Critique two of your colleagues’ posts by suggesting or proposing an alternative indicator/implication as it applies to the health services organization described by your colleague.
The PPACA brought about new additional requirements for not-for-profits or 501 (c) (3) HSOs as well as for-profits HSOs. Then the size of the business determined exactly what type of implications and new requirements that would be a result of the PPACA. While the PPACA had goals to reduce cost, move healthcare to a more efficient and accountable system as well as move the country to a more value-based purchasing system that is cost-efficient and has quality healthcare ingrained in the delivery system versus the volume-based delivery system it had been used to operating (Rosenbaum, 2011). This has been argued by many if that was the case. However, the basis of the “Value-Based Purchasing (VBP) system is to reward those physicians who provided extremely excellent quality care in a cost-effective manner with a 2% bonus while penalizing those physicians who did not provide quality care in a cost-effective manner with a 1% fee for services that were of poor quality (CMS.gov, n.d.). This is an intentional way the PPACA moved towards getting rid of fee-for-service. Also, some reimbursements rates were reduced while others saw an increase as well as the varying maximum and minimum reimbursement of Medicaid states (CMS.gov, n.d). With Premium Tax Credit and Cost-Sharing Reduction healthcare administrators need to understand the effects. The small business tax credit was intended to help but a healthcare administrator must be abreast on ways this can decrease or increase their cost structure so that strategic planning can counteract the outcome. Some businesses that met the size requirement were able to reap pre-tax benefits.
One of the implementations which some argue as not being helpful was the expansion of Medicaid. This was seen in the loud battles between states who refused to expand Medicaid even forgoing some of the Federal financial incentives (Haeder, 2015). This also played a part in what type of reimbursement would be given to an HSO. Also, not-for-profits were required to conduct community needs-based assessments which in my community I have seen as a way of creating a more collaborative healthcare environment. Therefore, for-profits, small business owners, and those in-between must understand the PPACA and take their business structure into consideration while implementing.
CMS. Gov. (n.d.). U.S. Centers for Medicare & Medicaid
Haeder, S. F. (2015). You can’t make me do it, but I could be persuaded:a federalism perspective on the affordable care act. Journal of Health Politics, Policy and Law. 40 (2). 281-323.
Rosenbaum S. (2011). The patient protection and affordable care act: Implications for public health policy and practice. Public Health Reports (Washington, D.C. : 1974), 126(1), 130–135.
Aa Patient Protection and Affordable Care Act
The “Affordable Care Act” (ACA) is usually used to refer to the final, amended version of the law; the comprehensive healthcare reform law was enacted on March 23, 2010.
Limitations of Health Insurance Regulation – ACA
The are several limitations regarding health insurance regulations:
· The cost did not decrease for everyone. Those who do not qualify for subsidies can find marketplace health insurance plans unaffordable. Some consumers may end up paying more for a plan that includes benefits.
· The loss of company-sponsored health plans; some healthcare organizations may find it more cost-effective to let their employees purchase their insurance on the exchanges rather than provide employer-sponsored coverage (Kaiser Family Foundation, 2019).
· People could face significant tax penalties if they were uninsured. This penalty no longer exists, but some states are now enacting their health insurance mandates.
· Shrinking network means many insurance companies are making their provider networks smaller to cut costs while implementing ACA requirements. This leaves consumers with fewer providers that are “in-network.”
· Shopping for coverage can be complicated with limited enrollment periods, difficulties with the websites and more coverage options (Kaiser Family Foundation, 2019).
Implications on Cost Structure and Reimbursement Rates
The Patient Protection and Affordable Care Act is a big piece of legislation. According to The New York Times, 48 million Americans lived without health insurance in 2012, 15.4% of the USA. By 2018, that rate dropped to 8.5%, resulting in 18 million more people with coverage (Capretta, 2020). The focus of the ACA is to increase the number of Americans with health insurance coverage. New subsidies for families buying health insurance through the exchanges and expanded eligibility for Medicaid brought health coverage to millions of lower-income households. New federal rules requiring private insurers to offer coverage on the same terms to everyone, guaranteeing that consumers with preexisting conditions could buy insurance without benefit exclusions or higher premiums (Capretta, 2020). The impact of those subsidies and regulations was significant. Efforts to achieve other policy goals were less successful as the ACA did not lessen high and rapidly rising healthcare costs for all Americans (Capretta, 2020). Also, delivery system reforms advanced by the Centers for Medicare and Medicaid Services Innovation Center have shown disappointing results, and mechanisms intended to lead in federal costs have been dropped. Despite the promise of affordability, consumers continue to mention medical expenses as their main economic concern (Capretta, 2020).
ACA has aimed to provide affordable health insurance coverage for all Americans. The ACA has been highly controversial, despite positive outcomes. Some people in the healthcare industry are critical of the additional workload and costs placed on providers also have adverse effects on the quality of care (Roland, 2019).
Capretta, J. R. A. J. C. (2020, April 10). The ACA: Trillions? Yes. A Revolution? No.: Health Affairs Blog. Health Affairs. https://www.healthaffairs.org/do/10.1377/hblog20200406.93812/full/.
Kaiser Family Foundation (2019). Average Single Premium per Enrolled Employee for Employer-Based Health Insurance.
Roland, J. (2019, August 17). The Pros and Cons of Obamacare. Healthline. https://www.healthline.com/health/consumer-healthcare-guide/pros-and-cons-obamacare.