligible for receiving funds for qualified adults.

Under the ACA, the federal government pays 100% for costs of the new eligible adults covering years 2014 to 2016. The federal government payment is to reduce to 90% in 2020 and the subsequent years (Rudowitz et al., 2015). The waivers approved for the states differ. For instance, state of Indiana received unique waiver approval. The approval prohibited the state from retroactive eligibility and allowed charging of high-cost sharing of non-emergency services. In other states, the waiver proposals are in developmental stages or pending approvals. Examples of states exploring alternatives are Tennessee and Utah.

Evaluation of Perspectives

In order to allow medical coverage for many people, the Medicaid expansion stakeholders have to establish a balance between the waiver applications of states. The Supreme Court ruling provided that states were at liberty to participate in the program or explore alternatives that were politically viable (Rudowitz et al., 2015). Section 1115 waivers provided a viewpoint in which states opted to test the approaches for the Medicaid program. The implication of the ruling was that states were at liberty to explore other options for expanding Medicaid. However, the decision did not abolish all the provisions provided in the ACA. Section 1115 waiver provides for alternatives that some states have explored by applying for approvals to implement the program in a political viable manner acceptable to the states.

The idea of the pilot projects raises concern about the sustainability of the funding process and feasibility of the projects. For instance, before the ACA, adults without children were ineligible for coverage based on disability or age status (Rudowitz et al., 2015). The federal law did not provide funds to match the funds for the ineligible adults irrespective of the low incomes. The limited coverage options for such adults were remedied by states applying Section 1115 waivers. Comparing the earlier situation before the ACA and now, the question of political viability of the Medicaid is not certain. It points to a perspective where political willpower is based on the federal funds but not the needs of the citizens. For instance, under the ACA, states apply for approval under Section 1115 and implement the Medicaid expansion without strictly following the federal rules.

The approvals make the states eligible to receive federal government funding (Rudowitz et al., 2015). The dispensation of expansion based on federal funding under the waiver approvals entices the states to the program and hence extensive coverage. However, it is worth noting that different states have applied for different approvals. For example, the state of Indiana received an approval not to provide ‘retroactive eligibility’. The future of the program could be short term and likely to be withdrawn in case the federal government funds matching the eligible adults reduce significantly.

The implementation of Medicaid expansion is based on the political viability of the states. The differing applications processes in the states compromise the comprehensive coverage for low-income citizens. In addition, the approval process does not include the inputs from the public. The lack of public participation negates the transparency and public engagement in the waiver approval process. Even though CMS has ensured that that there are common themes that guide the approval process, the transparency issues raise concerns on whether the expansion is centered on individual wellbeing or a purely political process. For instance, CMS waiver approval allows the states to charge premiums for adults with income range of 100 to 138% FPL. The waiver is unlike the federal law provisions that do not permit charging of premiums for adults with incomes below 150% FPL ($17,655 per year for individual in 2015). However, CMS has denied approvals for premiums for people with 100% FPL in the states where eligibility is based on payment (Rudowitz et al., 2015).

The primary goal of Section 1115 waivers is to increase Medicaid coverage. Many states are poised to use exemptions for the Medicaid expansion. States have different issues on the Medicaid expansion. The differences make the design of the waivers becomes very complicated. Thus, there is the need for extensive research and demonstrations of the effectiveness of the waivers. Evaluations of the states that have already implemented the waivers will be critical in the identification of the way forward for effective Medicaid coverage.

Reference

Rudowitz, R., Artiga, S. & Musumeci, M. (2015). The ACA and Medicaid expansion waivers. New York: Kaiser Commission on Medicaid and the Uninsured, Kaiser Family Foundation.

Introduction

When the Affordable Care Act (ACA) was introduced, one of its key goals was to cause increased competition among companies providing health insurances. By 2017, the government has not managed to achieve this purpose. Furthermore, the Health Insurance Exchanges currently provide less choice and competition than ever before. The failure of the reform makes critics claim that the state-based marketplaces where citizens can purchase personalized health insurance are on the verge of collapsing (Kaestner et al. 620). The paper at hand aims to investigate its current status to identify whether this statement is true.

Current Status of the Health Insurance Exchanges Operation in the US

Contrary to all the previous expectations, insuring companies’ participation in the exchanges initiated by the government is now at the lowest level during the past several years. As a result, customers are deprived not only of their insurance choice but also of even of their insurance opportunity (Antonisse et al. 25). Although some companies are still considering the option to enter the program, the majority of them have already decided to limit their participation to 2-5 states only, which puts people living in other states in a disadvantaged position.

The ACA was initially meant to expand on Medicaid, the program for the poor; yet, in 2012, this expansion was made optional by the Supreme Court. As a result, 19 refused of it, making people who earned less than $12,000 per year non-eligible for subsidies to purchase an individual insurance on the exchanges (Antonisse et al. 42). Since people with a low level of income tend to suffer from a bigger number of diseases, it becomes a challenge to provide all of them with insurances in other regions (Center et al. 119). This makes insurers’ operation in non-expansion states more expensive, which forces insurers to quit the program.

The situation is aggravated by the fact that more than 3 million people lost their employment insurances since their companies found it more cost-effective to pay the required penalty for allowing their workers to choose any plan that seems the most suitable for them on the exchanges. 30 million people who relied exclusively on their private health insurances were deprived of their plans since the companies that provided them failed to cover 10 crucial benefits outlined for the exchange (Center et al. 122). Replacing these plans was excessively expensive.

By the present moment, the total health care costs have increased dramatically due to the fact that a lot of people received medical examination for the first time in their lives and now their diseases, which were neglected for decades, have to be treated. Those who did not buy insurance have to pay a special tax, which has already increased the percent on income far above the threshold. Businesses are therefore discouraged to hire new people since they will have to pay more. Moreover, families can now deduct medical expenses that make more than 10% of their income (as compared to 7.5% before the launch of the program) (Center et al. 125).

The future prognosis is also far from being positive. Pharmaceutical companies are going to pay extra $85 billion in fees in the period up to 2023, which will inevitably lead to increasing drug costs (Kaestner et al. 626).

Conclusion

After 7 years of their enactment, the Health Insurance Exchanges still bring about more problems than benefits. Prioritizing particular groups of the population of the others, the ACA makes a lot of citizens feel disadvantaged by the reform. No practical steps have been performed on behalf of the government to overcome the crises. That allows agreeing with Donald Trump who considers the present-day state of healthcare in the United States a horror show (Flores-Ferrán 75).

Works Cited

Antonisse, Larisa, et al. The Effects of Medicaid Expansion under the ACA: Findings from a Literature Review. Henry J. Kaiser Family Foundation, 2016.

Center, Helm, et al. “A Critical Analysis of Obamacare: Affordable Care or Insurance for Many and Coverage for Few?” Pain Physician, vol. 20, no. 3, 2017, pp. 111-138.

Flores-Ferrán, Nydia. “I’m very Good at and maybe that’s Why I’m Center Stage…”: Pronominal Deixis and Trump.” English Linguistics Research, vol. 6, no. 1, 2017, pp. 74-91.

Kaestner, Robert, et al. “Effects of ACA Medicaid Expansions on Health Insurance Coverage and Labor Supply.” Journal of Policy Analysis and Management, vol. 36, no. 3, 2017, pp. 608-642.