Obamacare also called the Affordable Care Act (ACA) is a Congressional act that made monumental changes to healthcare insurance in America. Among the major changes associated with the ACA is the halving of the numbers of Americans without medical covers between its promulgation in 2014 and 2016. Further, the ACA also provided for improved terms for Americans with less than ideal medical insurance covers, such as those with cost-sharing programs (Zuckerman, Skopec & Guterman, 2017). The Act reduced the ratio of co-sharing even as it placed a ceiling on how much patients pay out of their own pockets. For the purposes of the instant essay, the focus patient falls within the category of the tens of millions who now have health insurance after 2014 specifically because of the provisions of the ACA. Further, for the purposes of comparison, the essay will focus on a standard for-profit US hospital. Finally, the essay will consider the ACA from the perspectives of the states that have already adopted it. Several conservative-leaning states elected to ignore the provisions of the ACA. The USA has one of the best healthcare systems in the world. The said system attracts both patients who come to seek treatment and students who come to learn how to treat patients in their own countries. However, healthcare in the USA is also among the most expensive in the world. High-cost areas include clinical care, cost of medication and equipment through to specialized, and ambulatory care (Feldman, 2011). Without an insurance cover, it is almost impossible for most Americans to afford healthcare. Further, having an insurance cover makes an exponential difference in how clinicians handle and treat patients in most healthcare institutions, more so the for-profit hospitals. The ACA presented a difference between having and lacking healthcare insurance, which in extreme cases meant the difference between life and death or proper care and major suffering .
The emergency room processes vary exponentially from patient to patient depending on the condition and insurance status but it normally follows the same general sequence as outlined hereinbelow.
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The Triage
The triage is normally a combination of an administrative and clinical process but does not involve any form of treatment. Normally a triage nurse conducts the triage process as soon as the patient walks into an emergency room. The nurse will take the basic statistics of the patient such as blood pressure and heart rate and ask a few questions about reason for seeking assistance at the hospital. During a major emergency, such as when a patient is wheeled in by paramedics, the triage nurse will seek these details from the paramedics. If the patient is conscious and coherent, the nurse may also ask the patient some questions. The general idea behind the triage is to designate the patient depending on the apparent condition. The three main designations are emergent, urgent and non-urgent, in their order of priority. On the other hand, it is also during the triage phase that the administration's duty of examining the client’s ability to pay for medical bills takes place (Sommers et al, 2017). For the ACA insured patient on focus herein, triage is relatively routine as the patient has an insurance cover.
Medical Exam
Depending on the outcome of the triage, the triage nurse will assign the patient either to a physician, an advanced practice nurse, a nurse or a physician’s assistant for a medical exam. The medical exam may vary exponentially depending on the patient’s condition. For example, the medical exam may include a few routine tests at a section of the emergency room or it may involve major testing using advanced equipment such as a magnetic resonance imaging (MRI) machine. How the clinicians will handle ACA patients on focus herein depends on the nature exams necessary. Most patients who only manage to get insurance coverage because of ACA will have cost-sharing programs (Zuckerman, Skopec & Guterman, 2017). In the case of normal tests, the clinician will treat the ACA patient just like any other patient. Further, if major exams are necessary to treat a life-threatening condition, the team will treat the patient normally, by carrying out the tests and handling the administrative issues later. However, in the case the tests do not relate to an active emergency, the costly exams will depend on the acquiescence of the patient stemming from the patient’s ability to pay for the exams.
Admission or Disposition
Depending on the results of the exams, the clinicians will decide to either admit or discharge the patient. For emergency cases, the clinicians will not only admit the patient expressly but also proceed to provide all necessary emergency treatment in spite of the emergency (Sommers et al, 2017). In the case of non-emergency based treatment, that requires admission the clinicians will discuss with the ACA focus patient on the way forward. The way forward may involve capable a capable patient agreeing to admission on a cost-sharing basis (Zuckerman, Skopec & Guterman, 2017). It may also involve the patient having to seek the services in a less costly setting such as a community or non-profit hospital. The instant scenario draws to sharp focus an incident that dominated the news in July 2018 when an injured woman begged in alarm for passerby not to call an ambulance for her. The woman must have realized that clinicians may not adjudge her situation as an emergency, a fact that will attract massive medical bills for her.
The other possible outcome is the discharge option, which clinicians may recommend if they can manage to handle the problem without admitting the patient. In most cases, the discharge option will still include some form of outpatient clinical care, with a possibility of some follow-up or ambulatory care. The level of treatment available to the patient will mainly depend on the nature of the applicable insurance cover (Sommers et al, 2017). Once again, some administrative processes will come into play, including payment for the examinations and any treatment already administered. In most cases, the hospital and the patient can work out an arrangement through cost-sharing.
Comparison with pre-ACA Times
Before ACA, the patient in focus herein would not have had any medical cover and in most cases insufficient funds to pay for private hospital-level medical expenses. The only similarity would be of the patient had a life-threatening emergency (Feldman, 2011). If paramedics wheeled the patient into the hospital in such a state, clinicians and the administration would treat her in the same way, before or after the promulgation of the ACA in 2014. However, in some cases, clinicians and administrators would try to play down emergencies to defray costs by transferring the patient to a community hospital. If the patient does not have a life-threatening emergency, the clinicians and hospital administrators would handle the situation differently. They would normally offer minimum care then refer the patient to another hospital, perhaps a community hospital (Feldman, 2011). In some cases, private hospitals may keep sending the same patient away with minimum care such as pain management until the same situation gradually exacerbates into a life-threatening emergency. The hospital would then handle the emergency, normally at a much higher cost but at government expense. It is an unfortunate system where a patient hopes to be in a terrible state in order to access medical attention.
Clinical Care: ACA v. Pre ACA Patients
The nature of treatment and clinical care available to patients before and after the advent of ACA in 2014 differs exponentially (Sommers et al., 2015). It is important to state that the said treatment is not yet ideal. For example, in most developed countries, anyone found unwell within the borders of the country is entitled to primary healthcare. Administrative issues such as insurance or even citizenship status are secondary. However, in the USA, the issues of clinical care and the cost implications thereto go hand in hand. As reflected above, the ACA-covered patient will get treatment subject to any cost-sharing measures. A patient covered under Medicaid or other full cost programs will also receive full treatment. Before the advent of ACA, such patients fell under the non-covered patient bracket (Sommers et al, 2017). It is important to note that even at the present times; there are still tens of millions of non-covered patients. For such patients, having a full-blown emergency is the only redeeming feature as the hospital can then treat the patient the cost of the government.
If such a patient was unwell but the situation is not an emergency, the outcome would be very different before and after the implementation of the ACA. Most private hospitals would decline to attend to the patient beyond first aid even if the patient was in a position to pay for the same . For most private hospitals, a medical cover is a necessity for treatment. If the patient did not have money, the other option would be seeking treatment in a community hospital (Feldman, 2011). These hospitals are well-meaning and determined to assist the sic k. However, they are also understaffed, underfunded and often having more patients than they can handle. The patient would thus see some delays, more so in the case specialized treatment such as surgery. On the other hand, the cost of medication would be a major burden for such a patient. In some cases, uninsured patients have to prioritize between buying medicine or paying for necessities such as food and housing.
Over and above medication, some patients also need ambulatory care at home, as they continue to recover. Conversely, due to advancements in modern clinical care, it is possible for patients to survive major injury or acute conditions. However, many such patients may require some equipment to enable them manage the conditions or the adversities the injuries or conditions visit upon them. Before ACA, uninsured patients would only access the level of ambulatory care that their loved ones could afford. Under ACA, such patients get assistance through government programs such as an expanded Medicare (Sommers et al, 2017). On the other hand, regarding mental health issues, ACA covers treatment for psychological and psychiatric issues even when it is not an emergency (Abraham et al., 2017). Under an ACA-based cover, the patient can get also get rehabilitation and treatment for substance abuse-related disorder. Before ACA, patients without insurance could not access treatment for most mental health issues unless in extreme cases. Based on the above, as far as treatment is concerned, ACA may not have resulted in an ideal situation, but it amounts to a major improvement.
Conclusion
On the one hand, the narrative and analysis above present some good tidings as some Americans who could not access health insurance got access through the ACA in 2014. However, there are also bad tidings since tens of millions of Americans still lack health insurance. The plight visited upon the patient on focus herein before 2014 is still a reality for many Americans. From a positive perspective, the expansion of medical insurance through ACA placed tens has helped tens of millions of Americans. Most of them can now access clinical care even in private hospitals subject to cost-sharing provisions. Due to the expansion of ACA, tens of millions of Americans can now access medication, mental healthcare and ambulatory care that was either inaccessible or extremely costly before 2014. Ideally, everyone domiciled in the USA should have access to primary healthcare services at the expense of the state through a workable program but policymakers have yet to arrive at such a program.
References
Abraham, A. J., Andrews, C. M., Grogan, C. M., D’Aunno, T., Humphreys, K. N., Pollack, H. A., & Friedmann, P. D. (2017). The Affordable Care Act transformation of substance use disorder treatment.
Feldman, J. (2011, May 25). Do Doctors in America Turn Away the Uninsured? Retrieved from https://www.huffpost.com/entry/do-doctors-in-america-tur_b_478267 .
Sommers, B. D., Gunja, M. Z., Finegold, K., & Musco, T. (2015). Changes in self-reported insurance coverage, access to care, and health under the Affordable Care Act. Jama , 314 (4), 366-374.
Sommers, B. D., Maylone, B., Blendon, R. J., Orav, E. J., & Epstein, A. M. (2017). Three-year impacts of the Affordable Care Act: improved medical care and health among low-income adults. Health Affairs , 36 (6), 1119-1128.
Zuckerman, S., Skopec, L., & Guterman, S. (2017). Do Medicare Advantage plans minimize costs? investigating the relationship between benchmarks, costs, and rebates. Issue Brief (Commonw Fund) , 1-11.
