The Affordable Care Act is a milestone healthcare legislation that was passed in the United States in 2010, only has its historical comparative in Medicare and Medicaid which were passed in 1965. It is the first legislature that attempted to wholesomely address the failures of the American healthcare system by tackling cost control, quality and access to healthcare simultaneously (Obama, 2016). The law is became necessary as the country was lagging far behind in its healthcare provision for its citizens registering as one of the poorest performers when compared to other developed nations in the world (McDonough, 2015). This is why its main focus was on the two fronts that have made more than half of the American populace unable to access healthcare services before its passage and continued implementation; the expansion and improvement of medical insurance coverage, and reforming the health care delivery system.
Regarding general health care access, by 2016 the ACA was on the verge of achieving a coverage of about half of the uninsured population by the following year, which translates to 92% of all authorized immigrants and citizens (McDonough, 2015). This has been made possible through varied law requirements that have given the uninsured population options that they can afford. For example, the ACA has made insurance coverage more available to small businesses and individuals in new marketplaces (which it created) regardless of pre-existing conditions. The premiums for such is only allowed to differ regarding location and age. The new health insurance marketplaces created through the ACA are based on state and were created using toll-free numbers and websites that allow people to purchase health plans by quality and price (Doonan & Katz, 2015).
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Medicaid and Medicare have also experienced transformations and improvements under the ACA. The wellness and prevention benefits under Medicare have been expanded, and coverage for prescription drugs has improved. The ACA is even financing experiments that are testing different delivery systems and payment methods to help control healthcare costs. Under Medicaid, the ACA has its main aim of covering all families and individuals whose income is below 138% of the level of poverty (Doonan & Katz, 2015). This in effect would make America achieve a historical fete, by creating a strong coverage for its low-income citizens. This move still faces the challenge of the Supreme Court ruling that allowed for states to choose whether or not to expand the Medicaid Programs. An interesting fact is that although states that have expanded the Medicaid programs have registered more people having access to medical coverage, even states that have voted against the expansion still show increased numbers of people under coverage an indicator that the other programs under ACA are having a positive effect (Doonan & Katz, 2015)..
Central to the push for to reform the health care delivery system is the initiatives created by the Affordable Care Act. The ACA has created payment incentives in Medicare for physicians and hospitals to improve performance in their cost and quality metrics apart from readmissions and hospital-acquired conditions. This initiative started in 2013 and has seen 1% of total payments in Medicare redistributed to performing hospitals, and it is set to increase to 2% in 2017. The physicians’ initiative began in 2015, and preliminary results show a 5% increase in payment adjustments (Blumenthal, Abrams, & Nuzum, 2015).
Bundled-payment initiatives also have their origin in the ACA. They provide a single payment for specific services given by hospitals, post-acute care services and physicians in relation to a given condition or procedure. To further boost the improved organization of the health care delivery system, health care providers are being encouraged by the ACA to create Accountable Care Organizations. These are for the promotion of coordination and integration of inpatient, ambulatory and post-acute services so that the cost and quality of care for Medicare beneficiaries is taken responsibility for (Obama, 2016) (Blumenthal et al., 2015). The ACA also has created a Center for Medicare and Medicaid Innovation (CMMI) which is funded 1 billion dollars each year for ten years to undertake a plethora of experiments meant to reduce cost and improve quality within Medicare and Medicaid. One such experiment is the Comprehensive Primary Care Initiative which focuses on making cost savings (Blumenthal et al., 2015).
As it is with Medicare and Medicaid, the ACA is expected to go through teething processes to make it more robust. It is still too early to give conclusive facts on its failure or success. However, the situation could be less bumpy if the current party polarization was lowered. The most important action is ensure that all stakeholders in healthcare are educated and aware of all the machineries created within the ACA to have a more knowledge-based approach to fine-tuning it.
References
Blumenthal, D., Abrams, M., & Nuzum, R. (2015). The Affordable Care Act at 5 Years. New England Journal of Medicine , 373 (16), 1579–1580. https://doi.org/10.1056/NEJMc1510015
Doonan, M., & Katz, G. (2015). Choice in the American healthcare system: Changing dynamics under the Affordable Care Act. Current Sociology , 63 (5), 746–762. https://doi.org/10.1177/0011392115590092
McDonough, J. E. (2015). The United States Health System in Transition. Health Systems & Reform , 1 (1), 39–51. https://doi.org/10.4161/23288604.2014.969121
Obama, B. (2016). United States health care reform: Progress to date and next steps. JAMA - Journal of the American Medical Association . https://doi.org/10.1001/jama.2016.9797
