Affordable healthcare has several features that affect reimbursement, which directly impacts the healthcare providers. The first feature I will discuss is the insurance market regulation. This factor helped the Affordable Care Act to introduce community rating regulations across the whole country. The feature had a profound effect on the insurance providers in the sense that it ended their ability to exclude preexisting medical conditions, set premiums according to the persons' health status, and their power to deny the issue of insurance or enrollment of people based on health (Gruber & Sommers, 2019). The providers were affected because they now had the responsibility to sign up for people from all communities regardless of their previously underlying existing medical conditions, which has a tremendous financial cost for the service providers. Another notable effect of this feature is the mandate that family-oriented insurance plans cater to the children until they reach 26.
The second feature that affects reimbursement is the state exchanges and premium credits (Gruber & Sommers, 2019). First of all, this feature helps all legal citizens who could not previously access Medicaid or Medicare since they have incomes ranging from 100 to 400 percent of the poverty line and also had the ineligible status. The premium tax credits offered to these citizens helped them by offsetting their cost of insurance. This feature will significantly allow the providers more comprehensive coverage since they will provide insurance to people who could not access it due to being ineligible before, which translates to more income.
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The second feature; the state exchanges and premium credits will have more effect on the providers. This is because it primarily involves more people who initially were not eligible for affordable care. It will have more impact in the sense that, with more people to cater to increasing the healthcare needs, which in turn, the providers will have more income but also will deal with more transactions for insurance reimbursement.
References
French, M. T., Homer, J., Gumus, G., & Hickling, L. (2016). Key provisions of the Patient Protection and Affordable Care Act (ACA): a systematic review and presentation of early research findings. Health services research, 51(5), 1735-1771.
Gruber, J., & Sommers, B. D. (2019). The Affordable Care Act's effects on patients, providers, and the economy: What we've learned so far. Journal of Policy Analysis and Management, 38(4), 1028-1052.
Nikpay, S., Buchmueller, T., & Levy, H. G. (2016). Affordable Care Act Medicaid expansion reduced uninsured hospital stays in 2014. Health Affairs, 35(1), 106-110.
Protection, P., & Act, A. C. (2010). Affordable Care Act. Public Law, (111-148), 124.
