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by Katiuska Rodriguez
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The Affordable Care Act (ACA)
The Affordable Care Act (ACA) initiated numerous fundamental aspects focusing on ameliorating health outcomes and reducing expenses within the United States. Despite diverse views on this Act, several elements have been deemed substantially advantageous for the healthcare system:
Broadened Medicaid: The ACA made Medicaid qualification more inclusive across multiple states, granting healthcare coverage accessibility for lower-income individuals and families. This expansion has facilitated essential healthcare service access for multitudes of formerly uninsured American citizens – promoting improved health results and minimized long-term costs (Baumgartner et al., 2020). Supplying coverage for those with lower incomes alleviates the weight of unpaid care on medical institutions and practitioners.
Preventive Care and Well-being: ACA obligates health insurance policies to incorporate pre-emptive functions – such as immunizations and assessments – in a non-cost-sharing manner. By accentuating prevention, people are likelier to undergo early interventions and treatments; this approach subsequently leads to superior health results and diminished overall healthcare expenditures.
Health Insurance Marketplaces: The creation of health insurance marketplaces permits individuals and smaller companies to scrutinize and acquire health insurance arrangements (Glied et al., 2020). These marketplaces foster rivalry among insurers, potentially resulting in price reduction while supplying consumers with cost-effective alternatives. Financial support via these marketplaces contributes to improved affordability for individuals earning less.
Prohibition of Pre-existing Condition Exclusions: ACA prohibits insurance agencies from denying coverage opportunities or imposing heightened premiums because of pre-existing conditions. This stipulation ensures that persons suffering from chronic ailments or previous medical complications can attain economic coverage (Adamson et al., 2019). This enhances the management of such conditions while ultimately curbing exorbitant emergency care expenses.
Medicare Adjustments: Within the ACA, numerous stipulations serve to manage Medicare expenditures; for instance, lowering excess payments directed towards private insurers via Medicare Advantage and inaugurating merit-based compensation models. These modifications advocate for resourceful Medicare funds utilization while aiding in prolonging the program’s financial viability.
Accountable Care Organizations (ACOs): The ACA endorses the establishment of ACOs – a collection of health service providers collaborating to elevate care quality while diminishing expenses. These consortiums concentrate on care synchronization, data dissemination, and results-oriented reimbursement schemes; this amalgamation facilitates more streamlined and economical healthcare distribution.
Patient-Driven Clinical Residences: The ACA supports the notion of patient-driven clinical residences – settings where primary caregivers organize a patient’s treatment plan and act as the principal communication hub. This configuration promotes enhanced correspondence, reduces superfluous examinations and therapies, and refines chronic condition supervision; collectively contributing to superior health results and decreased expenses.
Indeed, the ACA has made considerable advancements in ameliorating healthcare availability and curbing expenses; however, it is not exempt from complications and detractors. Several elements – especially those concentrating on broadening coverage scope, fostering preventative care measures, and inspiring inventive care delivery approaches – retain the capacity to persistently exert positive influences on healthcare consequences and expense management. The enduring discourse on healthcare policy within the United States frequently revolves around refining and expanding these provisions to further enhance the nation’s healthcare infrastructure.
References
Adamson, B. J., Cohen, A. B., Estevez, M., Magee, K., Williams, E., Gross, C. P., & Davidoff, A. J. (2019). Affordable Care Act (ACA) Medicaid expansion impact on racial disparities in time to cancer treatment. https://ascopubs.org/doi/abs/10.1200/JCO.2019.37.18_suppl.LBA1
Baumgartner, J., Collins, S., Radley, D., & Hayes, S. (2020). How the Affordable Care Act (ACA) has narrowed racial and ethnic disparities in insurance coverage and access to health care, 2013‐18. Health Services Research, 55, 56-57. https://doi.org/10.1111/1475-6773.13406
Glied, S. A., Collins, S. R., & Lin, S. (2020). Did The ACA Lower Americans’ Financial Barriers to Health Care? A review of evidence to determine whether the Affordable Care Act was effective in lowering cost barriers to health insurance coverage and health care. Health Affairs, 39(3), 379-386. https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2019.01448
by Gretel Valdes Alfonso –
The Affordable Care Act (ACA) brought about several key provisions that aimed to improve healthcare outcomes and decrease costs within the Medicare program and the broader healthcare system. The ACA introduced a range of preventive services for Medicare beneficiaries with no cost-sharing. This includes vaccinations, screenings, and annual wellness visits. By focusing on prevention and early detection, the ACA aimed to improve health outcomes and reduce the burden of chronic diseases.
The ACA gradually closed the Medicare Part D prescription drug coverage gap known as the “doughnut hole.” This helped seniors afford their medications, reducing the likelihood of medication non-adherence due to cost concerns and ultimately leading to better health outcomes. The ACA incentivized the creation of ACOs, which are networks of healthcare providers that work together to coordinate care for Medicare beneficiaries. ACOs aim to improve the quality of care while reducing costs through better care coordination, reducing duplicative tests, and focusing on preventive care.
The ACA initiated a shift from fee-for-service reimbursement to value-based payment models. These models reward healthcare providers for delivering high-quality care rather than just the quantity of services provided. This incentivizes better care coordination, reduces unnecessary procedures, and encourages more efficient care delivery. Under the ACA, the Medicare Shared Savings Program was established, allowing healthcare providers to share in the cost savings they achieve while providing high-quality care to Medicare beneficiaries. This encourages providers to be more efficient and effective in their care delivery. The ACA introduced penalties for hospitals with high readmission rates for certain conditions, encouraging hospitals to improve post-discharge care and reduce avoidable readmissions. This improves patient outcomes and reduces healthcare costs associated with unnecessary hospital stays.
While not directly related to Medicare, the ACA’s Medicaid expansion increased access to healthcare for low-income individuals, including many older adults who were not eligible for Medicare. This expansion helped ensure that more people had access to preventive care and early treatment, ultimately improving overall health outcomes and reducing healthcare costs by addressing health issues before they become more serious and expensive to treat. The ACA provided funding for adopting electronic health records (EHRs) and encouraged sharing of health information among providers. This enhances care coordination, reduces medical errors, and improves the overall quality of care.
Overall, the ACA’s provisions aimed at improving preventive care, care coordination, and payment reform have positively improved healthcare outcomes and decreased costs within the Medicare program and the broader healthcare system. These changes are part of a broader effort to move from a volume-based healthcare system to one that prioritizes value and quality of care.
References
1- Peterson, M. A. (2020, August 1). The ACA a decade in: Resilience, impact, and vulnerabilities. Duke University Press. https://read.dukeupress.edu/jhppl/article-abstract…
2- Borgschulte, M., & Vogler, J. (2020). Did the ACA Medicaid expansion save lives?. Journal of Health Economics, 72, 102333. https://www.sciencedirect.com/science/article/pii/…
