Patient Protection and Affordable Care Act - Research Paper Example

Patient Protection and Affordable Care Act The Patient Protection and Affordable Care Act, otherwise known as Obama Care, is a federal healthcare law of United States of America legislated on March 23, 2010 which enforce massive restructuring of US health services and has tremendous financial impact on all states like Illinois. What is Obama Care? The Obamacare require that all Americans must be covered by health care industry for preventative care and as measure when insurance company will deny policy support when illness pervades among pre-need subscribers (National Conference of State Legislation, 2012, p. 1). Under the new law, children are no longer denied of the coverage based on pre-existing conditions (NCSL, 2012). They will be considered beneficiaries of parents until they will reach the age of 26. The healthcare reform has nationalized its system at the cost of $940 billion (NCSL, 2012). Such amount is exacted from budget cuts, taxation and government funding (Gravelle, 2010). On a positive note, it was perceived to have reduced the national fiscal deficiency by $1.2 trillion (NCSL, 2012). This was perceived as the strategic resolution to provide remedy to the serious concern about 32 million Americans who have no health insurance (NCSL, 2012) notwithstanding critique from other stakeholders that changes will also potentially impact to medicare system and the need for hospitals to cope with the increasing demand of health consumers as budget for national services are rationalized by the state. Healthcare subscribers still need to realize though that preventive health measure remains necessary since Obamacare program is designed as a government’s response to bridge the gaps on financial resources in case of hospitalization. Its appreciable still to note that central to this healthcare reform is the gender non-discrimination clause in its policy; restriction enforced to pre-need companies to make them customer-centered in providing insurance benefits; obliging insurance companies to justify any increase of insurance fees; availability of option to avail healthcare in accordance to their income bracket and nature of employment (NCSL, 2012). The co-payments for domestic violence screening, birth control and related expenses are no longer allowed (NCSL, 2012). Annual and lifetime limits for caring for the patients are already removed and micro-businesses will enjoy tax credits if their workers are afforded with insurance. Notwithstanding these positive reforms, there are still those who categorized that the Obamacare remains favorable to the affluent or the moneyed middle class who could save more from the healthcare benefits. They opined that there are still about 25% of entrepreneurs that are uninsured, 50% are dependent on their respective family, and there are about 60% with private insurance enjoy incomes at about 400% above the poverty level (NCSL, 2012). These affluent will qualify for tax credits other than the fact that it can subsidize healthcare to 83% small business owners that are currently considered not insured (NCSL, 2012). Department of Healthcare and Family expectations of Obama care for state of Illinois The Institute of Medicine (IOM) have already provided directives for the Department of Health and Human Services (HHS) pertaining to essential benefits of mandatory insurance under the health reform law's insurance exchanges (NCSL, 2012). Medical experts observed that the report and directive did not listed specific medical services to be covered by premiums of insurers but it recommended a framework to define the minimum benefits that can be generated under the insurance policy (NCSL, 2012). DoH acknowledged that the Patient Protection and Affordable Care Act (PPACA) was the most comprehensive changes to the provision of health insurance since the development of Medicare and Medicaid by requiring all Americans to have health insurance by 2016 (NCSL, 2012). An estimated 30 million individuals believed uninsured are expected to obtain insurance through the private health insurance market or from the state expansion of Medicaid programs (NCSL, 2012). Costs and benefits are closely correlated here for people to appreciate the pre-need insurance system. Authorities sought balance between the coverage of medical support for pre-need subscribers at a cost that they can afford or based on the capacity of the policy subscriber’s capacity to pay (NCSL, 2012). At least, the new Obama policy secure Americans to benefit support for “ambulatory patients, emergency services, hospitalization, maternity and newborn care, mental health, medical support for disorder, behavioral health treatment, drug prescription, rehabilitation and habilitative services, laboratory services, preventive and wellness, chronic disease management, and pediatric services that include oral and vision care (NCSL, 2012, p. 1).” This is otherwise considered as essential benefits (NCSL, 2012). As the healthcare is nationalized, the DoH and Family expects also total quality improvement in healthcare that will facilitate systematization of health services and organization (Ciampa, 1992; Datta & Vandegrift, 2011) Experts believed that holistic health reform can only be undertaken when there is collaboration among government officials, health sector, clienteles and other important stakeholders to completely enforce the new policy and to manage changes (Meltzer, Chung, Khalili, Marlow, Arora, Schumock, & Burt, 2010). This is because the Obama care requires an increased accountability among health providers, peoples’ participation, and reformation or strengthening of health sector to make it patient-centered and attune to technological modernity. As the health sector is expected to address the perennial causes of mortality and morbidity as well as the emergent public health threats, health professionals must not only assume the responsibilities but also reform its fiscal management to enhance its services (Whetten & Cameron, 1991). All states, including Illinois, must also work to transform its governance to make it health-sensitive with special care focused on the needs of women, children and elderly. Performance standard will likewise be enforced and regular evaluations and monitoring will be undertaken to ascertain that total quality management is exercised to complement with the Obamacare policy (Weeks, Helms, & Ettkin, 1995). It is likewise expected that hospitals and related institution needs to strategize how they will institute changes for competitive leveraging. Dysfunctional offices were reviewed and improved documentation and reporting was demanded to generate records that could become bases for evaluations and formulations of recommendations. These records will also become sources of statistical facts about how DoH performs its administrative and operational aspects in health care management based on targeted goals and programs (Weeks, Helms, & Ettkin, 1995). The weaknesses of human resources and expertise should be complemented with technological innovation and sustain education of new health discoveries. On a positive note, Illinois federal completed the Obamacare by enforcing policies that prohibit smoking in public places since 2008; preventing obesity and improving nutrition; enforced Wisewoman and cervical cancer programs to reduce heart diseases; and other preventive health laws that regulates safety in workplaces and excessive use of alcohol or toxic substances among its constituents (Illionis, 2012). Cost to Illinois taxpayers and how it will be funded The passage of Obamacare is expected to beef up and support to about 1.9 million Illinoisan reported to have no health insurance (Chicago Tribune, 2012). As the law is mandatory, all of them are required and are obligated to get health insurance at competitive prices available online and in the market (Chicago Tribune, 2012). Illinois’ officials perceived that they need to partner with the federal government in setting up exchanges by 2012 and to refined the laws that will make it more beneficial to Illinois residents to enjoy the state-run health insurance providers. Illinois figured that they needed $ 2 billion annually starting 2014 to 2016 that will be assumed by the federal government 100% but they likewise figured that the state will be hooked to increase budget of the Medicaid expansion cost (Chicago Tribune, 2012). By 2020 the Department of Healthcare and Family Services, Illinois will be spending an estimate of $ 238 million annually (Chicago Tribune, 2012). Whether the figure is realistic or a conservative estimate is yet to be determined. The Obamacare simply shifted the healthcare burden to the state and thus pressure the state to undergo fiscal reform too to meet the health care demands (Chicago Tribune, 2012). If it has undertaken budget cut $1.6 billion from its &15 billion Medicaid program by delisting beneficiaries, officials perceived that they need to undertake budget cuts more (Chicago Tribune, 2012). More studies are yet to be undertaken how to fine tune fiscal and healthcare reform that will harmonize fund allocation and healthcare implementation (Chicago Tribune, 2012). As of these days, the federal has standing applications for funding from health-related grants especially for the minority; HIV prevention or surveillance services; and for emergency medical services (Illinois Department of Public Health, 2012).. An interesting aspect of fund generation is the legislation of Illinois Carolyn Adams Ticket for the Cure Lottery where revenue will be allocated to Illinois Department of Public Health (IDPH) (2012) for breast cancer prevention, research and education. Obama care’s impact on state of IL –effective or ineffective At the outset, the healthcare is going to afford support for those 1.9 million people who have no insurance (NCSL, 2012). Under the law, it’s always the prerogative of the state to define measures to deliver appropriate social services to reduce problems and provide more access to healthcare services of the country (NCSL, 2012). This is also figured as remedial measures so that people who can’t afford health services will be able to access professional health support through health insurance. That way, all of the people will have access to professional medical services and hence decrease mortality and morbidity rates. It was also able to protect pre-need consumers from the competition and negligence of insurance companies to take care the concerns of their clienteles (NCSL, 2012). Hence, pre-need companies can no longer refrain from serving those needing healthcare services instead of simply milking them out of these premiums. If deeply contextualized on the policy, Obama care requires shared responsibility between the national and federal states. Hence, for the federal government to be able to support the new healthcare policy, the federal state must also review its fiscal resources and undergo budget cuts from unnecessary expenses and must rechannel this to social services and healthcare. Further, the new healthcare policy revolutionized the process since consumers can now make choices whether to take public insurance or avail Medicaid and Medicare. Aside from these, they can also elect the rate of the insurance to avail based on their salary and economic status in the community. However for Illinois, the federal government must also refine the application of the laws by undertaking fiscal reforms too so that it can help subsidize. Those who will opt for Medicaid are provided with chances by the policy to have the freedom of choice. Companies managing at least 50 workers are compelled now under Obama care to provide healthcare support to its employees otherwise, they will risk for penalties. Recently, Illinois adopted a binding resolution in 2011 that” urged Congress and the President to immediately consider enactment of a Single Payer option based on the Medicare model for adoption as an additional component of a national health reform plan (NCSL, 2012) and legislated Public Act No. 98 of 2011 requiring the “state Attorney General to post on its public website the summary pricing reports required from pharmaceutical manufacturers and group purchasing organizations under the transparency provisions of federal Patient Protection and Affordable Care Act (NCSL, 2012).” Debate/Opinions about the new law The law was subjected to heated debates and arguments before it’s signed as a policy. Insurance companies, especially coming from private entities, may have found this law as both friendly and unfriendly in their business ventures because they can no longer negate their responsibility from their clients owing because the law obliged them not to deny their subscribers on healthcare support. Others who are opposed to this new policy thought that obliging them to secure healthcare for their very selves will compel them to allocate budget albeit absence of or lacking of resources to meet their health needs. The affluent who control insurance companies and those who can afford high pre-need fees argued that this healthcare shouldn’t be nationalized because this cost the government to subsidize those who lacked the capacity to obtain an insurance policy. In June 28, 2012 the U.S. Supreme Court have resolved the legal controversy of the policy but upheld the provisions of the Patient Protection and Affordable Care Act (Cauchi,, 2012). The SC rejected the provision which sought to penalized states that will not comply with the expanded eligibility requirements for Medicaid and have further proposed that the legislative body must continually analyze and rectify the law and its effects (Cauchi,, 2012). The opponents to federal health reform have widely considered and sought voting to know of the public agree or is disagreeing with PPACA provisions but as the United States Supreme Court have rendered legal decision on controversial provisions on June 2012, the issue became moot and academic (Cauchi,, 2012). There is still a need to figure out other states that would likely block the law by not enforcing it by 2014 (Cauchi,, 2012). Before President Obama was reelected into office, others voiced that US healthcare was the most expensive health care service thus far and was blamed as one of the many causes in the lowering of US wages, removal of retirement policy for future senior citizens and increased the allocation for public health spending which cause federal debt and deficits (Reuters, 2012). But the debate failed to elucidate and correlate the role of government and the need to secure its citizenry as the nation’s human resources and with whom taxation are generated. The debate was roused in a political climate and for election-related purposes and hence shut other’s stakeholder’s position on Obamacare, such as the appreciation of stakeholders in improving healthcare access for those who have none. Election experts have already forecasted that the 2012 presidential election in America will deal on significant variables on unemployment rate, inflation, budget deficit, surplus, national debts, taxation policy and healthcare budget as determinants of electoral result and figures for election propaganda. Datta and Vandegrift (2011) also pointed that the need to review the policy and the government’s Medicaid expenditures to go about fiscal reforms in favor of healthcare. Medicaid has spent $360.3 billion in 2009 or 2.55 percent of national gross domestic product (GDP) and albeit this budget, the Affordable Care Act of 2010 (i.e. the new Obama healthcare initiative) further expanded the eligibility criteria for the Medicaid program (Datta and Vandegrift, 2011, p. 1). Although there is significant increase in healthcare spending under Medicaid program in the recent part of this decade, but Datta and Vandegrift (2011) pointed that Obama’s welfare reform has significantly contributed to the reduction of annual Medicaid expenditure by about $1.2 billion from the total healthcare spending at $2.5 billion. Conclusion Reelected president Barack Obama recognized the need for affordable health care for everyone for a noble purpose i.e. to provide all Americans necessary access to healthcare as respond to growing concern for the wellness of all constituents. This concern is not an imposed agenda of the national government for the people rather, a respond to peoples clamor growing problem in accessing expensive medication and health services. Waśniewski (2012) expounded that the issue of national healthcare system’s effectiveness and efficiency can only be delivered if the national government will build a model for quality healthcare that is not driven by market competition but inspired by the desire of national government to deliver quality social services for its people. Healthcare financing brings significant transaction costs but the law ensures that the cost will be proportional to their demographically defined size and net revenues (Waśniewski , 2012). The federal can also sourced from grants and other tax generating measures. This year, America has an estimated population of 315 million populace and which ranked third among world’s population even if it has a low fertility rate of 1.89 per woman (IndexMundi, 2012). The country has a birthrate of 13. 5/1,000 population of which 40% of these births came from single women. It has also a net migration of 4.3 migrant per 1000 population (IndexMundi, 2012). It has an infant mortality rate of 6.2 per 1000 live births. It has also a significant prevalence of HIV related deaths and illnesses (IndexMundi, 2012). The nation also faces the leading causes of mortality and morbidity for both children and adults. Health stakeholders should consider that a number of American populace live below poverty line and barely afford a comfortable lifestyle, hence, their income is budgeted to at least get the minimum necessities. Others simply compromise their health so that they can send their children to school and the indecency of this life are evidenced in ghettos of urban centers. Illinois have considered too – the welfare and wellness of its constituents and its role in responding to social services to the worst off and needy part of the society. There is therefore no mistake that the government must genuinely answer for the needs of its people and to make this public institution truly serve its purpose. Reformed healthcare services are just one of these. References Ciampa, D. (1992). Total Quality. Reading, Addison-Wesley, Massachusstts, US. p.1. Chicago Tribune. Illinois and Obama Care. Chicago, US, Web, 05 July 2012, p 1. Cauchi, R. State Legislation and Actions Challenging Certain Health Reforms 2011-2012, National Conference of State Legislation, Washington, D.C., US, 2012, p. 1. Gravelle, J. G., Tax Options for Financing Health Care Reform. Congressional Healthcare Service, National Conference of State Legislation, 2012, p. 1-27. IndexMundi. United States Demographic Profile of 2012. MIT, US. 2012, p 1. Datta, A. & Vandegrift, D.,Effects of welfare reform and the state children’s health insurance program on medicaid and total health expenditures. MPRA Paper 36486, University Library of Munich, Germany, 2011. 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