PPACA
The Patient Protection and Affordable Care Act was signed into law in March 2010 by President Obama and since Medicaid and Medicare represented the most significant legislative overhaul and coverage expansion. It made health insurance coverage available to approximately 30 to 50 more million Americans. The population of the uninsured had gone down by roughly 50% by 2016, a major milestone. Medicaid and Medicare, and the employer market structures remained largely unchanged but individual markets went through a radical transformation.
The main reasons for the creation of PPACA were to increase healthcare insurance coverage, improve its quality, and reduce the rising costs. The law saw the creation of health insurance marketplaces to provided information to consumers and stimulate competition to drive healthcare costs down. All insurers are required to cover pre-existing conditions. Dependents are allowed to stay on their parent’s insurance coverage until the age of twenty-six including those who do not live with their parents. PPACA created 4 tiers of insurance coverage classified into bronze, silver, gold and, platinum. All classifications have essential health benefits. The categories vary in terms of out-of-pocket costs versus monthly premiums. Individuals holding the platinum tier pay the highest monthly premiums but their out-of-pocket costs are the lowest.
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One of PPACA’s most significant requirements was the individual mandate that required all people to have insurance or pay a penalty. This measure was intended to lessen the free-rider problem, shun death spiral, and prevent the system from submitting to adverse selection. There were several groups that were not subject to individual mandate including illegal immigrants and citizens eligible to Medicaid but not enrolled.
PPACA has improved healthcare in the United States by increasing coverage and reducing the cost of healthcare. Healthcare is now more accessible and affordable to the majority of Americans compared to the period before its enactment. This is achieved through the funding of prevention and community-based public health programs. The act also supports research and tracking of essential health processes. It has begun to reduce disparities in health insurance coverage, improved access to preventive care, and ultimately reduced the rate of federal spending on healthcare. These benefits have been achieved while at the same time insurers have been prohibited from charging women more and discrimination for those with pre-existing conditions has been prevented.
PPACA reduction of costs should be accelerated by more of its reforms. In 2014, healthcare spending accounted for 17.5% of the GDP and is expected to reach 20% by 2025 (APHA, 2018). This percentage is projected to be higher were PPACA not there. The act supports defensive medicine. Currently, only 3% of spending focuses on defensive medicine (APHA, 2018). Chronic conditions take at least eighty-six percent of healthcare spending relegating prevention and public health. PPACA reduces disparities within the U.S. healthcare system and without it racial and ethnic minorities would particularly suffer more. For example, Black Americans are twice as likely to die from diabetes.
Managed Care
The term managed care is used in America to refer to a spectrum of activities planned to provide American health insurance and reduce the cost of for-profit health care while raising the level of quality care. Managed care is characterized by regulation of the whole healthcare provision process, the interconnection of treatment centers, and the participation of healthcare providers financially in insurance risk. Its models founded on a network between health insurers and healthcare providers. It aims to reduce healthcare costs through economic incentives for both the healthcare provider and the patient to create the capacity to choose a less costly form of care.
Managed care models in the United States include Health Maintenance Organization, Point of Service, and Preferred Provider Organizations. HMO mostly only pay for healthcare within the network. One pays more to get healthcare within the network if Preferred Provider Organizations are used while POS enables an individual to make a choice between PPO and HMO at the time of care. Integrated delivery systems have healthcare facilities referred to as provider network which receive incentives to use. There are programs for quality improvement including case and disease management. Managed care also promotes preventive care through patient education and wellness incentives.
The role that managed care has had in the United States is debatable. Managed care seeks to raise the quality of care while cutting costs but evidence to that is mixed. Those who support it say that it has increased overall healthcare standards made it more efficient and led to a better quality of healthcare. Opponents of this form of care blame higher health costs on managed care. Other negative effects of managed care include a high number of uninsured people and a lower quality of healthcare to citizens.
Managed care decreases the overall cost of healthcare for individuals able to access it. when people stay within a designated network as required, they are provided with services and procedures at a discounted rate. One can also seek healthcare outside the network making it possible to have fast service. Information is also fluid within a network. A patient’s file is available throughout a network within a short time. On the downside, managed care limits coverage for those without insurance. Finding a healthcare provider for them is virtually not possible. Managed care also has very rigid rules. If one is not satisfied with the care they are receiving with one model, it may not be possible to move to another.
References
APHA. (2018). Why do we need the affordable care act? The American Public Health
Association . https://www.apha.org/~/media/files/pdf/topics/aca/why_need_aca_2017.ashx
