Health Reform Law - Coursework Example

LEGAL FINAL PROJECT Introduction The quest to providing quality and affordable healthcare is certainly a responsibility that no single outfit can carry out on its own. It is for this reason that there have been various forms of collaboration efforts between stakeholders in the healthcare sector to ensuring that this all important ambition for the health sector is achieved (Admin, 2010). As stakeholders, the government is a very important component when it comes to ensuring and achieving quality and affordable healthcare. The advantage that the government has often had over other stakeholders is that the government comes in three major arms namely executive, judiciary and legislature. Each of these arms also act as an indirect independent stakeholder, making the government alone stand out as a stakeholder for change within the healthcare sector (Kane, 2012). Whiles playing their part, governments have always used legislatures that are backed by executive instrument and further interpreted and enforced by the judiciary. It is not surprising that there have been a number of health reform laws that the country has witnessed over the years. This paper seeks to find the impact of these health reform laws on both service providers and service users in the country. Overview of Health Reform Law Coverage Expansions and Market Reforms In the United States, health reform legislations have generally been put in place over the years for the purpose of ensuring that right to health care is respected from the perspectives of access, government spending, fairness, quality and sustainability (Kane, 2012). Very lately, part of the attention has shifted to the issue of coverage expansion and market reforms. By coverage expansion, reference is being made to the use of legislations to ensure that as many citizens as possible are covered under one form of health insurance scheme or the other (Rosenbaum, 2011). Typical references can be made with the Patient Protection and Affordable Care Act (PPACA) and Health Care and Education Reconciliation Act (HCERA), which were all signed in 2010. Even though coverage expansion and market reforms are not the only focus of these Acts, it is noted that insurance cost and availability is one of the major motivations that brought these two legislations into existence (Admin, 2010). Ahead of these, the 2008 Health Reform Law had made similar provisions for coverage expansion and market reforms. In a study by the reputable Commonwealth Fund, which was published in 2003, it was found that 16 million U.S. adults were underinsured. The statistics were worsened with knowledge that half of personal bankruptcies in the U.S. involved medical bills (Todd, 2005). As such revelations unfolded, it was prudent that coverage expansion that came with market reforms that made the act of being insured less expensive be used. Health Care Quality and Payment Incentives As the issue of coverage took center stage in public and academic discourse, one issue that came up very sharply was the quality of care and payment incentives to facilitate the coverage. News Desk (2013) noted that in a state of absolute concern for coverage without being mindful of quality, the temptation is that a lot will be receiving healthcare but cases of deaths and diseases will continue to surge high. As a result of this, quality of healthcare became part of the key agenda of both the 2008 Health Reform Law. Based on criticisms raised by the Physicians for a National Health Program about the fact that a free market solution hinders high quality, the recent health reform laws became focused on two major areas for achieving quality, which were the quality of health maintenance organizations and the quality of managed care (News Desk, 2013). As these two sectors are directly involved in the quality assurance of the health care system, the reforms have brought about adequate autonomy for their operation and management. This way, it is now possible to subject individual service providers to scrutiny for quality outcomes. What is more, there have been payment incentives that have come the way of employers, who form majority of the cost bearers of health insurance policies in the U.S. As part of the Health Reform Law, statewide system of quality-based incentive payments known as the pay-for-performance incentives was introduced. The result of this has been that there is now better measurement reporting and payment for health care quality that creates stronger incentives for health care providers to improve their quality (Minnesota Department of Health, 2014). Estimated Costs and Impact of Health Reform The health reform has been estimated to come with cost rise in the funding of healthcare in the country, even though the Congressional Budget Office (CBO) argues that “the Medicaid expansion will add very little to what states would have spent on Medicaid without health reform” Angeles (2012). Quantitatively, the aspect of the reform that focuses on expansion of Medicaid has been focused by most commentators. In this, it has been argued that Medicaid expansion will reduce state and local government costs for uncompensated care and most other forms of services that are given to the uninsured (Angeles, 2012). This is because such costs will now be accommodated for as part of increase in coverage. Once this happens, there will be only modest increase in the state Medicaid cost. It is however important to understand the position of the Federal government and State in the sharing of cost and the impact of the Health Reform. For example, over the periods of 2014 to 2022, Federal government is going to assume 93% of expansion cost. In the figure below, this cost comes to an estimated $931 billion for Federal government and $74 billion for the States. Copied from Angeles (2012) On the part of CBO, it estimates that the impact of such spending on the nation’s budget will be only 2.8% as showed in the figure below. Copied from Angeles (2012). Implementation and Oversight Rules and Guidance Documents In order to ensure that the Health Reform Law comes as a consumer focused law that comes to meet the needs and rights of citizens, there have been institutions and stakeholders who have been mandated with the task of offering guidance and regulations to all. A typical example of such body is The Center for Consumer Information & Insurance Oversight (CCIIO). As part of its roles, there are published documents, as well as online services that seek to offer consumer support and information in the forms of external appeals and summary of benefits and coverage and uniform glossary (CCIIO, 2014). The documents and services also include content requirements for plan finder, pre-existing condition insurance place (PCIP), early retiree reinsurance program (ERRP), and health insurance marketplaces with plan management assistance (CCIIO, 2014). Furthermore, consumers are assisted through rules and guidance on minimum acceptable risk standards, premium stabilization programs, state innovations, consumer operated and oriented plan (CO-OP) program, health insurance market reforms, and the regulations that bind such reforms (CCIIO, 2014). In effect, the CCIIO seeks to provide very comprehensive rules and guidance documentations to consumers to make their decision making process easier. Congressional Oversight To ensure the nationalistic nature of the Health Reform Law, it was directly approached from a perspective that will be acknowledged as being a nationwide reform that ought to be supported by all. One of the first approaches to use was to allow several months of healthcare debate from 2008 to 2010 in both the Senate and the House. Today, there is a congressional oversight given to the law. Typical example of such a congressional oversight group is the Committee on Oversight and Government Reform. Under this group is the 113th Congress Oversight Committee, which is made up of both Republicans and Democrats, coming together to find a common place about the way forward for the Health Reform Law. As a congressional oversight, the committee seeks to function in a highly independent atmosphere that is devoid of political biases. Through its mandates, there has been sanity within the reform through authorization, appropriations, investigative, and legislative hearings (Kaiser, 2012). Legal Challenges U.S Supreme Court Decision and Individual Mandate The coming of the Health Reform Law has not been without legal challenges. For example groups that opposed the PPACA went to the Supreme Court to challenge the constitutionality of the legislation. In its June 28, 2012 ruling of National Federation of Independent Business v. Sebelius the Supreme Court held that individual mandate is constitutional under Congress’s taxation powers (Goodhue, 2012). This came as a follow up appeal to the November 14, 2011 ruling by the same court. As a result of the Supreme Court ruling, there was a limitation on the expansion of Medicaid in comparison to what was initially proposed under the PPACA. Even though most other provisions of the PPACA remain effective, there are commentators who believe that the reform could never be said to be as holistic as it was proposed to be if this ruling by the Supreme Court had not come in (Rosenbaum, 2011). States’ Rights Issues Another issue that has been regarded as a major setback by most commentators is the ruling on States’ right on the expansion of Medicaid. As the expansion on the Medicaid was supposed to be a major component of the reform, it was expected that it would be embraced by all without any legal limitations. But as part of the Supreme Court ruling on National Federation of Independent Business v. Sebelius, the current position is that all provision of the ACA will be allowed to take effect but this will happen in to states’ determination of Medicaid expansion. In effect, the earlier calculations of how the expansion on Medicaid was to save cost on health spending are seen to be challenged. References Kane, J. (2012, October 22). Health costs: How the use compares with other countries. Retrieved from http://www.pbs.org/newshour/rundown/2012/10/health-costs-how-the-us-compares-with-other-countries.html News Desk. (2013, October 4). Under the affordable care act, no co-pays for some preventive services. Retrieved from http://www.pbs.org/newshour/rundown/2013/10/under-obamacare-new-preventive-services-must-be-covered.html Rosenbaum, S. (2011). The Patient Protection and Affordable Care Act: Implications for Public Health Policy and Practice. Public Health Rep, 126(1), 130-135. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001814/ Admin. (2010, July 16). Healthcare reform: Obama administration issues rules on preventive services and care. Retrieved from http://myhealthcafe.com/healthcare-reform-obama-administration-issues-rules-on-preventive-services-and-care Goodhue, D. (2010). Attoneys General Sue To Stop Health Care Bill. New York: All Headline News. Kaiser FM. (2012). Congressional Oversight. CRS Report for Congress 97-936, Halchin LE. Congressional Oversight The Center for Consumer Information & Insurance Oversight (2014). Regulations and Guidance. Accessed April 7, 2014 from http://www.cms.gov/cciio/resources/Regulations-and-Guidance/index.html Todd Zywicki, "An Economic Analysis of the Consumer Bankruptcy Crisis", 99 NWU L. Rev. 1463 (2005) Angeles J. (2012). How Health Reform’s Medicaid Expansion Will Impact State Budgets. Accessed April 8, 2014 from http://www.cbpp.org/cms/?fa=view&id=3801 Federal Government Will Pick Up Nearly All Costs, Even as Expansion Provides Coverage to Millions of Low-Income Uninsured Americans Minnesota Department of Health (2014). Health Care Quality Measures - Quality Incentive Payment System. Accessed April 7, 2014 from http://www.health.state.mn.us/healthreform/measurement/qips.html Read More