Current and Future Health Policies Affecting Health Care Costs, Quality, and Access
In this final project, imagine you are the chief executive officer (CEO) of your health organization, and you are asked by your organization’s board of directors to prepare a policy proposal to be submitted to your local area Congressperson.
In this policy proposal you are defending, challenging, or both the policy mandate. You need to use the information that you have learned over the past weeks about health care management in the U.S. to address the following:
From your research over the course of the last few weeks, assess what impact do you think the changes to the Patient Protection and Affordable Care Act (PPACA) and/or current legislation will have on the uninsured population in your local community or region?
Evaluate and prioritize the importance of the provisions studied in previous weeks (e.g., Medicare, Medicaid, and the individual mandate) from the most important to the least important. State the reasons you ranked the provisions in the order you presented.
Analyze the potential success or failure of this Act and changes based on your organization and your local health care needs. Justify your opinion.
Discuss future implications of this Act’s success or failure.
Recommend policy updates, changes, revisions, and so forth to the PPACA and/or current legislation that will address the opportunities and challenges that your organization and local community may deal with.
Note: Your policy proposal should be 5-6 pages, not including title page and reference page, formatted in the APA style, and it should include 8 quality references, 4 of which are from peer-reviewed health care journals and published within the last 5 years.
Current and Future Health Policies Affecting Health Care Costs, Quality, and Access
The US healthcare system has experienced various changes attributed to the implementation of diverse health reforms such as the Patient Protection and Affordable Care Act (PPACA). This healthcare reform law was passed into law in 2010. It focused on achieving various goals, including increasing healthcare coverage, improving the quality of care, increasing access to healthcare, and minimizing healthcare expenditure (Courtemanche et al., 2020). This healthcare reform legislation contains diverse provisions that target achieving the three goals. They include Medicare, Medicaid, and Individual Mandate. This healthcare reform law has transformed the US healthcare system in various ways. It has expanded health coverage to many Americans. The total population of insured Americans increased significantly. For instance, the law extended health insurance to people with preexisting conditions from discrimination, low-income individuals, and children and younger adults (Courtemanche et al., 2020). Also, the law made healthcare more affordable. However, this healthcare reform law has undergone various changes that affect the US in various ways. This essay aims at assessing the effect of the changes to PPACA on the uninsured.
Impact of Changes in ACA in the Community
PPACA has experienced various changes which have affected its impact on the US healthcare system. One of them includes the abolition of the individual mandate. This provision aimed at ensuring every individual gets health insurance or faces a tax penalty (Breed, 2018). This change is likely to increase the number of uninsured people in the community. Secondly, the healthcare reform law allowed states to expand their Medicaid programs. However, the Trump administration gave the states the authority to demand individuals qualified for expanded Medicaid to show that they are employed or enrolled in school (Courtemanche et al., 2020). This is likely to limit many individuals from becoming eligible for insurance and lead to coverage gaps in the community. The change made on ACA includes the termination of ACA cost-sharing subsidies (Courtemanche et al., 2020). This has impacted the community in various ways. For instance, the insurers will be required to raise premiums to offset the loss of the CSR payments. As a result, many people in the community eligible for cost-sharing reductions will be unable to afford the costly premiums.
This is one of the essential provisions of ACA that plays a vital role in providing health and financial stability to about 60 million older people and younger people with disabilities. This federal social insurance program is split into different parts. Part A of this program covers inpatient hospital stays, hospice care, care in a skilled nursing facility, and aspects of home health care. Part B provides coverage for particular doctors’ services, outpatient care, preventive care, and medical supplies. It also comprises Part D. This covers prescription drugs and many recommended vaccines (Klees et al., 2020). ACA has improved Medicare by enhancing its coverage, quality of care, and financial outlook. For instance, more than thirty-seven million medicare enrollees got free preventive services in 2013, like diabetes, screenings for cancer, among other chronic health conditions. Besides, about eight million enrollees saved more than $ 11.5 billion by 2016. This healthcare reform law has achieved this by enhancing the management of chronic conditions and bridging gaps in preventive care and prescription drug benefits, and supporting efforts made by healthcare providers to offer high-quality care and minimize costs (Klees et al., 2020).
This is a state and a federal program covering Americans with a low income and limited resources. It also comprises the Children’s Health Insurance Program (CHIP), protecting children who need affordable care. This program covers a wide range of services, including doctor services, hospitalization, x-rays, clinic treatment, laboratory services, nursing services, pediatric and family nurse practitioner services (Klees et al., 2020). However, the Medicaid benefits differ by state. The health reform law aimed at improving Medicaid by expanding eligibility to adults with incomes up to 133% FPL (Klees et al., 2020). ACA also sought to expand the number of Americans coverage by offering new premium tax credits for acquiring private health plans and abolishing policies excluding individuals with preexisting health conditions and creating annual limits on out-of-pocket costs (Klees et al., 2020).
This ACA provision aimed at increasing coverage. It thus required people to acquire minimum essential coverage. Those who failed to do so were subjected to a tax penalty. This provision led to a decrease in uninsured individuals in the U.S (Fiedler, 2020).
The ranking of ACA provisions is based on their total enrolment/coverage and U.S. healthcare expenditure. Medicare and Medicaid accounted for 23% and 18% of the U.S. health expenditure in 2020 (Yang, 2021). Besides, Medicare covers the highest percentage of U.S. Americans. In 2020, 18.4% were covered by Medicare, while Medicaid covered 17.8% of the U.S. population (United States Census Bureau, 2021).
PPACA has impacted the US healthcare system in various ways since 2010. First, the law has expanded coverage to many Americans since its adoption. The number of uninsured nonelderly Americans reduced by twenty million by 2016. However, a negative trend was experienced between 2017 and 2019, whereby the number of uninsured Americans increased by 2.2 million due to high healthcare costs (United States Census Bureau, 2021). Secondly, the law enhanced access to care among individuals with preexisting conditions from discrimination and removing the barriers women faced, limiting them from getting adequate care. Before ACA, insurers in the individual market discriminated people with preexisting conditions by denying them coverage due to their health status and setting pricing and benefits policies excluding them. ACA abolished the discriminatory practice, whereby women were charged higher health insurance rates than men and treated pregnancy as a preexisting condition (Garcia, 2019). Thirdly, the healthcare reform law increased access to coverage among young adults and children through marketplace financial assistance and Medicaid expansion. Fourthly, PPACA has made health care to become more affordable. The law permitted the provision of financial aid for private coverage. Therefore, a large number of enrollees are eligible for financial support with premiums, and also many got reduced cost-sharing.
Future Implications of ACA’s Success or Failures
ACA has played a vital role in increasing the number of insured Americans. The increase in insured Americans is likely to enhance access to care among many people (Oberlander, 2020). Thus, this will promote the overall health of the community members. Secondly, ACA has abolished discriminatory practices which limit women and individuals with preexisting health conditions from access to care (Garcia, 2019). Therefore, this will lead to an increase in the number of women and older adults accessing care. Besides, ACA has various failures. For instance, health insurance remains very expensive. This is likely to lead to high health insurance premiums, which will limit many people from acquiring health insurance (Oberlander, 2020).
ACA can be strengthened by expanding access to healthcare among moderate and medium-income Americans. This can be achieved by increasing credits for moderate and middle-income families. Secondly, ACA’s success can be promoted by improving Medicaid for low-income Americans (Oberlander, 2020). One of the measures that can be taken to achieve this includes ensuring that Medicaid payment rates are adequate to ensure satisfactory provider contribution. Thirdly, there is a need to enhance ACA’s impact in making health care affordable. This can be achieved by improving the application of health savings accounts for moderate-income US residents (Oberlander, 2020).
Breed, L. N. (2018). Federal Updates Major Tax Reform Bill Signed, Repealing the ACA Individual Mandate. Policy, 1, 4. https://www.sfdph.org/dph/files/election/FederalStateLocalUpdate01-4-2018.pdf
Courtemanche, C., Marton, J., Ukert, B., Yelowitz, A., & Zapata, D. (2020). The impact of the Affordable Care Act on health care access and self‐assessed health in the Trump Era (2017‐2018). Health services research, 55, 841-850. https://onlinelibrary.wiley.com/doi/abs/10.1111/1475-6773.13549
Fiedler, M. (2020). The ACA’s Individual Mandate In Retrospect: What Did It Do, And Where Do We Go From Here? A review of recent research on the insurance coverage effects of the Affordable Care Act’s individual mandate. Health Affairs, 39(3), 429-435. https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2019.01433
Garcia, G. (2019). The Effects of the Affordable Care Act on Women’s Health. https://digital.library.txstate.edu/handle/10877/8237
Klees, B. S., Wolfe, C. J., & Curtis, C. A. (2020). BRIEF SUMMARIES Of MEDICARE & MEDICAID: Title XVIII and Title XIX of The Social Security Act. https://www.cms.gov/files/document/brief-summaries-medicare-medicaid-november-13-2020-archive-document.pdf
Oberlander, J. (2020). The Ten Years’ War: Politics, Partisanship, And The ACA: An exploration of why the Affordable Care Act has been so divisive despite the law’s considerable accomplishments. Health Affairs, 39(3), 471-478. https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2019.01444
United States Census Bureau. (2021). Health Insurance Coverage in the United States: 2020. http://www.census.gov/
Yang, J (2021). Medicare – Statistics & Facts. https://www.statista.com/topics/1167/medicare/#dossierSummary__chapter5