...the provision of health coverage to Americans, and is the most far-reaching law affecting managed care and insurance since the enactment of Medicaid and Medicare (Kongstvedt, 2013). By ensuring that all Americans have access to health care and are covered under some kind of policy, the Affordable Care Act is expected to give 30 million more Americans health insurance putting an increased demand on an already taxed workforce. According to Anderson (2014) the ACA breaks the promises of access and quality of care for all Americans by escalating the shortage and increasing the burden and stress on an already fragile system. Although there are many kinks to work out, health care reform is not only necessary, but it must happen in order to keep moving forward. Before reform our health care system was truly in crisis. The Impact of the ACA on Current Practices in Health Insurance The ACA has changed a lot in health insurance and most changes were intended to go into effect within the first 12 months. Some immediate reforms such as restrictions on the use of annual and lifetime benefit limits, expansion of coverage to dependent children, access to emergency and preventive services, and creation of new mechanisms to provide health insurance information to consumers (Kongstvedt, 2013). For individuals who already...
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...HCS/455 May 18, 2015 John Cutspec Policy Process: The Affordable Care Act The Patient Protection and Affordable Care Act signed by President Obama on March 23, 2010 as the means to enforce Health Insurance reform. Its main object is to make Health Insurance and Preventive care accessible and affordable to the American population. The Affordable Care Act The ACA major components include: Medicaid expansion, allowing states the opportunity to expand their existing Medicaid programs to include, (OPA, 1015) “individuals under 65 years of age with incomes up to 133% of the federal poverty level… (as well as) certain low-income adults without children” (Medicaid Expansion). Health Insurance Marketplace (HIM), available for access to individuals and small businesses enabling them to compare a variety of plans on the basis of price, quality and benefits and to choose the most affordable option according to their needs. The proposed three models are State Operated, State and Government Operated, and Federal Government Operated, for States that choose not to establish a program. Under the ACA, health services provided by all Insurance companies (participating or not on the HIM) are required to offer individuals and small businesses, affordable health Insurance plans that allow access to ten services identified as Essential Health Benefits (EHB). EHB services include, Ambulatory and Emergency services, Hospitalization, Maternity and newborn care, Mental health, substance use...
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...Introduction…………………………………………………………………………………………………………………3 The History of Healthcare Reform……………………………………………………………………………..…4 The Problem with the ACA……………………………………………………………………………………………6 The Current Policy………………………………………………………………………………………………………..8 Policy Alternatives………………………………………………………………………………………………………10 Evaluation Criteria………………………………………………………………………………………………………10 Policy Recommendation……………………………………………………………………………………………..12 Conclusion…………………………………………………………………………………………………………………..13 References………………………………………………………………………………………………………………….14 Introduction Recent health care reform legislation, The Patient Protection and Affordable Care Act and Education Reconciliation Act, which is now being referred to simply as the Affordable Care Act (ACA), was signed into law by President Obama on March 23, 2010. Since the 20th century, several United States presidents have faced challenges in passing national health reform into law. Before the ACA was enacted, national health reform proposals under different governments in the United States faced strong opposition from various stakeholders and multiple interest groups. Therefore, the enactment of the ACA is revolutionary healthcare reform in the history of the United States. Healthcare insurance is a program that assists in paying medical expenses through privately purchased insurance or social welfare programs. In other words, health insurance is a system that provides protection against health costs. This newly legislated healthcare reform offers health insurance for all Americans...
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...in age, there are many health care payment systems that are offered to the people. One of the most well known systems is called the Affordable Care Act, which is also known as Obamacare. President Barack Obama created this health care payment system, hence the name “Obamacare”. The Affordable Care Act (ACA) is also one of the more new care systems in our country. Enacted in March of 2010, it will expand health coverage to over 25 million Americans. The Affordable Care Act is broken down into three sections: coverage, costs, and care. It offers people more guarantees than other health care systems do. There are many American citizens that do not like the idea of this new care act, while others believe it helps greatly. The purpose of this care act is mainly to offer more Americans with access to health care insurance as well as improve the quality of the care and insurance. Along with these goals, it looks to reduce the spending on health care in the United States. This history of the Affordable Care Act is not a long one, due to its recent birth. “The Patient Protection and Affordable Care Act (the ACA, for short) became law with President Obama’s signature on March 23,2010,” (Manchikanti, E35). It is one of the most remarkable transformations since Medicare and Medicaid in 1965. Obamacare argues that it changes every aspect of health care. This ranges from not only the insurance itself but to the delivery of the care. “Health care reform became a major component of campaigning...
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...Introduction: ACA (Affordable Care Act) was signed by President Obama on March 23rd 2010 to reform the US medical system. ACA changes the non-group insurance markets in the US and each individual should have health insurance which helps significantly to develop the markets of the public insurance and support the private insurance coverages which leads to rise in the revenue from the new taxes and reorganizes the Medicare health insurance plan. According to Gurbers assumption of funding ACA is mainly based on the “Three legged Stool” approach followed to fix the Non employer insurance in the United states and which helps in the increasing the market of the health insurance in the country. The reforms included based on the three legged stool strategy to the non-group insurance market. First to prohibiting exclusions for the pre-existing conditions and charging different prices based on the health status. The second leg of the stool looks in to the individual authority to take the insurance policy. The third leg of the stool deals with the Subsidiary for the low income families to have the insurance plan. ACA finances through following sources for the above are 1) To improve the government Medicare plans for the seniors by reducing befits of the private Medicare Advantage programs which affects the 14% financing share. 2) Decreasing of the Medicare reimbursement through decrease in adjustments provided to the hospitals every year for the Medicare reimbursement due to this 33%...
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...Stephanie Myers December 4, 2014 The Affordable Care Act and Medicaid Reimbursement Shortcomings Fewer physicians are accepting new Medicaid patients today, mainly because of low reimbursement rates and the large increase in the number of Medicaid enrollees. As many states have expanded Medicaid in response to the Affordable Care Act (ACA), which promises additional federal funds for a number of years, the number of Medicaid patients has increased dramatically. The problem is Medicaid only reimburses doctors about 60 percent of what private insurers pay (Glans, 2014). Many physicians limit the number of Medicaid patients they serve in comparison to those with private insurance because they simply cannot afford to take too many patients receiving subsidized care (Glans, 2014). Unfortunately, some refuse to accept any Medicaid patients, and with the shortage of primary care providers, is access really improving? Insurance officials recognize the reduced rates in some plans, and express are under enormous pressure to keep premiums affordable. They believe that physicians will make up for the lower pay by seeing more patients, since the plans tend to have smaller networks of doctors. From the provider perspective, if a rate has already been negotiated from insurance, it should be the same on or off the exchange since the same services is being provided (Rabin, 2013). Yet many physicians complain of not being able to see their current patients, so it is unlikely public insurance...
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...Cost of U.S. Health Care. BY Vilando. HSA500 November 15, 2015 Funding the Rising Cost of U.S. Health Care. The United States continues to spend significantly more on health care than any country in the world, however, even though with this statistics the U.S has a lot of uninsured and does not have the healthiest citizens. In this paper, opinions will be given on the rising cost of overall’s health care’s impact in the U.S economy, followed by a comparising and contrasting factors impacted by the new health care act, pros and cons of using the private insurance rather than using the new health care reforms and the cost associated with its implementation and access to different groups will also be discussed. Rising Cost of Health Care The cost of the U.S health care system is higher than any country in the world. Its efficiency is also under serious scrutiny. If it was not an emergency, most physicians would require insurance verification. Therefore patients will be delayed of treatment. Moreover, the health care system in the U.S should be redesigned in terms of prevention rather than treatment with people who are already sick. Insurance should not go higher for people that have pre-existing conditions or with more health risk. Also the emergence and new discoveries in the field of medical technology can...
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...debate the advantages and disadvantages of ObamaCare, aka Affordable Care Act (ACA), for the American people. While many are elated and view the government as taking responsibility for those who in the past have not seen a doctor on a regular basis due to having no insurance, there are still others who believe that the passage of the law will be detrimental to the country’s economy. Many are concerned that individuals will no longer have the choice of what type of medical attention they receive because the government will make those decisions for them. The truth is the Affordable Care Act requires certain types of coverage and ends discrimination that has led to higher costs and cancellations for women and people with pre-existing medical conditions. “The new ACA is a law aimed at reforming the American healthcare system. Its main focus is on providing more Americans with access to affordable health insurance, improving the quality of healthcare, regulating the health insurance industry, and reducing health care spending in the US.” In spite of the many attempts by the GOP to overthrow the ACA, the fact is that it is not Government provided healthcare, but an approach by the government to subsidize and regulate private health insurance and expand Government healthcare programs like Medicare and Medicaid. There are ongoing arguments between Democrats, Republicans, and the American people over the ACA offering contraception with no charge to the patients, particularly for companies...
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...quality of care and places a financial strain on the government, individuals and families, employers and employees, and public and private providers. Most of the Medicare beneficiaries have to enroll in the MA program to help them to succeed and receive the adequate treatments without MA to help the disadvantaged seniors on the island, Puerto Rico's elderly citizens will be forced to turn to Mi Salud in larger numbers. Although Mi Salud is scheduled to receive an average of $690 million annually during the next five years, the widening deficit in MA funding is likely to create a net negative impact on federal funding for healthcare in Puerto Rico. The Health care Policies and Issues Ethical concerns and issues The Affordable Care Act (ACA) policies are intended to give patients more access to health care without any restrictions as in the past that were imposed by the Health Care Industry and at a reasonable cost capping the administrative costs to the industry to no more than 20% of what the insurance costs. These restrictions were based on how much a person paid for health insurance, the...
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...employees and employers. Introduction The Affordable Care Act (ACA) as signed on March 23, 2010 by President Barack Obama with the purpose to provide complete health insurance that will; hold insurance companies’ accountable, decrease the cost of healthcare, guarantee more choices, coverage expansion, and enhance the quality of care for all Americans (ACA History, 2016). The affordable care Act is comprised of two separate pieces of legislation; Patient Protection and Affordable Care Act, the Health Care and Education Reconciliation Act of 2010 (ACA History, 2016). How ACA Came to Existence For the last 75 years democratic Presidents had attempted to create a nationwide insurance system but they were all unsuccessful. In 2009 was the first year of Obama’s presidency and the house of Democrats introduced a plan of 1,000-page plan with the intention to overhaul the healthcare system on July 14th causing a raged debate on the topic (ACA History, 2016). The senate prohibited individuals that were unlawfully present in the U.S. to benefit from the health reform. Although all republicans voted against it, the senate bill was amended and approved by the House on March 21, 2010 with 219-212 vote (ACA History, 2016). Despite the promise of the GOP candidate to undo ACA, Obama’s reappointment on November 2012 allowed the ACA to turn into a reality. Features of the Law by Year 2010 -Small business were granted rebate for providing...
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...on ACA Readmission Patient Safety Organization (PSO) was designated by the Affordable Care Act to assist Hospitals with relatively high readmission rates to reduce the number. Readmission is defined as an admission of a patient to the hospital within 30 days of the date of discharge. According to the Centers for Medicare & Medicaid Services (CMS), University Hospitals was on the list of high readmission rates, with an AMI of 21.8, HF of 26.6, and a total of 1328 of discharges. There are many resources available on reducing unnecessary hospital readmissions, for example, the ProjectRED, which “can reduce readmissions by integrating better communication among clinicians and patients and by instituting follow-ups after discharge” (CMS). However, one important approach was to improve the transition process in inpatient and outpatient care for UH. By setting up a detailed and enforceable action plan to improve continuity of care, UH should focus on the following aspects: the compliance of national safety goals and regulations, the quality of transition approaches, the follow-up of regular reexamine, etc. These are not only methods to avoid high readmission rates, but also techniques to improve patient satisfaction and to reduce unnecessary administrative costs. Furthermore, another plausible approach is to bring closer relationship between hospitals and patient families, since they are an important part of patient satisfaction. Pay-for-performance Based on CMS. ACA established...
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...Health Care Reform: Impact on Patient Safety, Quality of Care, and Economics November 7, 2015 Health Care Reform: Impact on Economics, Patient Safety and Quality of Care With the implementation of the Affordable Care Act (ACA) in 2010, never before in the history of the United States has there been a more opportune time to cater to the stakeholders, American citizens, and health care industry to improve quality and the way in which health care is delivered. Health care reform has changed and improved the entire spectrum of the health care environment. The three primary goals of the ACA are; consumer protection, improving quality/ lowering cost and increasing access to affordable care (DHHS 2014). Health care reform has affected all three of these goals and have impacted both positively and negatively, patient safety, quality of care and American economics. Impact of Health Care Reform on the Economy According to a study by the Congressional Budget Office (CBO), there have been substantial savings in Healthcare costs. One major reason for the savings is preventative health care. Preventative healthcare saves money on prevention and early detection of illnesses and diseases. The result is people don’t have to wait until their illness becomes so serious that they end up having to go to an emergency room for costly procedures. It has also lowered heath care cost by making preventative health care available and affordable for 33 million Americans who would...
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...The Healthcare Reform aka Obamacare aka Affordable Care Act (ACA) was signed into law reform by president Barrack Obama and taken into Supreme Court on June, 28th 2012. The goal of the affordable Care Act is to provide individuals with health insurance that they can afford. Americans applied for coverage when open enrollment in the marketplace starting October 1st 2013 and started receiving coverage by January 1st 2014. Obamacare is not for those who already have health coverage through an employer, Medicare or Medicaid. If you already have insurance you do not have to worry about this. “Obamacare does not replace private insurance Medicare or Medicaid” (obamacarefacts.com). The Healthcare Law will benefit those on Medicare Medicaid and private insurance providing better options, better values and better healthcare. A topic that has been trending is whether Obamacare is “affordable” or not. The Healthcare Reform will cost families and individuals a small percentage of what they earn after cost assistance. Obamacarefacts.com state “Obamacare will cost most of us between 3% and 9% of our income after cost assistance.” Cost assistance is given to low to middle income Americans. People who do not qualify for tax credits and cost assistance can still find a good deal in the health insurance marketplace. The ACA for a lot of Americans have provided affordable health coverage, but for many who are struggling with will already have to find the extra money for coverage. Obamacare...
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...Medicaid is the State and Federal joint venture that provides medical coverage to the eligible individuals. The purpose of Medicaid in Texas is to improve the health of people whose income and resources are insufficient to pay for health care. The Texas Health and Human Services Commission's (HHSC) Medicaid Office is responsible for statewide oversight of Texas Medicaid. The mission of the Texas Medicaid program is to improve the health of Texans by emphasizing prevention, promoting continuity of care, providing a medical home for Medicaid recipients and ensuring that each recipient can receive high quality, comprehensive health care services within the community. (6) Medicaid serves primarily low- income families, children, caretakers of dependent children, pregnant women, cash assistance recipients, people aged 65 and older, and adults and children with disabilities. Medicaid pays for acute health care (physician, inpatient, outpatient, pharmacy, lab, and x-ray services), and long-term services and supports (home and community-based services, nursing facility services, and services provided in Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICFs/IID)) for people age 65 and older and those with disabilities. Texas Medicaid provides major portion of healthcare services through managed care model. (1) There are basically four Medicaid programs in Texas. The type of coverage an individual gets depends on his/her...
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...health care coverage for the elderly, poor, and disabled. Medicare has become the largest single payer health entity spending $57.9 billion in 1980, $271 billion in 2003, and $513 billion in 2010 (Social Security Administration, 2012). Whereas, Medicaid being state funded, its governance is state-specific for spending. There have been very few changes to The United States health care payment system since Medicare’s and Medicaid’s inception, until March 23, 2010, when President Barac Obama signed into law the Patient Protection and Affordable Care Act (ACA). The three main goals of the ACA are to: increase the access to health care for all Americans, increase their quality of care, and make this care affordable. Unfortunately, despite the ACA’s good intent, its scope was far reaching, glossed over current problems within health care, and created more issues. It is filled with contradictory verbiage that required multiple teams of lawyers to decipher (with many different interpretations), and changed health care reimbursement with unknown consequences. Description of Policy and the Legislation The ACA attempts to solve the reimbursement problems in several ways. The act established the Center for Medicare and Medicaid Innovation within the Centers for Medicare and Medicaid Services, which is responsible for overseeing voluntary pilot reimbursement models (Guterman, Davis, Stremikis, & Drake, 2010) . The pilot models include: patient-centered medical homes, accountable care organizations...
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