For many Americans, limited access to health is a critical concern. Health care access, as well as insurance coverage, are generally highly correlated. Typically, health insurance enables people to get the necessary medical attention that they may need. In addition to obtaining medical care, health insurance coverage determines how healthy individuals are, in general. Many U.S citizens lack health insurance. As a result, those monitoring the health of citizens are concerned that people in this modern day era still do not have a health insurance plan. The establishment of the Affordable Care Act (ACA) has provided Americans with the opportunity to acquire access to health care services. Because of the act, there has been a significant increase in the number of people enrolling for health insurance.
The Affordable Care Act, aside from Medicaid and Medicare, is one of the most exciting health care reforms in the history of the United States. It was enacted in 2010 by President Barrack Obama, and its primary purpose is to expand health insurance coverage access. The regulation typically targets middle and low-income people and families. This is because many people in these groups do not have health insurance coverage. According to Feldman, Buysse, Hubner, Huffman & Loe (2015) , the Act was designed to “ decrease the number of uninsured Americans, make health insurance and health care affordable, and improve health outcomes and performance of the health care system” (p. 207).
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Generally, ACA employs two main methods to raise health insurance access. Firstly, it increases Medicaid access based on income for people with wages “up to 138% of the federal poverty level (FPL)” (Kominski, Nonzee & Sorensen, 2017, p. 489) . Additionally, it establishes eligibility for people with salaries between 139% and 400% FPL to request for subsidies (Kominski, Nonzee & Sorensen, 2017) . These subsidies are used to buy health insurance exchanges. Before the law was passed, many Americans were uninsured, and among those with no insurance coverage, a majority had wages below 400% FPL (Kominski, Nonzee & Sorensen, 2017) . The enactment of ACA in 2010 has enabled such groups of individuals to enjoy the benefits under the Act. For this reason, the ACA can tremendously enhance health insurance access for low-income individuals.
ACA has several benefits. It has afforded people the legal right to healthcare coverage that is accessible. Talbert, Martin, Frazier & Byas (2018) inform us that the act grants the benefit of free wellness examinations as well as preventive services. Also, it has minimized Medicaid and Medicare fraud abuse. Besides reducing fraud abuse, it has lowered the costs of prescription drugs. Further, it has raised the initiatives of quality improvement for providers as well as hospitals which, in turn, increases payments to providers and hospitals that attain acceptable indicators of quality improvement. Moreover, the law provides new health care strategies to enhance care in all sectors.
The ACA is also beneficial as it ensures that health care is affordable and is of the utmost quality for all. However, challenges arise mainly in terms of economic effect, stakeholder disengagement, and provider obstacles. These challenges indicate that ACA will markedly impair the fiscal position of the federal government relative to the previous regulation (Talbert et al., 2018). The finances used for ACA implementation mostly rely on federal funds, and it benefits the public and the health care system directly. The ACA, additionally, makes insurance affordable to people by providing refundable tax credits. Such credits offer the alternative of applying a credit to a person’s monthly premium to minimize annual tax credits for low-income earners.
Also, with the ACA, states can create their insurance exchanges; however, the regulation asserts that the federal government will develop the exchanges if the states fail to do so (Talbert et al., 2018). This, thus, enables the ACA to maintain lower costs via options of competitive pricing as a result of escalated member pools as well as ban insurance organizations from invalidating coverage. In the past, in case of an error or technical mistake in a customer’s application request, an insurance firm could reject coverage payments based entirely on the detected errors.
During a hospitalization or emergency department visit for a consumer under the ACA and if a medical test is required, physicians first find out electronically whether a specific medical test is covered. Also, before submitting the tests, physicians inquire for the particular amount of money the insurance firm is paying, and further how much the patient needs to pay. When it comes to hospital discharges well as readmissions, Medicare and insurance have specific guidelines on how many hospitalizations they will pay for with regards to diagnosis and treatment plan an individual might be admitted for. Once an individual gets past the deadline, the hospital may not be reimbursed for the stay unless another medical issue arises. It is only at this point that the hospital can bill as well as be reimbursed. For a consumer under the ACA and Medicare, in case of preventable infections whether from surgery or weak immunity to infections, Medicare will refuse to provide reimbursement to the hospital for the care they must give during a person’s extended stay in the hospital. Because of the hospital readmission policies as a result of ACA implementation, consumers under the ACA will experience a higher degree of more effective communications from the staff of the hospital. A consumer is provided with patient satisfaction surveys to rate the quality of care he or she has received. Also, a consumer is provided with adequate reading material, and he or she may be requested to watch several videos concerning how to effectively take care of themselves after being discharged. Also, physicians may even call the patient at home for a follow-up check. More so, when it comes to after care, a physician should follow up to see if the consumer is taking their medications. A physician also provides prevention referrals and recommendations.
A consumer under the ACA is also entitled to prescription drug coverage. With ACA, prescription drug coverage is included with all exchange plans in the person as well as small-group markets (Reisman, 2015) . According to Reisman (2015) , before ACA implementation, roughly one out of five plans of health insurance bought privately by people as well as families did not have drug benefits. However, presently, during hospitalizations, a consumer under the ACA enjoys drug benefits. In other words, such a consumer can be given drugs by the hospital, and his or her health insurance will cover. Also, ACA demands Medicaid programs to supply the benefit of prescription drugs. Under this law, insurance plans are not mandated to cover all prescription medications. They may also restrict the medications they include, covering only generic drugs if available. Nonetheless, a consumer under the ACA can request as well as obtain access to clinically suitable medications that are not covered.
Hospitals, in the past, were able to choose which insurance plans they would allow. In this regard, a hospital could restrict coverage for visits to the emergency room outside it's emergency care providers’ network. During this period, people experienced financial hardship if they got injured or sick while they were away from home. However, with the enactment of the Affordable Care Act, all health insurance plans that are privately provided in the marketplace are to provide a similar set of essential health advantages. Therefore, for a consumer under the ACA, he or she will enjoy emergency service, hospitalization, and ambulatory patient services. Also, with ACA, a consumer has the right to emergency room services at any hospital. Copayments or coinsurance are not necessary if one receives emergency care from an out-of-network hospital. Also, a consumer can get emergency room service from a hospital outside his or her plan’s network without obtaining prior approval from the insurance plan.
To sum up, the Affordable Care Act is a crucial health care law in the United States. The original intentions of this law are to minimize the number of uninsured individuals and make health care and health insurance affordable. Also, the regulation seeks to improve the outcomes of health as well as the overall performance of the system of health care. The law primarily targets low-income earners, and with that, low-income individuals have enjoyed the law’s Medicaid expansions as well as insurance subsidies. Many low-income residents are uninsured. As such, the enactment of ACA has significantly reduced the number of uninsured low-income people. As many people are now able to afford quality health care and adequate health insurance plans, the process of hospitalizations has tremendously improved as a result of ACA.
References
Feldman, H., Buysse, C., Hubner, L., Huffman, L., & Loe, I. (2015). Patient Protection and Affordable Care Act of 2010 and Children and Youth With Special Health Care Needs. Journal Of Developmental & Behavioral Pediatrics , 36 (3), 207-217. doi: 10.1097/dbp.0000000000000151
Kominski, G., Nonzee, N., & Sorensen, A. (2017). The Affordable Care Act's Impacts on Access to Insurance and Health Care for Low-Income Populations. Annual Review Of Public Health , 38 (1), 489-505. doi: 10.1146/annurev-publhealth-031816-044555
Reisman, M. (2015). The Affordable Care Act, Five Years Later: Policies, Progress, and Politics. Journal For Managed Care And Hospital Formulary Management , 40 (9), 575-578. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4571845/
Talbert, P., Martin, L., Frazier, M., & Byas, D. (2018). Benefits and Challenges of the Affordable Care Act: What should be the Future of the ACA in 2018?. ACTA Acientific Medical Sciences , 2 (5).
