The affordable health care act was signed into law in 2010 under the stewardship of President Obama and a majority backing from the Democratic Party. The key drivers for the implementation of the act were access to healthcare, reduction of costs and patient protection against rogue insurance companies. Among the industrialized countries, United States spends the most on healthcare despite its shortcomings. These shortfalls have seen the quality of Medicare plummet overtime and hence the need for a comprehensive health plan. A patient under the affordable care act is expected to pass through a series of processes and procedures during a typical visit to the hospital. The first place the consumer will pass through is the emergency room where evaluation and stabilization are conducted. The patient may then be admitted into any of the three processes namely outpatient, inpatient, or observation status.
There have been signs of success under the affordable health care act backed by increased number of insured people. Emergency Department visits increased from 1.4 million between 2006 and 2016 to 2.3 million per year between 2013 and 2016 (Sama-Miller et al., 2017). These changes coincide with the time the provisions of the affordable care act were implemented in 2014, showing its positive impact. Although some changes had been introduced earlier in 2010, such as letting individuals use parents cover until the age of 26, many drastic changes occurred in 2014. These saw the expansion of Medicaid, creation of health care exchanges aimed at encouraging private markets for cover, and introduction of individual mandate. Further success has been experienced in the Medicaid enrollment rate with an increase of 21% while visits from uninsured individuals reduced by 2.1% during the same period (Ganguli et al., 2017). These represent a significant impact in the accessibility of medical care by Americans.
Delegate your assignment to our experts and they will do the rest.
The affordable care act has improved the quality of health care. Various checks and quality assurances have been enacted to monitor the state of hospital facilities. The Center for Medicare and Medicaid Services (CMS) rewards hospitals with incentives totaling to $850 million for meeting certain quality metrics (Inpatient vs. Outpatient Care and Coverage, n.d). The amount is raised by reducing diagnostic-related payments and re-allocating the same to performing hospitals. The quality metrics considers patient and family engagement, patient safety, care coordination, public health, healthcare resources use, clinical procedures and patient satisfaction (Calman, Hauser & Chokshi 2012). Under the program, the CMS seeks to reduce payments to hospitals that fail to meet the set standards. In addition, various state agencies have been set up to examine and layout plans regarding health care and payment systems.
The affordable care act along with the protection act aim to reduce the cost of health care and make it affordable to all Americans. The Independent Payment Advisory Board (IPAB) was instituted to provide specific growth rate targets and ensure the Medicare expenditure stays within certain acceptable limits. The board is comprised of a team of impartial experts from medical related fields such as health finance, economics and health plan management. Majority of the funding to steer the affordable care act agenda is from increased Medicare taxes among high-income earners, and new taxes upon pharmaceutical manufacturers, health insurance providers and medical device manufacturers. Although the act does not impose fee restructuring for services offered, it gives the Secretary of Health and Human Services authorization to correct mis-valued fee structure with services or procedures that have experienced significant changes in technology.
Admission into health coverage is compulsory for all Americans, with punishable taxes imposed to defaulters according to the affordable care act. Conditions are imposed to insurance companies too in order to enable an easier admission into the programs, that is Medicaid or Medicare. They are prohibited from denying coverage based on pre-existing medical conditions, withdrawing cover except in cases of intentional misinterpretation or fraud, charging older customers more than thrice the fee for younger ones, charging higher premiums based on health status, and providing plans than don’t cover essential health benefits with the exception of grandfathered or grandmothered plans.
During a visit to the hospital, a consumer under the affordable care act will first pass through checkup after which a decision is made on the next procedure. The patient can then proceed to outpatient care, inpatient care, or observation status. Under the inpatient process, the patient is admitted within the hospital facility for further treatment. The charges are broken down into two categories with inpatient plan; the fee of the hospital facility and the surgeon’s or physician’s fees.
In the outpatient care, the patient is not required to be admitted in the hospital facility but is expected to have hospital visits for routine checkup. Services provided include surgical procedures, mental health care, and rehabilitation services. The costs associated with hospital facility and the cost of the surgeon are handled as different coverage benefits (). Outpatient care may involve essential health benefits such as prescription drugs and thus eligible for cover under the affordable care act.
Observation status entails the process in which the doctors monitor patients without formal admission in the insurer’s or hospital’s records. The Medicare benefits enjoyed by patients in observational status are less than those in outpatient or inpatient process, hence is expected to incur higher expenses. The patients are ineligible for coverage during the follow up treatment under the affordable care act. It is a requirement to spend a minimum of three days, excluding the admission day, in a nursing home to qualify for Medicare coverage.
Rehabilitation cover gives the patient the choice between inpatient and outpatient treatment. The inpatient admissions in rehabilitation are not different from any other hospital admissions although there are cases when there exists a specialized rehabilitation facility. The corresponding treatment for outpatient services are cheaper compared to inpatient charges. The insurance schemes in the affordable care act involves addiction assessment, clinic visits, family counseling, addiction treatment medication, alcohol and drug testing, medical detoxification programs and family counseling.
Habilitative services are included under the essential health benefits in the affordable health care act. The essential health benefits include a list of ten categories of services that insurance plans are required to cover. Habilitative services are defined as services that help an individual maintain, acquire or improve skills that are critical to the daily life. These services include physical therapy, occupational therapy, speech therapy and services for persons with disabilities. Habilitation services are offered as either inpatient of outpatient process. Various states have slightly varying interpretation of habilitative services but they are all similar. Each state imposes a quantitative limit to essential health benefits including habilitation limits. The limits can involve restricting the number of visits allowed. For instance, in Colorado under the Kaiser silver plan, a maximum of 40 annual visits are allowed for occupational therapy as both habilitative and rehabilitative services (Paying for Rehab with the Affordable Care Act, n.d).
Prescription drugs are also included in the essential health benefits category. The affordable health care act obligates new qualified health plans to include prescription drugs into the category. It is unclear however, on the type and cost of the drugs covered. The out-of-pocket costs for a month’s supply of covered drugs are grouped as either copayments or coinsurance. Payment plans are separated into platinum, gold, silver and bronze, in order of rising costs for the corresponding drug type. This is a move towards reducing the cost of health care. In the existing family and individual insurance, only 20% of insurance plans cover prescription drugs (The Costs of Recovery with the Affordable Care Act, n.d).
Maternity and newborn care are part of the essential health benefits. These is an improvement to the previous system in which pregnancy and maternal care was subject to premiums and additional fees in the individual health care plan. Before implementation of affordable care act, women were at risk unwittingly buying insurance policy and later during pregnancy discover that the cover does not include maternal and pregnancy related care. It was common to find coverage that includes maternity care costing 25% to 75% more than those without (Koh & Sebelius, 2010). By pulling resourcing together through the collective health insurance package, it is possible to cover for newborn children and pregnant women at no additional costs.
In the case of preventive care, medication and services related are covered at no additional costs by the insurance provider. This has enabled more than 71 million people free access to vaccines, cancer screenings and primary care. The number of patients seeking flu vaccinations, blood pressure and cholesterol checks has seen a significant rise since 2010 while cervical, colorectal and breast cancer screening rates have remained relatively unchanged (Altman D. 2016). The provisions by the affordable care act prohibits insurance providers from imposing further costs to customers seeking preventive care, unless additional medical services are sought by the consumer.
The affordable health care act has reduced the cost of medical care as well as improve the quality. It has eliminated barriers to entry for individuals with pre-existing diseases or conditions to acquire health insurance coverage. Treatment and hospitalization for consumers is much streamlined with lucrative benefits including ten essential health benefits enjoyed by all subscribers. The act regulates the insurance market ensuring a level field for a fare distribution of health care services to Americans.
References
Sama-Miller E, Akers L, Mraz-Esposito A, Zukiewicz M, Avellar S, et al. 2017. Home Visiting Evidence of Effectiveness Review: Executive Summary. OPRE Rep. 2017–29. Washington, DC: Adm. Child. Fam., US Dep. Health Human Serv.
Ganguli I, Souza J, McWilliams JM, Mehrotra A. 2017. Trends in use of the US Medicare annual wellness visit, 2011–2014. JAMA 317:2233–35
Inpatient vs. Outpatient Care and Coverage. (n.d.). Retrieved from www.valuepenguin.com: https://www.valuepenguin.com/inpatient-vs-outpatient-care-and-coverage
Calman NS, Hauser D, Chokshi D. 2012. “Lost to follow-up”: the public health goals of accountable care. Arch. Intern. Med. 172:584–86
Paying for Rehab with the Affordable Care Act. (n.d.). Retrieved from www.addictioncenter.com: https://www.addictioncenter.com/rehab-questions/affordable-care-act-obamacare/
Rehab Under Obamacare: The Costs of Recovery with the Affordable Care Act. (n.d.). Retrieved from addictionresource.com: https://addictionresource.com/rehab-answers/rehab-under-obamacare/
Koh HK, Sebelius KG. 2010. Promoting prevention through the Affordable Care Act. N. Engl. J. Med. 363:1296–99
Altman D. 2016. The Affordable Care Act's little-noticed success: cutting the uninsured rate. Oct. 12, Kaiser Family Found., Menlo Park, CA.
