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Health Care Reforms-Integration and Reflection

Health Care Reforms-Integration and Reflection

Quality healthcare provision has always been on the agenda list of many governments across the globe. The United States, not left out, has seen several reforms in the mainstream health care delivery system. Historic reforms at the federal level date back to 1965, when President Lyndon Johnson enacted federal legislation that made way to Medicare and Medicaid. Ever since, several other reforms have been made, with the landmark reforms being the 2010 health care reforms that initiated the Patient Protection and Affordable care Act (PPACA), popularly known as Obamacare that was enacted by President Barrack Obama. This paper seeks to analyze the effectiveness of the Affordable Care Act reform to the health care delivery system in the US.

The intended purpose of the PPACA is to enhance access to the quality provision of health care while minimizing the consequences that may result from not being insured. It achieves this by bringing reforms on the private insurance market that are aimed at making health insurance available to more people, especially individual units and small-group purchasers, expansion of the Medicaid program to reach the working poor who receives an income of up to 133% of the federal poverty level as well as to put down measures that will revolutionize medical decision making. PPACA has so far not only met its intended purpose but also exceeded its expectations.

Based on 2013 estimates, the PPAC will provide insurance coverages to close to 37 million Americans that do not have insurance covers. The framework created for the attainment of this goal is based on its postulated objectives and includes reforms on the private insurance markets as well as the expansion of the Medicaid program. By institutionalizing state-run marketplaces exchanges and providing subsidies on purchasing individualized insurance by middle-income families, this provision creates competition among insurers that in turn causes them to lower their premiums and offer more quality and efficient insurance services. This provision also allocates state funds that are targeted on increasing the availability of the Medicaid program to individuals who otherwise are not eligible for Medicaid program (Silvers, 2013). The combination of these two strategies is expected to increase insurance coverage to millions of Americans in the coming decades.

The Affordable Care Act has gained considerable achievements on its objectives since its enactment in 2010. It is estimated that close to 17 million uninsured Americans have obtained insurance since its rollout (McMorrow et al., 2020). Recent data asserts that the rate of uninsured young adults in the US has decreased to 11.9% by 2015, indicating a drop of up to 6% since 2013(Kantarjian, 2016). These gains have been attributed to the expansion of the Medicaid program as well as the expansion of both individual and small group health insurance exchanges. These increases in insurance coverages are an indication of the immense success achieved by this reform.

With the improvement in health care seeking accustomed to increased insurance coverage, quality of health care service provisions needs to be assured to all legal US residents. The ACA provides for several mechanisms that are geared towards the attainment of quality health services in the various Medicaid registered healthcare institution. The law reinforces primary care by increasing the rates of reimbursements to various states as well as introducing innovative health care service delivery models that are centered on the patients (Wadhera et al., 2019). These approaches ensure quality health service delivery not only by enhancing the efficiency of delivery but also by ensuring that the providers’ needs are well catered for.

The establishment of the Center for Medicare and Medicaid Innovation is another feature that ensures quality service delivery to the patients. This institution is responsible for carrying out researches on the innovative payment and delivery system models that are capable of improving the quality of services delivered under Medicare and Medicaid programs. This institution thus serves as an umbrella that ensures that all Medicare programs are efficient and of standard quality.

The PPACA has, since its role out, successfully implemented several mechanisms. These include implementing reforms on the markets, establishing new health insurance exchanges, expanding the eligibility of Medicaid for the poor adults or of low income as well as establishing a Centre for Medicare and Medicaid Innovations.

The PPACA has successfully implemented reforms in the insurance market by directing several provisions that impact the insurance markets. Such reforms include banning annual limits, ensuring young adults are covered in their parents’ health insurance plans until they reach 26 years of age, initiation of health reimbursement arrangements that ensures reimbursement to employees by their employers for expenses on medical and medication, as well as standardization of market rates of insurance pricing (Rosenbaum, 2017). All these initiatives are targeted at leveling the playground for insurers by preventing out-of-measure insurance premiums that may be costly to the insurers.

Additionally, the PPACA has successfully established new health insurance exchanges. This act enabled the establishment of the Medicaid expansion program that is now offering insurance covers to millions of Americans. It covers low-income adults as well as special population groups encompassing pregnant women, children, the elderly, and people living with a disability. Medicaid presented dual benefits by offering affordable insurance to many people as well as putting competition on the insurance markets that saw a reduction of premiums to individuals seeking private health insurance (French et al., 2016). This, in turn, increased access to health insurance.

The eligibility to Medicaid has also been expanded substantially. By increasing funds to states to enable them to expand the Medicaid program, many people in states that have approved the Medicare program can now access it, including special group populations. Furthermore, poor residents or low-income residents whose income is below 133% below the poverty line, that were previously illegible can now be insured. This has greatly contributed to the higher figures of the insured since the rollout of the ACA.

The establishment of the Center for Medicare and Medicaid Innovation has also been a success. This center is mandated to identify innovative models for payment, and the delivery systems model plays a role in ensuring the quality of the health service delivery under the Medicare program. This establishment also coordinates care between the federal and states governments. This establishment thus ensures quality and efficiency in health service delivery.

Health care reforms have historically been an agenda for most US presidents. The 2010 reforms that conceived the Patient Protection and Affordable Care Act have realized significant benefits since its rollout. Aimed at enhancing access to health care, this act has exceedingly met its purpose and has secured insurance for millions of Americans. This act utilizes several mechanisms to realize its objectives, as described above.

References

French, M., 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. https://doi.org/10.1111/1475-6773.12511

Kantarjian, H. (2016). The Affordable Care Act, or Obamacare, 3 years later: A reality check. Cancer, 123(1), 25-28. https://doi.org/10.1002/cncr.30384

McMorrow, S., Blumberg, L., & Holahan, J. (2020). Ten Years Later: Reflections on Critics’ Worst-Case Scenarios for the Affordable Care Act. Journal Of Health Politics, Policy, And Law, 45(4), 465-483. https://doi.org/10.1215/03616878-8255421

Rosenbaum, S. (2011). The Patient Protection and Affordable Care Act: Implications for Public Health Policy and Practice. Public Health Reports, 126(1), 130-135. https://doi.org/10.1177/003335491112600118

Silvers, J. (2013). The Affordable Care Act: Objectives and Likely Results in an Imperfect World. The Annals Of Family Medicine, 11(5), 402-405. https://doi.org/10.1370/afm.1567

Wadhera, R., Bhatt, D., Wang, T., Lu, D., Lucas, J., & Figueroa, J. et al. (2019). Association of State Medicaid Expansion With Quality of Care and Outcomes for Low-Income Patients Hospitalized With Acute Myocardial Infarction. JAMA Cardiology, 4(2), 120. https://doi.org/10.1001/jamacardio.2018.4577

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Question 


Health Care Reforms-Integration and Reflection

The overall goal of the Session Long Project is to examine health care delivery in the United States. Read the article “Remaking the American health care system: A positive reflection on the Affordable Care Act with emphasis on mental health care” by Ogundipe, Alam, Gazula, Olagbemiro, Osiezagha, Rahn, and Richie (2015). After reading the article and conducting your own research, please respond to the following questions.

Health Care Reforms-Integration and Reflection

Health Care Reforms-Integration and Reflection

  • What is the intended purpose of the PPACA that was signed into law in 2010? Will it meet its intended purpose based on what you’ve read in this article and from your own research on the topic?
  • Has PPACA met its intended purpose based on what you’ve read in this article and from your own research on the topic?
  • What do the authors state are the issues with the quality of care being provided?
  • Identify and discuss the four mechanisms that have been implemented by the PPACA.

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