The Affordable Care Act, ACA, is heralded as the most significant legislation since the passage of Medicare and Medicaid in 1965. Enacted in 2010, ACA has three main objectives: availing affordable health insurance to more people through subsidies, expanding the Medicaid program for covering all adults with certain income levels, and supporting innovative care delivery methods in order to reduce healthcare costs (Rosenbaum, 2011). The act also seeks to strengthen access to primary healthcare, and strategically invest in public health by expanding community investments as well as clinical preventive care (Rosenbaum, 2011). Despite ACA’s role in transforming healthcare, it has various areas that need to be reformed in order for it to become more effective, and all-encompassing. This paper seeks to discuss the key components of the Affordable Care Act, and describe some of the areas that should be reformed. Also, reasons and evidence for the proposed changes will be provided.
Access to Health Insurance
ACA’s first component is reformation of the private health insurance market. This entails changing the operation and management of the health insurance market. The act has various provisions geared towards the creation of cost-sharing subsidies and premium, as well as new rules governing the industry. It also strengthens the current health insurance forms, while creating a new market that is affordable for families and people who lack affordable employer coverage like Medicare and Medicaid. In expansion of existing coverage, ACA mainly restructures Medicaid protect all persons whose family incomes are not more than 133% of the poverty level (Hofer et al., 2011). In other words, ACA seeks to change the financial relationship between US citizens and the healthcare system. The aim is to resolve the health insurance crisis that has often afflicted people, communities, families, the system, and national economy. Apart from provisions for shared responsibility and universal coverage, Towers (2013) contends that the act also establishes federal standards that health insurers should follow while offering products. The requirements significantly expand on standards that had been introduced in the 1996 Health Insurance Portability and Accountability Act (Towers, 2013). Furthermore, the act also sets various federal standards for insurers selling products to insurance markets. The aim of the standards is to prohibit discrimination against children, women, adults, and older individuals. Under the insurance component, employers are encouraged to implement organizational workplace activities for promoting and incentivizing optimal health outcomes. Qualified health plans have to meet certain federal standards regarding health-care quality, and provider network sufficiency (Towers, 2013). The act also establishes pre-existing condition health plans for providing affordable coverage for people whose conditions makes insurance coverage uninsurable or unavailable.
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Healthcare Efficiency and Quality
ACA realigns the healthcare system for futuristic changes in quality, design, and transparency of health information. This is achieved through the broad changes in Medicaid and Medicare for empowering the HHS and other programs for testing new delivery modes, including medical homes, and bundled payments. These changes seek to enable public payers to nudge the system and influence it to work in various ways, measure care quality, and evaluate performance. The other element in this component is the provision of prescription drug discounts. When seniors attain the coverage gap, they will access a 50% discount during the purchase of Medicare (Rosenbaum, 2011). Seniors can also access free preventive care, including annual wellness visits as well as personalized prevention plans. Regarding affordability, the act introduces new innovations for reducing costs. This is mainly targeted at minimizing wastes in the system, and adoption of mechanisms for reducing costs, and enhancing patient outcomes. The act also has a National Quality Strategy that generate efficiency and quality measures for promoting value purchasing, better safety, as well as extensive health information across insurers (Rosenbaum, 2011). It emphasizes on efforts for collecting information about disparities to enable the US conduct an assessment of progress for the population, and subpopulations.
Accessibility and Long-term Care
The accessibility component seeks to make primary healthcare more accessible to underserved populations. A significant number of people are medically underserved because of elevated health risks, and inadequate number of professionals in primary healthcare. To tackle this shortage, ACA has invested in the development of community health centres. Rosenbaum (2011) argues that one of the major components of the act is to increase access to services within the community and at home. For example, the Community First Choice Option permits states to provide services, community and home-based, to disabled persons using Medicaid instead of institutional care (Shaw et al., 2014). The accessibility component results from the affordability element that seeks to ensure that all persons can access quality healthcare. For persons who require long-term care, ACA establishes new options for promoting community-based care and protecting spouses of persons with serious illness from poverty. Also, it creates long-term care programs and services for willing persons, including Support Act, and Community Living Assistance Services (Rosenbaum, 2011).
Prevention of Illness and Diseases
Prevention is among the major objectives of the act as it seeks to improve public health, and train health professionals. ACA directly invests in public health through new regulatory requirements connected to clinical preventive services. It has also established a Prevention and Public Health Trust Fund for financing community investments that enhance public health. With a value of $15 billion, the fund offers more funding for prevention activities (Shaw, Asomugha, Conway, & Rein, 2014). In addition, the act invests in programs targeting subpopulations to offer free preventive care. For example, ACA makes new investments in tobacco cessation programs, and activities focusing on oral health-care prevention. More importantly, it allows investments in training professionals in primary healthcare.
Rights and Protections
The Affordable Care Act grants people with control over healthcare. Various consumer protections and rights are available through the law. Patient’s Bill of Rights stipulates consumer protections, and grants knowledge required for making informed health choices (Shaw et al., 2014). Many health insurance plans have to provide easy information that can enable citizens to understand benefits and coverage of a health plan. The other right is related to the freedom to appeal health plan decisions. Consumers can appeal coverage determinations, and decisions could be reviewed through an external process. Also, citizens can get recommended preventive health services without paying anything.
Accountability
The final component of accountability seeks to ensure that insurance companies are accountable. The first sub-component aims to reduce healthcare premiums. To ensure that there is efficient spending on primary healthcare, ACA mandates that not less than 85% of premium dollars that insurance companies collect are allocated to healthcare services, and quality improvement (Antwi et al., 2015). In case insurance organizations fail to meet these objectives due to their high administrative costs or the quest for higher profits, the act mandates them to offer rebates to consumers. The second element in this component aims to tackle overpayments made to large insurance companies, and strengthen Medicare advantage. Through the payment of at least $1000 to insurance companies for every individual, there has been an increase in premiums for all beneficiaries (Shaw et al., 2014). The law makes the playing field even through elimination of this discrepancy. Persons covered by Medicare Advantage plan still receive Medicare benefits, and the act offers bonus payments to plans providing high-quality care.
Reform Areas
ACA had made substantial progress in solving challenges that have been afflicting the healthcare system of the US related to quality, affordability, and access. Since its enactment, there has been a decline in the uninsured rate by 43% because of reforms in healthcare (Obama, 2016). However, certain areas of the act remain ineffective and counterproductive in improving the quality of healthcare. This paper proposes that five major areas should be reformed in the act: improvement of affordability of premium tax credits, tackling unaffordable cost sharing, addressing the “family glitch,” support for enrolment help, and incentivizing all the states to expand Medicaid.
First, the act’s affordability guidelines are not sufficiently affordable for premium tax credits. Consequently, Mcdonough (2016) argues that about 7.1 million of the 32.3 million of the uninsured can access tax credits, but decide not to utilize them. Therefore, there is need to improve the affordability of premium tax credits. This should be set at a maximum of 8.5% cap on insurance costs for households. Secondly, there is need to tackle unaffordable cost-sharing. The reason is that many families that have private health insurance are exposed to unaffordable cost sharing levels. The evidence is that people with incomes ranging between 250 per-cent and 400 per-cent of FPL receive premium support, but lack cost-sharing protections (Mcdonough, 2016). Also, families that have employer-based coverage experience higher cost-sharing. Consequently, there is need to further eliminate and reduce cost sharing. This could be tackled by setting the coverage value at the ‘gold” instead of “silver” Exchange standard. The other option could be the establishment of protections for all citizens by providing a maximum tax credit of $5000 for offsetting costs larger than five percent of household income.
Thirdly, the family glitch problem should also be addressed to improve access to healthcare. The reason is that families are still ineligible despite qualifying for subsidies. The evidence is that about two to four million Americans remain uninsured due to this purposeful ACA limitation. There is need to eliminate the glitch. Fourth, there is need to support enrolment and renewal. Many assume that the urge for enrolment help would disappear after a short period of implementation. However, this is not true, and there is need to allocate $500 million annually for enrolment assistance (Mcdonough, 2016). Finally, there is need to incentivize Medicaid expansion in all states. Medicaid expansion was made optional by the decision of the Supreme Court in 2012. However, various states have failed to expand. There is need to introduce new financial incentives to enable the other states to expand.
Overall, the major components of ACA are access to health insurance, efficiency and quality, accessibility and long-term care, prevention of illness and diseases, rights and protections, and accountability. Despite the act improving affordability, accessibility, quality, efficiency and accountability, it still falls short in various areas. The reform areas that should be addressed are the family glitch, expansion of Medicaid in all states, support for enrolment assistance, unaffordable cost-sharing, and unaffordable premium tax credits. There is need for bipartisan cooperation if these changes are to be realized.
References
Antwi, Y. A., Moriya, A. S., Simon, K., & Sommers, B. D. (2015). Changes in emergency department use among young adults after the Patient Protection and Affordable Care Act’s dependent coverage provision. Annals of emergency medicine , 65 (6), 664-672.
Hofer, A. N., Abraham, J. M., & Moscovice, I. (2011). Expansion of coverage under the Patient Protection and Affordable Care Act and primary care utilization. The Milbank Quarterly , 89 (1), 69-89.
Mcdonough, J. E. (2016). How Might Democrats Try to Improve and Expand the ACA in 2017?. The Milbank Quarterly , 94 (3), 468-475.
Obama, B. (2016). United States health care reform: progress to date and next steps. Jama , 316 (5), 525-532.
Rosenbaum, S. (2011). The Patient Protection and Affordable Care Act: implications for public health policy and practice. Public health reports , 126 (1), 130-135.
Shaw, F. E., Asomugha, C. N., Conway, P. H., & Rein, A. S. (2014). The Patient Protection and Affordable Care Act: opportunities for prevention and public health. The Lancet , 384 (9937), 75-82.
Towers, J. (2013). The Patient Protection and Affordable Care Act. Health Policy and Advanced Practice Nursing: Impact and Implications , 87.
