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Strengths and weaknesses of the affordable care act as a reform to the existing u.s. healthcare system
Introduction to affordable care act
Introduction to affordable care act
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ACO is an organization that consists of doctors, suppliers of health care e.g hospitals, clinics, all health care services, and anyone involved in patient care to provide the best possible care for all Medicare patients. This model was adopted by the Affordable Care ACT with the number one goal of providing timely, accessible and appropriate care for all Medicare patients. Not only was the ACO supposed to provide the best care, but a very important aim was to reduce unnecessary hospitalization of patients, unnecessary medical emergency visits, and any other duplicated medical service. This was supposed to bring about big changes in the health care system as it number one aim was to reduce the health care cost for the government and everyone
One being the Health Maintenance Organizations (HMO), which was first proposed in the 1960s by Dr. Paul Elwood in the "Health Maintenance Strategy”. The HMO concept was created to decrease increasing health care costs and was set in law as the Health Maintenance Organization Act of 1973, after promotion from the Nixon Administration. HMO would, in exchange for a fee, allow members access to employed physicians and facilities. In return, the HMO received market access and could earn federal development funds. An HMO is a integrated delivery system that combines both the delivery and financial aspects of health care for consumers. Under the HMO, each patient is appointed to a primary care physician (PCP), who is essentially accountable for the long-term care of the members that she/he has been assigned and any specialists that a patient needs to see should be referred by their PCP. Some examples of HMOs are Kaiser Permanente and Humana. HMOs are licensed at the state level, under a license that is known as a certificate of authority. A pro of an HMO is that treatment for a patient can begin prior to their insurance being authorized; A member may benefit from this because there would be little to no treatment delays. A con of an HMO is that in order to save cost, most HMOs provide narrow provider networks; A member may not benefit if in an emergency because their “in-network” emergency room might be far or there are “quick-care” in their
The Affordable Care Act seeks to reduce health care costs by encouraging doctors, hospitals and other health care providers to form networks which coordinate patient care and become eligible for bonuses when they deliver that care more efficiently. Accountable Care Organizations (ACOs) make providers jointly accountable for the health of their patients, giving them financial incentives to cooperate and save money by avoiding unnecessary tests and procedures. About four million Medicare beneficiaries are now in an ACO, and, combined with the private sector, more than 428 provider groups have already signed up (CMS, 2014). An estimated 14 percent of the U.S. population is now being served by an ACO (CMS, 2014).
Health Maintenance Organizations, or HMO’s, are a very important part of the American health care system. Also referred to as managed care programs, HMO's are combinations of doctors and insurance companies that are formed into one organization. This organization provides treatment to its members at fixed costs and decides on what treatment, if any, will be given based on the patient's or doctor's current health plan. Sometimes, no treatment is given at all. HMO's main concerns are to control costs and supposedly provide the best possible treatment to their patients. But it seems to the naked eye that instead their main goal is to get more people enrolled so that they can maintain or raise current premiums paid by consumers using their service. For HMO's, profit comes first- not patients' lives.
The ACA assumes that cost control responsibilities will be shared between MCOs and Accountable Care Organizations. Medicare is authorized to develop payment methods for ACOs. Payment must include a shared savings program – pay additional moneys to ACOs that achieve targeted cost savings while meeting quality standards. This cost control method with quality management increasing the utilization of the managed care.
The United States (U.S.) has a health care system that is much different than any other health care system in the world (Nies & McEwen, 2015). It is frequently recognized as one with most recent technological inventions, but at the same time is often criticized for being overly expensive (Nies & McEwen, 2015). In 2010, President Obama signed the Patient Protection and Affordable Care Act (ACA) (U. S. Department of Health & Human Services, n.d.) This plan was implemented in an attempt to make preventative care more affordable and accessible for all uninsured Americans (U.S. Department of Health & Human Services, n.d.). Under the law, the new Patient’s Bill of Rights gives consumers the power to be in charge of their health care choices. (U.S. Department of Health & Human Services, n.d.).
The current state of affairs in the development of health policy in the United States is that it is constantly in flux and its implementation is disorganized and inefficient. As was the case with the recently passed Affordable Care Act legislation, political and lobbying interests often intersect in a manner that makes meaningful, most appropriate changes unlikely. The ACA kept in place the fractured nature of American health care and insurance, and appears to have benefited insurance companies by increasing enrollments rather than making the care provided better on a large scale. The majority of the plans on the created exchanges, up to 87%, are funded by federal subsidies (Blumenthal, Abrams, & Nuzum, 2015). These plans must cover individuals regardless of pre-existing conditions. The burden of the cost of insurance shifted to tax-payers and the young/healthy who are now overly burdened with mandatory coverage that they may or may not need in
ACOs provide care for a specific group of individuals assigned retroactively based upon previous utilization for primary care however an ACO cannot mandate that patients see specific providers (Harrison, 2016). This can lead to problems if patients began seeing different doctors due to preference or convenience ultimately disrupting the continuity of care the ACO is attempting to achieve. It is also can be a significant factor if a particular organization is assigned numerous noncompliant patients. These patients would require significant effort by the organization to meet the quality standards such as blood pressure management, yearly physical, etc. Those efforts could potentially result in significant cost increase, nullifying any cost savings. Concern for other possible limiting factors includes the setting of the standards that organizations are to meet and what is structure of those responsible for governing
If the United States had unlimited funds, the appropriate response to such a high number of mentally ill Americans should naturally be to provide universal coverage that doesn’t discriminate between healthcare and mental healthcare. The United States doesn’t have unlimited funds to provide universal healthcare at this point, but the country does have the ability to stop coverage discrimination. A quarter of the 15.7 million Americans who received mental health care listed themselves as the main payer for the services, according to one survey that looked at those services from 2005 to 2009. 3 Separate research from the same agency found 45 percent of those not receiving mental health care listing cost as a barrier.3 President Obama and the advisors who helped construct The Affordable Care Act recognized the problem that confronts the mentally ill. Mental healthcare had to be more affordable and different measures had to be taken to help patients recover. Although The Affordable Care Act doesn’t provide mentally ill patients will universal coverage, the act has made substantial changes to the options available to them.
The Affordable Care Act (ACA) is a federal that was signed into law by President Barack Obama on March 23, 2010 to systematically improve, reform, and structure the healthcare system. The ACA’s ultimate goal is to promote the health outcomes of an individual by reducing costs. Previously known as the Patient Protection and Affordable Care Act, the ACA was established in order to increase the superiority, accessibility, and affordability of health insurance. President Obama has indicated the ACA is fully paid for and by staying under the original $900 billion dollar budget; it will be able to provide around 94% of Americans with coverage. In addition, the ACA has implemented that implemented that insurance companies can no longer deny c...
The Affordable Care Act (ACA) was passed into law to provide greater healthcare coverage to millions of Americans. The passage of the ACA bill into law was to eliminate the gap between existing health care disparities among the undeserved, underprivileged and minority groups. However, the ACA have not abolish health care disparities but only reduce them to some extent. For instance, The ACA mandates that both Medicaid and insurance plans cover lifesaving preventive services recommended by the US Preventive Services Task Force, including colorectal cancer (CRC) screening and choice between colonoscopy, fecal occult blood testing (FOBT) and flexible sigmoidoscopy (Green, Coronado, Devoe, & Allison, 2014).
The Affordable Care Act, more commonly known as Obamacare, is a new health policy created by the American federal government. Its purpose is to make healthcare more affordable and friendly for the people. Unfortunately in some way that does not prove to be the case. It is becoming apparent that Obama may have made some misleading statements to help get the ACA put into action. The ACA is sprinkled with many flaws that call for a reform such as people’s current plans being terminated, high costs, and at minimum some people’s hours being cut by their employers.
Health insurance, too many American citizens, is not an option. However, some citizens find it unnecessary. Working in the health care field, I witness the effects of uninsured patients on medical offices. Too often, I see a “self-pay” patient receive care from their doctor and then fail to pay for it. Altogether, their refusal to pay leaves the office at a loss of money and calls for patients to pay extra in covering for the cost of the care the uninsured patient received. One office visit does not seem like too big of an expense, but multiple patients failing to pay for the care they receive adds up. Imagine the hospital bills that patients fail to pay; health services in a hospital are double, sometimes triple, in price at a hospital. It is unfair that paying patients are responsible for covering these unpaid services. Luckily, the Affordable Care Act was passed on March 23, 2010, otherwise known as Obamacare. Obamacare is necessary in America because it calls for all citizens to be health insured, no worrying about pre-existing conditions, and free benefits for men and women’s health.
After the inception of ACA that is Affordable Care Act on March 23, 2010 various policies and regulations has been proposed which has more controversy (www.healthcapital.com, 2013). Affordable health act has impact on the stakeholders in different manner. The main concern in the medical field is the input cost which is increasing continuously. This is the biggest challenge for the US government as the increasing cost makes it impossible for the government to allocate appropriate resources in managing the requirements of the ACA public policy. There are more initiatives taken by the US government in implementing the ACA in an appropriate manner by continuously improving the quality of health care at affordable lower costs (www.healthcapital.com, 2013). According to Kaiser Health Tracking Poll conducted in March 2013, about 40% of the public are against the ACA and 37% are supporting the ACA which satisfies the legislative requirements (www.healthcapital.com, 2013). Key issue in health care industry is the quality of doctors and the number of doctors available, this ACA mainly aims to address the issue of all citizens especially poor. The constituency of the act makes the US government to think about the Supreme Court Judgement about emphasising all citizens should have health insurance (NYTimes, 2014).
In March 2010, the future of health care system in United States changed when The Affordable Care Act (ACA) (most popularly known as Obama Care) was approved. The law expands quality Health Care to more than ten million of previously uninsured people in United States. The Health Care law opens the door for access to care, more affordable to the cost of illness and the possibilities to get the care needed for citizens to be healthy.
According to Roy, 2013 the issues of providing the affordable care act will unite both the supporters and offenders of the public policy, but in this current situation where the input costs are rising, it will become impossible for government in managing the public policy related to affordable health care. In order to provide affordable health care, majority of the US government has tried out different policies time to time, but unable to get success in realizing the actual policy goals. By providing the affordable health care to majority of the people who requires more amount as controlling the input cost is not possible (AAMC, 2013). Lack of doctors is one of the primary issue in providing high quality health care to the citizens especially those who are financially poor. The Supreme Court of the country passed an Act related to Health insurance as all should have Health Insurance to all the country people by the year 2014, but the at the same time government is concerned about constitutionality of these act (NYTimes, 2013).