What is the likely impact of the Affordable Care Act (ACA) on healthcare access, cost, and quality?

What is the likely impact of the Affordable Care Act (ACA) on healthcare access, cost, and quality?BYDawn ChrissLasandra Williams

OBJECTIVES:Identify Affordable Care Act (ACA).Discuss who is newly covered and how is it achieved.Explain exchanges and how different states are approaching them.Explain the Medicaid program and what it has to do with ACA.Explain how ACA will affect health insurance.Explain the variables that are in play in the political debate over the impact of the ACA on cost, quality and access to care.Identify some key implementation challenges that state and national policy makers are facing.Identify why ACA is a good law.

AFFORDABLE CARE ACT (ACA) The Affordable Care Act, also known as the Patient Protection and Affordable Care Act (PPACA), and informally known as Obamacare, was signed into law by President Barack Obama on 23rd March, 2010. The Act is a health care law aimed at improving the health care system of the United States by widening health coverage to more Americans, as well as protecting existing health insurance policy holders (Medical News Today, 2012).

Source: Medical News Today. (2012). What is the Affordable Care Act? What is Obamacare? Retrieved from website http://www.medicalnewstoday.com/articles/247287.php.

WHO IS NEWLY COVERED?Employers with a business that employs 50 or more employees.Individuals under the age of 26 who are covered by their parents insurance. Individuals under the age of 30 who cant afford health insurance coverage, do not qualify for Medicaid and have hardships. Individuals who are covered by Medicaid and Medicare. However, depending on the state, Medicaid expansions may not exist.

Source: Health Insurance Explained: The You Toons Have it covered.[Video File]. Retrieved from website at http://1061evansville.com/obamacare-affordable-care-act-explained-simply-for-kids-and-grown-ups-video

HOW IS ACA ACHIEVED?Individuals will be mandated to have insurance coverage, if they dont have it, they will have to pay a tax penalty. Higher taxes will be required from the wealthy and services such as tanning. Additionally, hospitals and insurance companies will receive less pay when participating in Medicare. Source: Health Insurance Explained: The You Toons Have it covered.[Video File]. Retrieved from website at http://1061evansville.com/obamacare-affordable-care-act-explained-simply-for-kids-and-grown-ups-video

WHAT ARE EXCHANGES: HOW SOME STATES APPROACH THEM?Exchanges (market places), are health insurance plans that can be bought individually or from small group employers. There are two types of exchanges, public and private.

A public exchange may be run by the state or federal government, or by the state and federal government working together. While the private exchanges are not run by the government but by a private sector company, like a health plan or a consulting firm.States approach the exchanges differently. There are some states that build their own health insurance exchange on their own. There are some states who choose not to build their own exchange, within those states residents can choose an exchange from the federal government. A state can also partner with the federal government (both will share responsibility of the exchanges).

Source: Health Care Reform: What is a health insurance exchange? [Video File]. Retrieved from website http://www.aetna.com/health-reform-connection/reform-explained/video-exchanges.html

MEDICAID PROGRAMS AND ACA: Medicaid, which currently covers nearly 50 million low income Americans, funded an estimated 339 billion services in 2008. Medicaid is a federal/state partnership with shared authority and financing. States have the option to participate, and all 50 states do.The 2010 Affordable Care Act expanded Medicaid to all Americans under age 65 whose family income was at or below 133 percent of federal poverty guidelines ($14,484 for an individual and $29,726 for a family in 2011) in 2014.Source: National Conference of State Legislatures. (2011).States Implement Health Reforms: Medicaid and The Affordable Care Act. Retrieved from website http://www.ncsl.org/documents/health/HRMedicaid.pdf.

HEALTH INSURANCE CHANGES

There will be a required maintenance of effort (MOE) for state Medicaid and Childrens Health Insurance Program (CHIP) eligibility levels that were in place on March 23, 2010 through 2013. MOE is a specified level of financial effort in the healthcare area for which Federal funds will be provided in order to receive Federal grant funds. These requirements will be extended to 2019 for children to continue participation Medicaid.There will be a new modification of how income is calculated for most Medicaid aid applicants, including those in new eligibility groups. In 2014, states used Modified Adjusted Gross Incomes (MAGI) for eligibility of termination for most applicants.There will be enhance efforts made to improve the Medicaid program integrity which include fraud and abuse prevention, detection and recovery initiatives. Various Changes will be made to medication drug coverages.

Source: National Conference of State Legislatures. (2011).States Implement Health Reforms: Medicaid and The Affordable Care Act. Retrieved from website http://www.ncsl.org/documents/health/HRMedicaid.pdf.

IMPORTANT NOTE:

Some states are not participating in the ACA expansion program for Medicaid. In many states the burden of financial funding is unavailable. Expanding Medicaid may be the most pressing of the many funding issues related to the ACA that states face. Source: National Conference of State Legislatures. (2011).States Implement Health Reforms: Medicaid and The Affordable Care Act. Retrieved from website http://www.ncsl.org/documents/health/HRMedicaid.pdf.

POLITICAL DEBATE VARIABLES: THE IMPACT OF THE ACAThe future state of the ACA is unknown. While the Democratic Party seems to be onboard, the Republican Party is opposed to the ACA and has voted to repeal the Act more than 40 times. According to research and polls the general public has consistently indicated that more residents oppose the ACA than support it. Of the 1507 nationally representative residents polled in July 2014, for example, 37% supported the ACA and 53% opposed it.Despite these observations, the elements of the ACA are popular and millions of individuals have benefited from the subsidies to purchase insurance and from the liberalization of Medicaids eligibility rules.

Source: World Health Organization (2014) Challenges facing the United States of America in implementing universal coverage. Retrieved from http://www.who.int/bulletin/volumes/92/12/14-141762/en/.

IMPLEMENTATION CHALLENGES FACING STATE AND NATIONAL POLICY MAKERS

The ACA provided a comprehensive expansion of Medicaid to cover millions of low-income uninsured individuals. However, as a result of the Supreme Courts decision on the ACA, the Medicaid expansion is an option for states and not a requirement. The ACA established health benefit exchanges or health marketplaces and required that all qualified health plans include an adequate network. This refers to a health plans ability to deliver the benefits promisedby providing access to a satisfactory number of in-network primary careand specialty physicians, as well as all health care services includedunder the terms of the contract. To address this issue States have implemented laws to ensure that networks are of adequate size.As a way to improve quality of care, under the ACA several quality improvement initiatives have been present and are accompanied by financial incentives. For example, hospitals that perform well and are within the top quartile of various quality measures will face reductions in their Medicare reimbursements.

Source: World Health Organization (2014) Challenges facing the United States of America in implementing universal coverage. Retrieved from http://www.who.int/bulletin/volumes/92/12/14-141762/en/.

BENEFITS OF THE ACAImproving Quality and Lowering Health Care CostsFree preventive carePrescription discounts for seniorsProtection against health care fraudSmall Business Tax CreditsNew Consumer ProtectionsPre-existing conditionsConsumer AssistanceAccess to Health CareHealth Insurance Marketplace.

Providing insurance optionsCovering preventive servicesLowering costsYoung Adult CoverageCoverage available to children up to age 26Strengthening MedicareYearly Wellness VisitMany Free Preventive Services for some seniors with MedicareHolding Insurance Companies Accountable

Source: US Department of Health and Human Services (2013) Benefits of the Affordable Care Act for Americans. Retrieved from http://www.hhs.gov/healthcare/facts-and-features/key-features-of-aca/benefits-of-the-affordable-care-act-for-americans/index.html.

CONCLUSION: THE ACA IS A GOOD LAW

The ACA is much more than just a health insurance law. It addresses every aspect of the health service and was designed to encourage more primary care, to promote a greater focus on quality and to encourage hospitals and providers to coordinate care. Additionally, the ACA provides a health insurance capability for populations that previously did not have coverage. Therefore, the ACA is a good law.

REFERENCES:Health Care Reform: What is a health insurance exchange? [Video File]. Retrieved from website http://www.aetna.com/health-reform-connection/reform-explained/video-exchanges.html.Health Insurance Explained: The You Toons Have it covered.[Video File]. Retrieved from website at http://1061evansville.com/obamacare-affordable-care-act-explained-simply-for-kids-and-grown-ups-video. Kaiser Family Foundation (2013). What is Medicaids Impact on Access to Care, Health Outcomes, and Quality of Care? Retrieved from http://kff.org/medicaid/issue-brief/what-is-medicaids-impact-on-access-to-care-health-outcomes-and-quality-of-care-setting-the-record-straight-on-the-evidence.Medical News Today. (2012). What is the Affordable Care Act? What is Obamacare? Retrieved from website http://www.medicalnewstoday.com/articles/247287.php.National Conference of State Legislatures. (2011). States Implement Health Reforms: Medicaid and The Affordable Care Act. Retrieved from website http://www.ncsl.org/documents/health/HRMedicaid.pdf. National Conference of State Legislatures (2015) Insurance Carriers and Access to Health Providers Network Adequacy. Retrieved from http://www.ncsl.org/research/health/insurance-carriers-and-access-to-healthcare-providers-network-adequacy.aspx. US Department of Health and Human Services (2013) Benefits of the Affordable Care Act for Americans. Retrieved from http://www.hhs.gov/healthcare/facts-and-features/key-features-of-aca/benefits-of-the-affordable-care-act-for-americans/index.html.World Health Organization (2014) Challenges facing the United States of America in implementing universal coverage. Retrieved from http://www.who.int/bulletin/volumes/92/12/14-141762/en/.