The Affordable Care Act (ACA) was signed into law in the year 2010. The major provision of the ACA was passed in the year 2014 and approximately two years after it was introduced, the percentage of uninsured population was reduced significantly. The law also involved a series of healthcare reforms that aimed at improving quality of care and reducing healthcare costs. The specific section of the ACA that will be analyzed is “TITLE I—QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANS” and the subtitle is “Subtitle A – Immediate Improvements in Health Care Coverage for All Americans”.
Summary of Subtitle A
Subtitle A has four different sections where Sec. 1001 highlights the amendments of the public health service act. Other sections Sec. 1002 highlights health insurance consumer information, Sec. 1003. ensures consumers get values for their dollars and Sec. 1004 highlights effective dates for the implementation. Sec. 2711 prevents plans from establishing unreasonable annual or lifetime limits on dollar value of benefits and Sec. 2712 prohibits plans from rescinding coverage except for instances of misrepresentation or fraud. Sec.2713 required all plans to have preventive services while Sec.2714 extended the dependent coverage up to age 26. Other sections of the subtitle focused on coverage documentation requirements, prohibition of discrimination based on salary, quality of care improvement, and bringing down the costs of healthcare coverage.
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Connections to Family Nurse Practitioners
The ACA Subtitle A has several connections to family nurse practitioners and clients that adults and pediatric patients that have acute and chronic illnesses. Family nurse practitioners were impacted with the increase in the number of patients. This is because Subtitle A increased the dependent coverage age to 26 and prohibited rescissions and discriminations based on salary leading to a higher number of insured patients that were able to access healthcare. Lee and Monuteaux (2019) observe that 900,000 children were able to obtain health insurance after ACA was passed. The increase in insurance coverage meant that there was increased coverage for individuals with chronic diseases. Torres et al. (2017) observe that approximately half of Americans have at least 1 chronic disease. The introduction of ACA meant that racial and ethnic minorities that previous lacked insurance coverage were able to have healthcare access. One of the specific items that Subtitle A focuses on is nondiscriminatory insurance coverage and this led to the minority populations and people with low income having insurance coverage.
How ACA Subtitle Improves Healthcare Access and Quality of Care
The ACA Subtitle A focuses on improving healthcare access and quality of care. By raising the dependent coverage to age 26, young adults that were between the age of 19 and 25 experienced increased health insurance coverage and thus improved healthcare access (Wallace & Sommers, 2015). Parsons et al. (2016) observe that there was an increase in healthcare coverage for this population by 1.9%. Subtitle A focuses on improving the quality of care with Sec. 2717 requiring states to develop guidelines for initiatives and programs that would improve health outcomes through chronic disease management, care coordination, preventive services, and patient safety. Sommers et al. (2017) thus identified that the ACA resulted in an increase in preventive health visits and improved medical care. The overall impact increased healthcare access and quality of care was improved health and wellness among the United States population.
Economic and Financial Implications of Subtitle A
Subtitle A resulted in a reduction in healthcare costs and an increase in healthcare coverage which had multiple economic and financial implications. Sec. 2718 sought to bring cost of health care coverage by reporting their total premium revenues. Hu et a. (2016) thus observed that ACA resulted in a decrease in unpaid balances by $65 and $88 and the amount of unpaid balances decreasing by $1,140. Kamal et al. (201k) observe that there has been an increase in heath spending from 2014 which grew by 4.4% per capita as a result of more people having health coverage from ACA. However, such increases in healthcare spending have resulted in healthcare institutions experiencing strain in their resources and increased spending among insurance providers.
Analysis of Whether Subtitle A is Working or Not Working
Subtitle A is working because it has realized improvement in healthcare coverage, increase in healthcare access and quality of care. Sommers et al. (2017) observe that the uninsured population rates have dropped by approximately 20 percent due to nondiscriminatory care. The study also showed that there was an increase in preventive health visits and a 23 percent point increase in individuals that reported their health as excellent. For the adult population that had chronic conditions, the study found that there was an improvement in affordability of care and medication adherence. The implementation of sections of Subtitle A show that it is working effectively to improve the health status of the United States population.
Medicaid Expansion in Mississippi
Medicaid expansion has been a key issue in Mississippi with the legislators in the state choosing not to expand Medicaid. The recently held elections saw the election of a governor that opposed Medicaid expansion making it unlikely that Mississippi will expand Medicaid for the next four years (“Status of State Medicaid by State”, 2020). The implications of not to expand Medicaid has resulted in suffering among the residents. The state chose not to expand and forewent $1 billion from the federal government every year since 2012. Another implication is that the state has had the highest rank of uninsured rates and ranked 45 out of 50 (Mcausland, 2019). Many uninsured individuals have the burden of medical debt. Healthcare costs have made more than half of Mississippi residents avoid filling a prescription due to the associated costs and skip medical tests (Mcausland, 2019). The choice of not to expand Medicaid has resulted in poor quality of care and increased suffering among the population.
Conclusion
The chosen Subtitle A on immediate improvements in health care coverage for all Americans has resulted in an improvement in the number of insured individuals. This has had positive outcomes as the population has experienced improvement in healthcare access and quality of care. However, for states that have chosen not to expand Medicaid like Mississippi, they continue to experience a high percentage in the number of uninsured population and thus poor quality of care.
References
Hu, L., Kaestner, R., Mazumder, B., Miller, S., & Wong, A. (2016). The effect of the patient protection and affordable care act Medicaid expansions on financial wellbeing (No. w22170). National Bureau of economic research. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/30393411
Kamal, R., Sawyer, B., McDermott & Kurani, N. (2019). How much is health spending expected to grow? Current information on healthcare spending in the U.S. Retrieved from https://www.healthsystemtracker.org/chart-collection/much-health-spending-expected-grow/?_sf_s=health+spending
Lee, M., & Monuteaux, M. C. (2019). Trends in Pediatric Emergency Department Use After the Affordable Care Act. Pediatrics, 143(6), e20183542. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/31118219
McCausland, P. (2019). “Residents suffer as Mississippi and 13 other states debate Medicaid expansion”. Retrieved https://www.nbcnews.com/news/us-news/residents-suffer-mississippi-13-other-states-debate-medicaid-expansion-n1075661
Parsons, H. M., Schmidt, S., Tenner, L. L., Bang, H., & Keegan, T. H. (2016). Early impact of the Patient Protection and Affordable Care Act on insurance among young adults with cancer: analysis of the dependent insurance provision. Cancer, 122(11), 1766-1773. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4873374/
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. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28515140
“ Status of Medicaid expansion by state”. (2020). Status of State Medicaid Expansion Decisions: Interactive Map. Retrieved from https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/
Torres, H., Poorman, E., Tadepalli, U., Schoettler, C., Fung, C. H., Mushero, N., ... & McCormick, D. (2017). Coverage and access for Americans with chronic disease under the Affordable Care Act: a quasi-experimental study. Annals of internal medicine, 166(7), 472-479. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28114684
Wallace, J., & Sommers, B. D. (2015). Effect of dependent coverage expansion of the Affordable Care Act on health and access to care for young adults. JAMA pediatrics, 169(5), 495-497. Retrieved from https://jamanetwork.com/journals/jamapediatrics/fullarticle/2173572
