The Patient Protection and Affordable Care Act Components

Introduction

The Patient Protection and Affordable Care Act (ACA) is healthcare legislation enacted in 2014 in the USA as the main healthcare regulating law. Its goal was to update and reform the healthcare system of the country to meet the needs of vulnerable populations and provide equitable access to quality care to a broader population of American citizens. The law contains three main components, namely, insurance, Medicaid, and care service delivery by lower costs. This paper explores the impact of these components of the law on medicine and nursing practice.

Discussion

The first component of ACA makes healthcare insurance more affordable. The law provides subsidies to individuals whose income is “between 100% and 400% of the federal poverty level” (“About the Affordable Care Act,” 2022, para. 3). This provision increases the number of people eligible to obtain coverage for their healthcare services. The impact of this provision on the nursing practice is manifested through the enhanced workload of professionals and their need to improve cultural sensitivity to meet the needs of vulnerable populations. The second provision holds that the Medicaid program should expand “to cover all adults with income below 138% of the federal poverty level” (“About ACA,” 2022, para. 4). It positively affects impoverished populations by providing them with financial security for healthcare. It impacts the nursing practice by worsening the workforce shortage problem and encouraging higher efficiency of performance. The third component necessitates “support innovative medical care delivery methods designed to lower the costs of health care generally” (“About ACA,” 2022, para. 5). It affects patients through innovative approaches to treatment, benefits organizations due to reduced costs, and positively impacts the nursing practice by facilitating research and development.

Conclusion

In summation, ACA is aimed at increasing insurance coverage, expanding Medicaid, and lowering healthcare costs via innovation. The provisions positively affect the target populations of vulnerable underinsured patients by providing them with better access to and quality of healthcare. At the same time, it promotes innovation and development in the nursing practice while challenging the existing system with workforce shortage and ultimate workload increase issues.

Reference

(2022). Web.

Analysis of the Affordable Care Act

In modern times, many different acts are adopted which are aimed at improving the quality and accessibility of medical services. One of these initiatives was the Affordable Care Act (ACA), which has been causing debate about its effectiveness since its inception to this day. This is especially true of the online process for acquiring health care information, accessibility, affordability, and reducing the number of uninsured. Thus, this work agrees with the opinion presented in the article “How well is the Affordable Care Act working?” that the Affordable Care Act performs its functions to a greater extent, but it takes more time to fully understand it.

The article by Levitt was taken as the basis for this work, which investigated the effectiveness of the Affordable Care Act. Therefore, the author noted that regarding the online process for gathering information, not all states had adopted this innovation, which limits the full implementation of the act. Moreover, the initiative under study increased patients’ access to medical services (Lissenden, B., & Yao, 2017: Warner et al., 2020). However, many individuals suffer from too expensive medications for some serious diseases. At the same time, the article emphasizes that it “suggests that insurance is now more affordable on average than it was before the ACA’s implementation” (Levitt, 2014, p. 7). The main positive argument for the effectiveness of the ACA is the fact of reducing the number of uninsured individuals.

Thus, this work investigated the effectiveness of the Affordable Care Act based on the article written by Larry Levitt entitled “How well is the Affordable Care Act working?”. Thus, it came to the conclusion that the author’s opinion is confirmed that despite some positive aspects, the initiative is still experiencing difficulties in implementation. This is especially true of the availability and affordability of medical services for individuals.

Reference

Levitt, L. (2014). . JAMA Network.

Lissenden, B., & Yao, N. A. (2017). . Health Affairs, 36(1), 101-107.

Warner, J. J., Benjamin, I. J., Churchwell, K., Firestone, G., Gardner, T. J., Johnson, J. C., Ng-Osorio, J., Rodriguez, C.J., Todman, L., Yaffe, K., Yancy, C.W., Harrington, R.A., & American Heart Association Advocacy Coordinating Committee. (2020). Circulation, 141(10), 601-614.

Affordable Care Act and Minimum Essential Coverage

The Affordable Care Act (ACA) includes a provision that mandates all individuals to be covered by a health insurance plan, which has been a cause of significant controversy. Specifically, Sec. 5000A outlines a minimum essential coverage and tax penalties for failing to meet said coverage. This provision serves a dual purpose of ensuring Americans have access to health care, while at the same time attracting funds for the increased need for health care and insurance (Fiedler, 2020). Moreover, by mandating universal coverage, this provision ensures that the increased financial burden is equally distributed among the population.

Proponents of Sec. 500A point to the benefits of increased and, ultimately, universal insurance coverage: increased quality and access to care and spreading the financial burden. Furthermore, the entire ACA’s purpose of providing more equal access to health care is viewed as moral and just (Robertson-Preidler, et al., 2020). However, opponents of Sec. 5000A still contest its benefits, and even its constitutionality (Pratt, 2021). Particularly after the act was changed to remove the tax penalty for remaining uninsured, the provision was argued to be unconstitutional, unenforceable, and ultimately meaningless (Pratt, 2021). As one of the most broadly applicable and controversial provisions of the ACA, Sec. 5000A has a profound effect on health care organizations.

For California’s Office of the Patient Advocate (OPA), ACA presents a significant challenge. The office’s goal is to provide patients with information on available health plans, as well as inform them of their rights and manage their health care-related complaints. ACA has brought significant changes to the country’s health care system, including standards of care and insurance policies. Moreover, as a hotly debated issue, it can have various types of misleading information around it. Finally, Sec. 5000A, in particular, attracted previously uninsured patients, especially from groups who would not have previously sought it and, thus, were not informed about insurance. Therefore, informing and educating patients on these changes and providing accurate assessments and recommendations became a more challenging task. This is further complicated by the changes the act has taken since its introduction. While making OPA’s work more challenging, however, APA seeks to improve health care coverage and quality, thus aligning with the organization’s values.

Sec. 5000A’s ultimate effect on California’s OPA can be described as positive. As a government organization that focuses on gathering and distributing information, it benefits from having more patients interacting with the health care system. This allows it to collect more accurate feedback, particularly from patients belonging to underserved groups. In turn, this feedback can be used to better understand patient needs and preferences, and provide higher quality information and education. Furthermore, the feedback gathered by the OPA can be used to inform and guide further policy changes and research. Because of this, the organization can fulfill its purpose with a higher degree of accuracy and reliability.

However, this increase in the number of interactions also corresponds to a greater workload. Creating additional patient information and education materials constitutes more work. In turn, it raises questions about funding, which, for a government organization, maybe a significant issue. Thus, the positive effect of Sec. 5000A on OPA’s work is contingent on it receiving additional funds necessary to process the increased flow of information through it. If the office is underfunded, it may find itself incapable of processing the feedback and complaints it receives, and suffer negative outcomes in terms of collecting accurate information in time for it to remain relevant.

References

Fiedler, M. (2020). The ACA’s individual mandate in retrospect: What did it do, and where do we go from here? Health affairs (Project Hope), 39(3), 429-435.

Pratt, D. (2021). Focus on: The Supreme Court hears oral argument (again) on the constitutionality of the Affordable Care Act. Journal of Pension Benefits: Issues in Administration, 28(3), 9-15.

Robertson-Preidler, J., Trachsel, M., Johnson, T., & Biller-Andorno, N. (2020). The Affordable Care Act and recent reforms: Policy implications for equitable mental health care delivery. Health Care Analysis, 28(3), 228-248. Web.

Aspects of the Affordable Care Act

The Affordable Care Act aims to enhance our medical system in different ways. Some of them are reinforcing Medicare, lowering healthcare costs, and extending privacy rights. The government accomplishes these objectives in part by enforcing severer regulations. Thus, compliance methods are essential for all health care professionals, given the increased awareness of discipline, punishment, and recovery. Consequently, at least one of the main intentions in health care reform should be reducing waste, fraud, and abuse in this act.

Arguably, everybody in the United States is significantly influenced by healthcare fraud, waste, and abuse. Therefore, people and health care professionals should understand how to detect and help to prevent it. The ACA” produced the most significant gains in insurance coverage in nearly fifty years” (Sommers et al., 2017, p. 1120). Unfortunately, fraud occurs when someone deliberately lies to a health insurance provider to obtain money. When someone recklessly uses health care services, it is a waste. Furthermore, abuse issues while standard medicine practices are not followed, resulting in expenses and treatments. It does influence patients; thus, they should be able to spot it, while the authorities should prevent it.

Each health care organization should initiate the corresponding measures to comply with the ACA. The authorities have to make a distinct pattern such as informing all patients about possible schemes and promote it as well, because” the impact of healthcare fraud is significant and wide-reaching” (Stowell et al., 2018, p. 1041). As an example, humans should detect when doctors execute a procedure that is not included in their health plan or be aware of professionals who corrupt the system by giving multiple prescriptions for identical medicine. Additionally, patients are sometimes provided brand-named pills when a lower-cost nonexclusive alternative operates the same. Those shenanigans should be counteracted because the ACA has enormous influence in the US” addressing public health, including creating a public health council and a $15 billion public health fund” (Campbell & Shore-Sheppard, 2020, p. 9). The government and healthcare organizations should at least teach people how to avoid such situations.

To counteract these shenanigans, the government and healthcare organizations should partially teach people how to avoid such circumstances. Undoubtedly, it affects you when health care providers or anybody else participates in healthcare fraud, waste, or abuse. Consequently, for individuals, it may lead to substantial monetary losses, compromise their safety, and increase their health risk just because some untrustworthy professionals try to take unnecessary benefits.

References

Campbell, A. L., & Shore-Sheppard, L. (2020). . The Russell sage foundation journal of the social sciences, 6(2), 1-40.

Sommers, B. D., Maylone, B., Blendon, R. J., Orav, E. J., & Epstein, A. M. (2017). Health affairs, 36(6), 1119-1128.

Stowell, N. F., Schmidt, M., & Wadlinger, N. (2018). . Journal of financial crime, 25(4), 1039-1061.

Microeconomic Implications of the Affordable Care Act

Introduction

The Patient Protection and Affordable Care Act is a bill passed into law by the U.S. president Barrack Obama in the year 2010 (Goodson 12). This act is normally referred to as Obamacare. The act is one of the most important government developments and regulatory revamps in the United States’ healthcare system in the last 50 years.

The act mandates all insurance companies to provide medical insurance cover to all claimants regardless of their social background, sex, race, or ethnicity. The chief aim of the act’s drafters was to reduce the number of uninsured Americans. Before and after the passage of this law, critics asserted that the law was a threat to everyday workers.

Despite the fact that the law was meant to reduce the cost of medical access for the low-income population, critics argue that the law would ultimately leave employees worse off. Skeptics argue that the law would cost jobs, suppress economic recovery programs, and cause business doubts. This paper seeks to highlight the microeconomic effect of the act. In the paper, the effects of the act on an everyday worker would be highlighted and evaluated.

Positive implications of the act

Currently, the top three issues of the U.S. health care system affecting the employees are reduced access, reduced quality, and increased costs. When the act will be fully implemented in the year 2014, the government expects the act to tackle the above health issues. The U.S. health care system has continuously faced multiple challenges.

By the time the government stopped its heavy-handed managed care in the 1990s, the cost of health care services had risen sharply as the number of uninsured individuals increased. Before The Patient Protection and Affordable Care Act was passed into law in the year 2010, the number of uninsured individuals was estimated to be more than 46 million (Goodson 35). Equally, during this period new medical technology, pharmaceuticals, and workforce were in great demand.

As the country’s life expectancy continues to increase, its population will continue to age leading to more chronic health issues. In the year 2006, the U.S. healthcare system was reported to be among the most costly system in the world. According to these reports, the U.S. government spent over $2 trillion in health care expenditure during the same year (Pipes 56). These figures are disturbing since the above expenditure represents 16% of the country’s gross domestic product.

In the act, several mechanisms have been outlined on how to tackle the above issues. These mechanisms are mandates, tax credits, and subsidies. Within a period of 10 years, this act will ensure that every American has access to quality and affordable health care services. Through this approach, almost every employee would be covered by the health insurance scheme. Therefore, quality healthcare services will be accessible to all employees.

Economic consequences

According to the Congressional Budget Office, the act will lead to significant job losses. It is estimated that the act might lead to 650,000 job losses. An analysis by business owners group indicates that the employer mandate enshrined in the act will ultimately lead to eradication of up to 1.6 million jobs for the next five years. On the contrary, Centre for American Progress insists that with the passage of this act 250,000 to 400,000 jobs would be created within a period of ten years.

Critics have refuted these figures arguing that the CAP’s analysis relied on unsubstantiated cost estimates. At the time these conflicting approximations were released to the public, economists send President Obama a note indicating the economic consequences of the proposed bill. In the letter, the economists indicated that the bill contained some provision that would threaten job creations, reduce working hours, reduce wages, and reduce jobs.

According to the economists, the job-killing stipulations contained in the bill were New Tax, New and Increased Medicare Taxes, and the Employer Mandate. Through the New Tax provision, the act seeks to collect over $500 billion in the next decade. Notably, a larger share of these taxes would be collected from small business owners.

This implies that these individuals affected would see their capital being reduced resulting in stunted economic growth. Through this, everyday workers, who have been employed by these individuals, might lose their jobs. Equally, New and Increased Medicare Tax provision will affect the small business sector. Given the fact that millions of Americans are employed in this sector, their future employment is at stake.

As time passes, the provision would reduce the wages earned by these employees. In general, the above stipulation would threaten jobs and reduce economic growth. Another stipulation contained in the act that would affect employees is the Employer Mandate. This stipulation seeks to enforce a tax of up to $2000 per employee in an organization hiring more than 50 workers.

The tax would be applicable to all organizations that do not provide health insurance to their employees. Similarly, through this stipulation the government aims to tax all employers offering unaffordable health insurance schemes to their employees. It is apparent that the employers affected by this stipulation would reduce employment opportunities or passed on the insurance burden to their employees in terms of lower wages and reduced work hours.

Impact on low-wage employees

Substantial evidence indicates that with the passage of this law, low-wage workers were likely going to be affected than other workers would. As the act discourages employers from recruiting new workers, they will be forced to come up with other means of reducing the cost of doing business. Economists have pointed out that for higher skilled workers employers would obey the government directive and offer the required benefits. However, these employers would compensate the cost by reducing these employees’ wages.

On the other hand, economists have pointed out that employers would be offered with little reason to offer medical insurance cover to their low skilled workers. Therefore, employees would reduce job creation and employment for this category of job workers. Given the fact that the number of unemployed adults without a high school diploma is on the rise, this act would greatly affect the lower wage employees.

Some economists argue that in some situations, some employers would find that it hard to reduce the wages offered to their employees. To survive in such situations, these employers would respond through other ways. These ways would include outsourcing, reliance on temporary agencies, and increasing part time employees. Through these approaches, employers would bypass the act stipulations because the mandates do not apply to these approaches.

Loss of existing insurance coverage

Some economic experts assert that affordable care is too costly. In this regard, several employers would shun away from offering their workers with health coverage. In this event, employees would be forced to seek government-run insurance schemes. When the act will be finally implemented, it is estimated that millions of American employees would be unable to maintain their current coverage.

For instance, early this year a firm by the name Universal Orlando declared that it was planning to stop offering health coverage for its part time employees (Schmidt 10). The firm asserted that Obamacare’s prohibition of yearly benefits to be enforced in the year 2014 was going to increase their operational costs. According to the firm’s human resource manager, the plan was going to affect more than 500 employees in their organization.

Another organization that will drop coverage for some of its employees is Deloitte. According to the company’s reports, more than 10% of the company’s employees would be affected by the plan. The individuals who will lose their coverage would be forced to seek new government-run exchanges. With these illustrations, it is apparent that millions of American employees together with their dependants would lose their current insurance covers.

Increase premiums in the individual market

Currently, the effects of the affordable health act on premiums have generated heated debates in America (Ross & Betsy 12). Others argue that when the act would be fully implemented in the year 2014 premiums would sky rocket. On the other hand, some individuals argue that with full implementation premiums would reduce significantly.

Notably, the Obama administration is divided on the issue. Other individuals believe the cost would rise while others do not. Some experts have warned that premiums would vary depending on individuals’ age or sex. As such, women may realize lower cost in their premiums unlike men. Equally, older customers might experience a drop in the price of their premiums unlike the younger generation. According to Miliman Consulting Firm, premiums would increase next year by 9%.

The firm argues that the increases would be in order with the current premium hikes. The firm asserts that the increases could have been witnessed regardless of the act in place. With these discrepancies, Americans have to wait for next year when the affordable health plan would be fully in operation to realize the impacts of the act. This implies that it is now difficult to estimate the full impact the program will have on American employees and employers.

Conclusion

Although some consequences of affordable health care are debatable, it is apparent that the plan would result in reduction of employment for less skilled laborers. Therefore, Obama’s administration should put in place measures that would ensure that the less-skilled laborers do not lose their jobs. While these measures are in place, the administration should answer several questions concerning the myths that have been generated by the media and the employers on the effects of this plan.

Some employees have the wrong impression of the effects of this plan. Thus, the government should sensitize the public on the possible effects of this act. During the sensitization programs, the government should not be biased. Through this, the employees would learn about the implications of this act on their careers. Similarly, the government should be ready to amend the act if it reduces jobs or slows down the country’s economy as critics allege.

Works Cited

Goodson, Jefferson. The patient protection and affordable care act. New York: Viking, 2010 . Print.

Pipes, Sally. The truth about Obamacare. Washington, DC: Regnery Pub. ;, 2010. Print.

Ross, Betsy. Beating Obamacare: your handbook for surviving the new health care law Washington, D.C.: Regnery Pub., 2013. Print.

Schmidt, Paul L.. Medicare and the Patient Protection and Affordable Care Act. Hauppauge, N.Y.: Nova Science Publisher’s, 2013. Print.

Affordable Care Act for Quality Patient Treatment

The Affordable Care Act (ACA), or so-called Obamacare, is a federal act which was signed into law in 2010. Initially, it is aimed at providing Americans with “better health security by putting in place comprehensive health insurance reforms” (Medicaid.gov, n. d., par. 1). The latter ones are supposed to expand coverage, lower insurance, and healthcare costs, and improve the quality of care for the Americans.

To begin with, the ACA contributed to the establishment of the Innovation Center (About the CMS Innovation Center, 2017). It allows testing new methods of payment and service delivery models that can potentially cut down expenses of Medicare, Medicaid, and Children’s Health Insurance Program (CHIP). At the same time, the goal is to preserve or even enhance the quality of patient’s care. Generally, the Innovation Center is focused on testing new payment models, evaluating their results, and engaging more stakeholders to the development of additional models for testing. Hence, the Affordable Care Act funds a massive innovational process, which cannot be underestimated.

While working on developing new payment and service delivery models, the Innovation Center follows the official requirements and consults clinicians and analytical experts. The selection of organizations that participate in testing a model is an open, transparent process, and attracts the most qualified partners. The results of testing are usually aimed at increasing the efficiency of health care payments and policies.

For instance, the Innovation Center is currently implementing the Quality Payment Program, which was created by Congress to replace Medicare’s way of payment for physicians’ and other medical services (About the CMS Innovation Center, 2017). This model is based on the principle that healthcare specialists get more focused on care quality, as the participation in the program gives them a performance-based payment adjustment. Thus, they become more motivated and determined to the best patient’s outcome.

The National Quality Forum offers a range of tools to measure and improve the quality of healthcare. Its measure search tool, QPS, suggests dividing measurements by type: the cost/resource use, efficiency, outcome, process, structure, and intermediate clinical outcome. Most of them have been endorsed. As for the Electronic Health Record (EHR), it was made to automate clinician’s workflow and give all information concerning the patient and his treatment process.

Therefore, all types of NQF measurements can be used in EHR, as they encompass the main purposes of the Electronic Health Record. “Once a measure is endorsed by NQF, it can be used by hospitals, healthcare systems, and government agencies like the Centers for Medicare & Medicaid Services for public reporting and quality improvement” (National Quality Forum, n. d., par. 4).

Quality health services are one of the major concerns for the Centers for Medicare and Medicaid Services (CMS). Hence, using quality measures is essential to assess the process of treatment and outcomes. The Affordable Care Act requires that CMS use nationally endorsed quality measures in the Hospice Quality Reporting Program. The data from Hospices is used to calculate seven NQF-endorsed measures, and these measures can be used in Electronic Health Record. In addition, CMS are currently providing services for the Medication Measures Special Innovation Project (Quality Measures, 2016). This project has eight NQF-endorsed measures for the ambulatory care setting. Thus, some of the NQF measures can be used in EHR to ensure quality metrics from an EHR endorsed by the CMS.

References

CMS.gov. (2017). . Web.

CMS.gov. (2016). . Web.

Medicaid.gov. (n. d.). Affordable Care Act. Web.

National Quality Forum. (n. d.). Measuring performance. Web.

Keiser Permanente in the Affordable Care Act Context

Introduction

Society and business are closely interrelated in the aspect that society has an impact on business through policies and laws, and diverse companies influence society through their activities. One of the fields where this impact is well observed is health care because health care is one of the fundamental rights granted to every citizen and thus regulated by the state. The Affordable Care Act (ACA), also known as “Obamacare,” is one of the most meaningful laws in health care enacted during the recent decade.

It was put into power in 2010 and was expected to provide more American citizens with affordable insurance, expand the Medicaid program, and support innovative methods of care delivery (“Affordable Care Act (ACA), n.d.). Nevertheless, Medicaid could not provide the necessary coverage, which gave an opportunity to private insurance companies to provide affordable insurance for citizens with income below the poverty level. One of the corporations involved in insurance service under ACA is Keiser Permanente.

It is an integrated managed care consortium with headquarters in Oakland, California. Founded in 1945, Keiser Permanente developed into a corporation that unites such entities as the Kaiser Foundation Health Plan, Kaiser Foundation Hospitals, and some other regional Permanente Medical Groups. The mission of the company is to “provide high-quality, affordable health care services and to improve the health of our members and the communities” they serve (“About Keiser Permanente,” 2018, para. 3). Therefore, the corporation is likely to be influenced by the adoption of ACA, which is also aimed at the provision of affordable care. The purpose of this paper is to analyze the impact of the Affordable Care Act on activities related to insurance provided by Keiser Permanente.

Analysis

Pre-Conditions of the Affordable Care Act

ACA is the law that pushed a change in the healthcare system of the United States. It was a need for time and a result of thorough preparation before it passed. ACA was expected to provide insurance coverage for more than 94 percent of Americans (“History and timeline of the Affordable Care Act (ACA),” 2018). Passage and implementation of ACA were vital for a vulnerable population such as low-income individuals. Thus, studies conducted before ACA implementation revealed from 9 to 19 percent of nonelderly adult Americans who went without health care (Glied, Ma, & Borja, 2017).

These people claimed they could not afford insurance due to its high cost. Moreover, from 18 to 26 percent of Americans did not have a usual place of care and a personal doctor or health care provider (Glied et al., 2017). Therefore, a law that could bring positive change to insurance coverage and, as a result, to a general increase in access to care, was necessary for the healthcare system of the United States.

Reform in health care has been actively discussed in the Senate since 2009 but was not supported at that time. Nevertheless, surveys showed the necessity for reform because many uninsured individuals who could not afford care plans remained deprived of high-quality cars, which had a negative impact on population health in on the whole (“History and timeline of the Affordable Care Act (ACA),” 2018).

At the beginning of March 2010, the Senate still lacked votes to pass the bill to the President’s signature. Finally, on March 21, 2010, the House approved the version of the health care plan, and on March 23, 2010, it was signed into law by President Obama (“History and timeline of the Affordable Care Act (ACA),” 2018). Still, the provisions of ACA were not evenly implemented throughout the country, and as of 2014, only 24 states and District Columbia supported Medicaid expansion (Wherry & Miller, 2016).

The Impact of ACA on Keiser Permanente

Generally, the implementation of ACA provisions in the state of California had a positive impact on the activity of Keiser Permanente. It can be explained by the fact that California, where ACA adoption is considered to be the most successful, creates opportunities for the development of the insurance providers. After ACA implementation, Keiser Permanente developed a network of facilities that provide care, conduct research, and are involved in the improvement of community health. Currently, Keiser Permanente serves over 12.2 million members who have care plans with this corporation (“Fast facts about Keiser Permanente,” 2018).

Almost 10 million are from California, while others come from different states. To satisfy the needs of new members, the company runs 39 hospitals and 684 medical offices throughout the country (“Fast facts about Keiser Permanente,” 2018). These facilities employ over 22 thousand physicians, more than 53 thousand nurses, and more than 216 thousand other employees. Keiser Permanente has demonstrated a steady performance since 2010 and a regular annual increase in operating revenue. The most significant increase was recorded after 2014 when ACA provisions resulted in a sharp need for private health insurers.

Thus, revenue was $56.4 million in 2014, $60.7 million in 2015, $64.4 million in 2016, and $72.7 million in 2017 (“Fast facts about Keiser Permanente,” 2018). Keiser Permanente, in fact, became an insurance leader in the region. Thus, health plans of Kaiser Permanente provided both in Northern and Southern California are considered to be “the only plans in the state to receive 5 stars,” which is the highest possible rating (“Keiser Permanente’s overall quality of medical care earns the highest rating,” 2018, para. 1).

This rating is awarded for the general quality of medical care assessed in the annual Healthcare Quality Report Card, which is prepared and presented by California’s Office of the Patient Advocate. Kaiser Permanente suggests care plans that can satisfy diverse populations. For example, the company serves families and individuals as well as allows coverage through an employer and has Medicaid/Medi-Cal plan with affordable health options.

Benefits of ACA

There are diverse benefits that result from ACA adoption, most of which are evidence-based and proved through research. For example, Wherry and Miller (2016) reveal an increase in insurance coverage as one of the beneficial consequences of ACA implementation. Meaningful positive changes were recorded among citizens with both private and Medicaid insurance. Moreover, the general improvement of health insurance rate improved.

In addition, more individuals visited health care specialists of general practice and were admitted to hospitals after ACA adoption (Wherry & Miller, 2016). Also, ACA provisions stimulated further positive changes in the delivery and availability of health care throughout the country. One of the evident benefits mentioned by Federal agencies and other professional organizations in the field of health care is a decrease in health disparities that are considered a burden of American health care (Adepojou, Preston, & Gonzales, 2015).

Consequently, ACA is a contribution to the reduction of the disparity gap in the healthcare of the United States. In fact, ACA has already resulted in a decrease in discriminatory insurance practices that led to uninsurance among unprotected and low-income populations. It happened due to the fact that insurance became more affordable. Finally, ACA presents the first National Prevention Strategy and provides support for many public health programs.

Pressures and Costs of the Law on the Corporation

Despite evident benefits provided by the adoption of ACA, there are certain pressures that were put by this law on health insurers, including Keiser Permanent. Since the idea of ACA is to make health insurance affordable for those population groups that could not afford the premium care plans or could not qualify due to the health condition, the task of insurers was to develop such plans. Evidently, private insurers such as Keiser Permanente could not plan care and lose profit.

It resulted in an increase in cost for premium plans for individuals who could pay, which, in turn, led to the dissatisfaction of this group of clients. Nevertheless, the law banned charging higher premiums for existing clients, and insurance companies were at risk of losing costs. Still, ACA caused a significant increase in new clients. These were not only underserved poor-income individuals who could not afford care plans earlier, but many young people who did not have any care plans because they were healthy enough not to purchase insurance until it became obligatory.

As a result, bigger insurance companies such as Keiser Permanente obtained more benefits than losses due to an increase in a number of clients whose care plans covered the losses due to the provision of cheaper plans for low-income citizens. On the whole, Keiser Permanente had more benefits than pressures from the adoption of ACA in California.

Possible Causes of Amendments or Changes

ACA is being implemented successfully for almost eight years. Still, there are some triggers that can result in changes in this law. The major moving power in legislation is government and the President. Thus, changes in these political forces are likely to lead to amendments and changes in ACA and its provisions. After Donald Trump becoming the President of the United States, ACA has been much criticized.

Further attention to ACA from state legislators can result in amendments or reduction of its power, which will lead to change in the insurance market. Another possible cause of amendments or changes in ACA as one of the primary laws regulating American health care is an economic crisis. Economic problems usually lead to a decrease in the income of the population, thus reducing their ability to pay for premium insurance plans or any insurance at all.

Thus, a change can be needed to preserve coverage of population in case of deteriorated economic conditions. Also, a change in ACA provisions can be needed when private insurance companies refuse to provide affordable care plans due to the loss of income. In this case, there will be a need for amendments that consider current condition of health care system and demands of insurance providers. Finally, a change or some amendments are possible when the needs of population change. It may happen when insured individuals want to enlarge the services included in their coverage or, due to some reasons, the number of uninsured individuals starts to grow again.

Summary and Recommendations

On the whole, the example of the Affordable Care Act and Keiser Permanente provides evidence that business and laws produced by society are closely interrelated. The adoption of ACA was the demand of time because society needed a change in health care. In turn, ACA adoption had an impact on one of insurance providers, Keiser Permanente. In the case under consideration, both society and a business corporation benefited from the adoption of the law.

People who could not afford insurance or did not qualify for care plans received coverage and access to high-quality care, which means that the law met the needs of population and the business corporation had an opportunity to satisfy these needs. Thus, the following recommendations related to the interrelation of society, laws, and business can be provided. First of all, policies and regulations should be aimed at general wellness of society in different aspects including social, economic, and political. Secondly, adoption of a law demands careful preparation and research to make it working and useful for society. Thirdly, business corporations that are expected to be affected by new laws should be allowed to participate in discussions of legal acts because people involved in politics are not always aware of the economic consequences of their decisions.

Finally, there is a need for public discussions of new laws that are related to burning social issues to consider thoughts of people whom these laws are expected to serve. In case these basic recommendations are followed, new laws are likely to be beneficial both for business corporations and society and lead to an increase in both economic performance and public satisfaction. This approach will result in the more effective legislature and more productive regulation of social issues that involve the participation of business corporations.

References

About Keiser Permanente. (2018). Web.

Adepoju, O., Preston, M., & Gonzales, G. (2015). Health care disparities in the post-Affordable Care Act era. American Journal of Public Health, 105, 665-667.

. (n.d.). Web.

. (2018). Web.

Glied, S. A., Ma, S., & Borja, A. (2017). . Web.

History and timeline of the Affordable Care Act (ACA). (2018). Web.

Keiser Permanente’s overall quality of medical care earns highest rating from the Office of Patient Advocate. (2018). Web.

Wherry, L. R., & Miller, S. (2016). Early coverage, access, utilization, and health effects associated with the Affordable Care Act Medicaid expansions. Annals of Internal Medicine, 164(12), 795-803.

Affordable Care Act and Nursing Shortage

Introduction

While the Affordable Care Act (ACA) was implemented by President Barack Obama back in 2010, its effects and coverage continue expanding to this day, with remaining provisions expected to be phased in up until 2020. The purpose of the ACA was to provide the population of the United States with the increased security in healthcare services they receive through the expansion of service coverage, holding insurance companies accountable, lowering costs on health care, guaranteeing more choice of services, and enhancing the overall quality of care (“Affordable Care Act,” 2017). Therefore, the healthcare driver for the policy is a combination of several factors. Taking into consideration Kingdon’s policy window model, the problem stream related to the ACA is the insufficient access to healthcare services as well as challenges associated with insurance. Policy stream, in this case, is linked to the expansion of the act country-wide. Lastly, political stream is related to the ability of legislators to enforce the proposed changes.

Effects of the Policy

Based on the findings of the Commonwealth Fund, getting an insurance coverage increased the probability “of having a usual place of care by between 47.1% and 86.5%” (“Effect of the Affordable Care Act on health care access,” 2017, para. 1). Also, it was found that the ACA decreased the likelihood of patients not receiving healthcare services between 20.9% and 25%. Both National Health Interview Survey and Behavioral Risk Factor Surveillance System data show that prior to the implementation of the ACA, the population had lower rates of access to healthcare services while healthcare facilities showed the decreased profitability because the majority of their patients did not have a usual place of care. With regards to the effect of the ACA on the nursing practice, several accomplishments should be mentioned. First, the demand for nurse practitioners (NPs) skyrocketed due to the increased use of emergency rooms and regular hospital visits. To address this demand, it is forecasted that between 2010 and 2020, the active supply of registered nurses (RN) in healthcare facilities will increase from 3.5 million to 3.95 million (“How the Affordable Care Act affected nursing,” 2016). On the other hand, the nursing profession has been challenged by the increased workload and short-staffing that are dangerous issues that could only be addressed through hiring and training new personnel.

Policy Issue

As a direct implication of the Affordable Care Act, there is a shortage of nurses due to the increased workload in healthcare settings. An essential point with regards to this problem relates to nursing education as well as “effective workforce planning and policy making” with “better data collection and an improved information infrastructure” (Milstead, 2016, p. 5). Through the use of Kingdon’s policy window model, it is proposed to influence the further change in the policy to address the problem of the lack of nursing personnel in the workplace. The problem stream (issue identification) is as follows: due to the increased demand of patients for receiving healthcare services in emergency rooms or general hospital settings, the profession is currently challenged by the shortage of personnel that usually exasperates the increasing workload. Political stream is associated with the possible involvement of stakeholders such as nurse managers who will report the problem to policymakers. Lastly, the policy stream involves a solution – encouraging students to choose the nursing profession, preparing new nurses for the immense workload, and facilitating the effective collection of information to enhance professionals’ competence.

Conclusion

It has been shown that the ACA has achieved significant results after being implemented. The Act both improved Americans access to healthcare and decreased the number of uninsured. However, the increased demand for skilled RNs and NPs contributed to the shortage of personnel, which is a challenge that remains to be addressed.

References

Affordable Care Act. (2017). Web.

(2017). Web.

(2016). Web.

Milstead, J. (2016). Health policy and politics: A nurse’s guide (5th ed.). Burlington, MA: Jones and Bartlett Publishers.

Affordable Care Act: A Transparent Set of Available Coverage Choices

Introduction

Over the past several decades prior to the Affordable Care Act (ACA), America had disproportionately increased health care spending, although there had been no tangible reasons in terms of improved quality of services. The cost of insurance per employee had almost doubled, and a significant part of the population remained uninsured. The insurance market provided by employers had been extremely monopolized, which impeded labor mobility and created an environment where discrimination is possible. To address all these issues, ACA was passed, which provided a transparent set of available coverage choices. There are various levels of coverage defined by the ACA, including Bronze, Silver, Gold, and Platinum. There is also a catastrophic plan for specific circumstances and certain age group.

A Bronze plan is targeted at people who are generally healthy because it is the cheapest of metal plans and features high deductibles and copays. Bronze level coverage will pay for 60 percent of the full cost of medical services (Patient Protection and Affordable Care Act, 2010). A Silver plan is suitable for those who want to pay a little more because there is more routine care needed. Seventy percent of all costs will be covered under this plan (Patient Protection and Affordable Care Act, 2010).

Gold level plans have high monthly premiums but low deductibles. It is suitable for those who visit health care facilities more often. All Gold level plans must pay for 80 percent of the total cost (Patient Protection and Affordable Care Act, 2010). A Platinum plan provides benefits equivalent to 90 percent of the full price (Patient Protection and Affordable Care Act, 2010). It has the highest monthly premium but the lowest deductibles. A Catastrophic plan covers all preventive services and additional three primary care visits per year before requiring the first deductible to be met (Patient Protection and Affordable Care Act, 2010). It is cheaper than the previous four coverage levels, but not everybody can qualify for this plan.

Health Care Reform Challenges

There are firm distinctions in how people approach health care reform. These differences in views have been fueling both political and informal debates for many years, posing a hindrance to prospective laws and acts. Among the specific factors making health care reform difficult are the lack of clear vision, prioritization between costs and access, debates over whether the government should take full control, political partisanship, and economic self-interest of critical stakeholders.

The lack of a national vision on health care will always result in contradicting proposals. While many politicians would support a system where everybody would benefit, the discussion will still have no uniform shape because there is no enforced national idea that would hold all propositions consistent (Giaimo, 2016). There are also endless debates on whether the country must care for every individual despite the costs, whether it must leverage the expenses and the number and quality of services, or whether it should prioritize money savings (Giaimo, 2016). The country must be able to choose between access and costs. The ones concerned with budgets may object to reforms that require excessive amounts of expenditures.

The third reason is concerned with the debate over the government’s involvement in health care. The reality embodies the cooperation between private firms and lawmakers. The dominance of the free market, however, is evident because the lack of responsibility on the government’s behalf led to the system’s failure to serve the population (Giaimo, 2016). Political initiatives are in stagnation due to government passiveness. Political partisanship is another reason because the parties tend to focus on competing ideologies rather than concentrating on shared values and goals (Giaimo, 2016). This competition results in debates that never conclude with reasonable decisions.

The last reason is about the financial interests of various people that have a voice in the discussions. Health care reform is expensive, and someone will have to pay for it, be it the government or private companies. People that may potentially lose profit because of reforms will always oppose them and use Special Interest Groups (SIGs) to promote their interests in the political arena.

References

Giaimo, S. (2016). Reforming health care in the United States, Germany, and South Africa: comparative perspectives on health. London, UK: Palgrave Macmillan.

Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010).

Affordable Care Act Repeal and Demand and Supply

Introduction

The Affordable Care Act changed many aspects of US health insurance and the healthcare system. One of the most significant changes was the Medicaid expansion because it allowed many Americans to receive benefits and afford insurance. Consequently, the abolition of the ACA will take away this opportunity from many people, which will significantly reduce the demand and supply for health insurance and affect the purchasing power of citizens and the labor market.

Impact on the Health Insurance Market

The first most significant and predictable impact of the ACA’s potential repeal is reducing the demand for health insurance. Popken (2017) notes that ASA has created 20 million new insured clients, which is a significant number of clients for insurance companies and healthcare providers. Since there is no other plan today that could replace the ACA, its cancellation is likely to result in the same insurance conditions that were in 2010. This fact means that most Americans who cannot afford insurance due to low income will refuse to buy it. At the same time, the consequences of quarantine and the pandemic are the loss of jobs by many employees, which only increases the number of people who cannot afford insurance. Consequently, the repeal of the ACE will cause a sharp drop in demand and affect both the work of insurance companies and healthcare facilities.

A decrease in demand will also lead to a reduction in supply because it will not be profitable for companies to offer a variety of insurance plans for people who cannot afford them. In addition, the ACA also had clauses on the compulsory services that insurance must cover and the elimination of discrimination against people with illnesses; thus, its cancellation could also reduce the offers for individual private insurance (Guo et al., 2017). In other words, if these requirements do not work, companies can reduce the number of insurance plans to a minimum but increase costs to cover the shortage due to low demand. Thus, health insurance can become even less affordable for the population.

Effect on the Labor Market

Moreover, the lack of insurance for most people means the unavailability of medical services, which will increase costs and decreases the number of jobs in the healthcare sector. According to Wishner and Burton (2017), the adoption of the ACA forced healthcare providers to adapt to the growing demand for medical services; as a result, thousands of workers were hired in clinics, emergency, and information centers. Consequently, since many Americans cannot afford medical services because of their high cost, their demand will also fall, as will the need for medical personnel. Thus, thousands of unemployed will appear in the labor market due to the low supply of jobs. Such changes will also negatively affect the US economy because a high unemployment rate leads to a drop in government revenue from taxes.

Impact on Citizens’ Purchasing Power

Another consequence can be a decline in the demand of buyers for various goods and services or a decrease in their purchasing power. In their study, Caswell and Waidmann (2017) noted that residents of states that expanded their Medicaid programs had improved their financial situation. However, the potential repeal of the ACA will lead to opposite outcomes due to higher insurance prices, larger medical bills, and unemployment.

First, the loss of jobs for thousands of healthcare workers can lead to a difficult financial situation in which they cannot afford to purchase devices, cars, entertainment, or other things that are not essential for life. People who lose their benefits but are forced to buy insurance because of their health conditions or pay bills themselves can also cut costs. This prognosis also applies to people with low income who will have to cut costs to pay medical bills in the event of illness or urgency. At the same time, the threat of COVID -19 and its severe consequences for some people shows a high probability of treatment costs for any person. Consequently, the demand for various non-essential goods and services will decrease due to the high costs of healthcare services that do not correspond to the income of most people.

Conclusion

Therefore, the repeal of the ACA will harm the supply and demand of health insurance, healthcare jobs, and consumption in general, due to the elimination of benefits for the low-income population. First, Medicaid’s return to 2010 conditions will make many Americans unable to afford insurance, which will reduce demand for it and medical services. For this reason, companies can fees but decrease coverage to generate income from people who need and can afford insurance. The jobs created after the adoption of the ACA will become unnecessary, which will reduce the supply in the labor market, and many health workers will lose their jobs. The lack of insurance benefits, the high cost of healthcare services, and increased fees will force the population to cut their costs, which will reduce the demand for non-essential goods. Consequently, the repeal of the ACA will harm almost all areas of the US economy and affect the health and financial stability of a significant part of the population.

References

Guo, E., Jacobs, D. B., & Kesselheim, A. S. (2017). . American journal of public health, 107(2), 253–254.

Caswell, K. J., & Waidmann, T. A. (2017). . Medical Care Research and Review, 76(5), 538–571.

Popken, B. (2017). . NBC News.

Wishner, J., and Burton, R. (2017). HThe Urban Institute.