Impact of Affordable Care Act on Healthcare Access, Cost, and Quality - Essay Example

Likely impact of Affordable Care Act (ACA) on healthcare access, cost, and quality Likely impact of Affordable Care Act (ACA) on healthcare access, cost, and quality Introduction Health matters have been issues of concern in the United States for a very long time. This is in regard to quality, cost and accessibility to care. Due to the high cost of living in the contemporary world, the cost of health care has been inflated tremendously hence restricting many individuals from accessing quality services. Subsequently, many individuals in the United States lack health insurance and this additionally worsens the problem of access to care, as well as its quality. This paper explicates the likely impact of Affordable Care Act (ACA) on access, cost, and quality of care in the United States. Definition of quality, access, and cost of healthcare Before elucidating the likely impact, it is of importance to define the words quality, access, and cost in relation to healthcare. A number of aspects are considered when defining quality of healthcare. Quality means that optimum outcomes are achieved, proper identification of illnesses is done, sufficient treatment and rehabilitation achieved, cases documented properly, and laid down standards and values are respected (Miles, 2012). Access to healthcare on the other hand denotes the ease of use and convenience to healthcare facilities or institutions in regard to their propinquity. Access to some extent also is viewed in consideration to the number of healthcare providers or physicians available in a specific area. Areas with fewer health professionals are considered to have less access to care while those with more physicians or health professionals are considered more accessible in terms of care (Miles, 2012). Subsequently, cost of care is viewed in a number of ways. In political realms, cost of healthcare is defined in terms of national as well as State expenditures in health matters. Health care providers define cost in terms of expenditure incurred through offering care services to individuals. In relation to commerce, cost of healthcare is viewed in terms of rates of insurance and premiums (Miles, 2012). Healthcare quality, access, and cost is affected by political issues in a country and the kind of action plans implemented to reform the health sector. In the U.S. in particular, the implementation of the Affordable Care Act (ACA), otherwise known as the Obamacare has impacted the health sector immensely. In fact, there was much opposition to the implementation of this act though the Supreme court eventually ruled in the year 2012 that all features of the act were legal. There was a feeling among many individuals that the fact that the act requires all Americans to enroll for healthcare plans lest they pay fines is iniquitous and as well unwarranted. Many people felt that no one ought to be compelled by law pay for health insurance (Guber, 2011). Primary intent of the law In elucidating the ACA, Eibner et-al (2013) points out that; The Affordable Care Act was signed into law on March 23, 2010, and represents the biggest change to the U.S. health care system since Medicare was enacted in 1965. The act expands the Medicaid program, requires most individuals to obtain insurance or pay a penalty, provides subsidies to individuals who have low to moderate incomes and no affordable source of coverage, and imposes fines on business with more than 50 employees that do not offer adequate coverage to their workers if those workers seek federally subsidized coverage as an alternative (p. 1). This fact is reiterated by The Kaiser Family Foundation (2013) who also add on the fact that successive legislations on the act expanded coverage, and as well led to advancement of healthcare delivery systems. It is worth noting that the ACA also initiated national guidelines aimed at proscribing insurance companies from denying private and small scale employers, and high-risk individuals from acquiring health insurance cover (Eibner et-al, 2013). This act according to Eibner et-al (2013) also introduced restrictions to insurance companies that prevented them from charging these small scale and private employers discriminating prices on health indemnity cover. Key variables of the analysis Implementation and political issues Implementation concerns relating to ACA have caused ripples politically in the U.S. Politicians opposing the act have argued that reimbursement touted as striking in the act are more likely to produce discouraging results (Rosenbaum, 2011). These arguments have been based on the fact that a substantial reduction of premiums can only be achieved with the cooperation and involvement of all Individual Americans. There has also been politically instigated concerns that ACA will force younger adults to pay higher premiums rates than would be the case were other systems implemented instead of the ACA. Younger adults tend to prefer plans that cover them only in calamitous cases as opposed to older adults who prefer an all-inclusive cover. The ACA mandate requires younger adults to acquire an all inclusive cover; those opposing the act therefore consider this more costly (Rosenbaum, 2011). There are age-specific premiums rates under the ACA that requires insurance providers to charge similar or analogous premiums for individuals of the same age group regardless of their health status. There have been concerns that this will push individuals falling under such age groups to enroll in health insurance plans only when they fall sick. In essence, this would mean that only ailing individuals and senior citizens would be covered by health plans. Subsequently, this would also translate to an increase in premium rates (Miles, 2012). Other political views have been directed towards the fact that enforcing price controls in regard to costs of health care will only worsen the situation (Miles, 2012). Additional political views focusing on ACA includes the impacts of the act on job creation and the economy in general. Smalls businesses with smaller numbers of workers have been exempted from acquiring indemnity for their workers. Therefore, in a bid to cut-back on expenditure through enrolling workers in health plans, most business owners will opt not to expand their business. This means no job creation and a limit in the rate of growth of the economy (Miles, 2012). Impact on access to care Who is newly covered? A methodical investigation conducted by the Rand Corporation and sponsored by the United States Department of Health and Human Services stipulated a potential increase in the number of Americans enrolling individually to health insurance through individual contracts or government programs. This investigation estimated that new individual enrolments for individuals under the age of 65 years will double in the year 2016 due to the implementation of ACA (Eibner et-al, 2013). Exchanges Consequently, individual States are offered support by the act to arrange health insurance exchanges or connections for such small scale and private employers, as well as individuals. By definition, health insurance exchanges are arrangements harmonized by States that allow citizens to buy health insurance in a reduced price through offering subventions (Fernandez and Mach, 2013). In doing so, the act allows States to employ the use of internet-based gateways or systems whereby individuals, private and small scale employers can choose and sign up for their preferred insurance plans, and also support them financially through offering credits (Kaiser Family Foundation, 2013). States incapable of offering exchanges to their citizens are allowed to bestow this obligation to the national government. Status of Medicaid expansion According to Gruber (2011), approximately thirty million Americans are projected to acquire medical cover with the introduction of ACA. There is a distinct relationship between the Medicaid program and the ACA. Approximately fifty million low income earners in the U.S. are currently covered by Medicaid (Gruber, 2011). Medicaid is a national program with adequate monetary allocation and assistance from the Federal and State governments, and donors. All States in the U.S. are therefore collaborators of Medicaid. Gruber (2011) additionally asserts that the signing of ACA into law expanded Medicaid, meaning increased access to Medicaid for more low income earners including grown-ups without children. Expected impact on cost Impact on health insurance premiums Affordable Care Act has impacted health insurance premiums both positively and negatively. In other words, some aspects of the ACA have led to an increase in premiums while others have led to a decrease. The fact that high risk individuals have been protected from paying discriminating health insurance rates means that premium rates will subsequently increase to cover the losses. Many individuals in the U.S. have also qualified for tax premium credits and this translates to a reduction in premiums. State controlled exchanges have also greatly led to a reduction in premiums through offering subsidies to individuals (Miles, 2012). Impact on aggregate spending The new law under the ACA necessitates individuals to enroll in covers offering minimum medical costs of actuarial rates, meaning that more individuals will noticeably relocate to more liberal and munificent health insurance plans. Such abrupt relocations will increase the demand for such munificent plans and hence leading to an increase in aggregate spending. The ACA has allowed health insurance providers to charge higher fees for older citizens as well as tobacco users. Therefore, these individuals are at a higher risk of paying higher rates as compared to non tobacco users and younger adults hence additionally increasing aggregate spending (Eibner et-al, 2013). Impact on effectiveness One of the greatest impact or effects of ACA is in regard to the effectiveness of health care. As noted earlier, ACA has significantly expanded health insurance for individuals in the U.S. In real sense therefore, more people will be seeking care. This takes us back to the problems that have faced the health care field since time immemorial particularly inadequate staff. Health care institutions all over the world including the U.S. have been operating with inadequate staff and hence increasing the number of individuals in need of care will only make the problem worse. Anderson (2014) asserts that ACA has increased the number of Americans covered by health insurance with approximately thirty million individual. She additionally asserts that "When congress enacted the national health law, it unleashed a potential tsunami of newly insured patients, flooding a delivery system that was already strained and fragile" (para. 1). Many individuals have argued that the signing into law of the ACA was done at a time the health sector was ill-equipped in terms of staff and infrastructure. This notion has been attributed to the fact that Medical training is conducted for a good number of years and hence the health sector will have to operate for long without adequate staff hence causing unnecessary pressure on the workforce. Inadequate staff also means that many patients will have to wait in long queues in health institutions as the small number of staff grapple with their high numbers (Miles, 2012). According to Anderson (2014), the issue of inadequate staff will introduce additional issues such as dissatisfaction among patients, many individuals will have difficulties accessing care, and time spent by care providers offering care to individual patients will be significantly cut. ACA will also definitely build up or increase the need for health care as more individuals will be fascinated by the subsidized health care. The fact that there is scarcity of medical staff coupled with inadequate resources will destabilize or weaken actions plans proposed by legislators for implementation. Available health providers will also be affected both physically and emotionally. This is in terms of increased levels of stress due to long working hours and pressure to handle the long queues of patients. There are also considerations particularly in regard to ethical and legal standards that ought to be observed in health care. There is a higher likelihood of ignoring or disrespecting patients decisions and choices relating to health care when the staff is stressed or under pressure. Such factors will therefore have a negative effect on the effectiveness of overall care (Miles, 2012). Impact on the quality of care Value and status of electronic medical records The world is changing at a very speedy rate in terms of technology. People from all over the world have adopted the use of computers, phones, and other technological gadgets. Technology has also significantly altered the way people communicate. The field of health care has also not been left behind. Since the time of our fore fathers, there has been the need for a faultless exchange and flow of medical information. Patients Medical records contain very sensitive information pertaining to their health status and hence ought to be treated with utmost confidentiality. Such faultless flow and exchange of medical information has been made possible by Electronic Health Records (EHRs). These systems have changed the manners in which health care is delivered to a great extent (Miles, 2012). The value of EHRs as compared to paper records used in previous years can never be understated. EHRs have led to improvement of quality of care, expediency, involvement of patients in the provision of care, increased precision in terms of analyzing ailments, improved competence and effectiveness in the medical field, reduced expenditure tremendously, and also improved coordination and dexterity within the health sector (Miles, 2012). The adoption of EHRs in healthcare is one of the directives or guidelines of ACA. ACA directed the use of EHRs as a directive in a bid to ensure that all medical cases and procedures are documented. In other words, EHRs systems makes it easier for any physician or medical practitioner to access medical records of a patient and as well view his or her medical history. This helps reduce medical errors. In addition, health insurance providers can be able to access patients medical records or information easily in order to arrange reimbursements in a prompt manner (Miles, 2012). Health insurance providers requires all medical or health information associated with the patient for them to facilitate reimbursements. Impact on the delivery of care ACA has also altered the healthcare delivery systems. Due to the fact that the directives and guidelines introduced by the ACA are burdening the healthcare providers, many of them have amalgamated or unified their health institutions. These amalgamations have enabled them to have elevated concession from insurance providers (Rosenbaum, 2011). However, this has reduced competition for provision of quality healthcare in the market hence consumers have been forced to be contented with average services (Miles, 2012). The burdens arising from ACA in terms of numerous directives coupled with insufficient staff has led to changes in how health care providers provide care. Anderson (2014) notes that a good proportion of health providers have opted for cash-only services. This means that patients in some institutions are required to pay upfront for services. This trend has arisen as an attempt for health providers to minimize or eliminate overhead costs in totality. ACA has presented an opportunity for health care providers to collaborate with Medicare and Medicaid programs in order to access the necessary support, for the most part, resources imperative in the provision of quality care. Such collaboration translates to improved coordination of resources. ACA also lays a lot of attention on patient-centered care. Under the act, consumers or patients are required by law to pay for the quality of service provided in health institutions rather than for mere services (Miles, 2012). The fact that care providers are penalized for poor performance in terms of provision of care has forced them to ensure a more patient-centered care. Cases of readmissions are also considered when penalizing care providers. This means that they have laid much emphasis on patient-centered care in order to identify and treat ailments correctly, and as well minimize medical errors hence reducing readmission rates. High performers are awarded additional benefits. In a bid to get these benefits therefore, patient-centered care has been imperative (Miles, 2012). Decreased quality of health as a result of the implementation of ACA is attributed to stress in the medical profession, additional paperwork, additional penalties, dissatisfaction and burnout of staff. In terms of additional paperwork, Anderson (2014) brings forward the fact that ACA had led to the introduction of additional one hundred and nine diverse guidelines and directives. A lot of man-hours are required therefore in terms of paperwork to formalize these guidelines and directives. There is also the fear that conformity to these directives will lead to a reduction of time spent by health providers to care for patients. There has been a lot of debates with a huge number of people arguing that the work of health care providers ought to be provision of care rather than filling up the numerous paperwork introduced by the ACA framework. Anderson (2014) also notes that an increase in the total working hours brought by the shortage of staff and increased number of people in need of care will considerably reduce work safety. In other words, medical errors will increase as a result of burnout and stress within the medical and nursing profession. Anderson (2014) asserts that ACA has led to overreliance on "Mandates, penalties, and bonus reimbursements for compliance with its regulatory standards. 2225 hospitals were penalized in 2013 under the Hospital Readmissions Reduction Program, part of the ACA legislation" (para. 30). This clearly shows that health care providers are grappling with providing quality care and at the same time make profits in a bid to keep their businesses running. Consequently, direct investments such as modern technology aimed at improving delivery of care will be hard to implement for lack of finances. Another problem associated with reduced profits or revenue include lay-offs of workers. Anderson (2014) denotes that six thousand employees in the medical field were laid off in the year 2012 alone. Laying off employees at a time the health field is experiencing shortage of staff will greatly impact negatively on quality of services in health institutions. Impact on equity of care There has also been debates on whether ACA will realize a collective and impartial coverage. One of the objectives of the ACA is to align provision of care with the ideologies or philosophies of universality and equitability proposed by the Institute of Medicine (IOM) in the year 2004 (Ross, 2013). These philosophies were delineated to be followed by health insurance providers in a bid to reform the sector. Under the act, it is obligatory for insurance providers to cover all individuals lacking serious life threatening situations or ailments. Therefore, the act is geared towards the provision of equal and collective care for all Americans (Ross, 2013). This means that access to healthcare has been expanded by the ACA. Summary In summation, there are numerous likely impacts of ACA on cost, access, and quality of health care in the U.S. In terms of access, the Act has expanded Medicaid and hence more people will access health insurance. Some factors relating to the Act will elevate the cost of healthcare while others will decrease it. For instance, tax premium credits and premium exchanges will lower premiums. The law requires Americans to enroll in plans covering minimum cover hence more people will shift to the more appealing plans. This will cause more demand to specific plans hence an increase in premiums. There are a lot of concerns relating to the effects of ACA on quality of care. The health sector is already struggling with insufficient or shortage of staff. Implementation of ACA added more paper work to the physicians and other care providers hence reducing the amount of time spent caring for patients. Due to the expansion of Medicaid by the ACA, more people now have health insurance. This means that the already insufficient staff has to deal with more patients and hence leading to burnout, stress, and increased medical errors. These factors in a nutshell will affect the health delivery system as a whole. Personal conclusion On balance, ACA is a good law. This is attributed to the fact that more people have acquired health insurance and hence the health status of the nation is substantially adequate. Other issues such as shortage of staff will be sorted in a few years as a result of more job openings in the health sector and hence more people will pursue healthcare related careers. Many people were previously blocked from accessing quality healthcare services due to lack of health cover. A healthy nation is a productive nation. The advantages of the act outweighs its negative concerns. References Anderson, A. (2014). The Impact of the Affordable Care Act on the Health Care Workforce. Retrieved from http://www.heritage.org/research/reports/2014/03/the-impact-of-the- affordable-care-act-on-the-health-care-workforce Eibner, C., Cordova, A., Nowak, S. A., Price, C. C., Saltzman, E., & Woods, D. (2013). The Affordable Care Act and Health Insurance Markets: Simulating the Effects of Regulation. Retrieved from http://www.rand.org/content/dam/rand/pubs/research_reports/RR100/RR189/RAND_ RR189.pdf Fernandez, B., & Mach, A. L. (2013). Health Insurance Exchange Under the Patient Protection and Affordable Care Act (ACA). Congressional Research Service. Retrieved from http://fas.org/sgp/crs/misc/R42663.pdf Gruber, J. (2011). The Impacts of the Affordable Care Act: How Reasonable are the Projections?. Cambridge, MA: National Bureau of Economic Research. Miles, T. P. (2012). Health Care Reform and Disparities: History, Hype, and Hope. Santa Barbara, CA: ABC-CLIO. Rosenbaum, S. (2011). The Patient Protection and Affordable Care Act: Implications for Public Health Policy and Practice, 126(1), 130-135. Ross, J. S. (2013). Will the ACA achieve universal, equitable coverage?. Retrieved from http://www.pnhp.org/news/2013/april/will-the-aca-achieve-universal-equitable- coverage The Kaiser Family Foundation. (2013). Focus on Health Reform: Summary of the Affordable Care Act. Retrieved from http://kaiserfamilyfoundation.files.wordpress.com/2011/04/8061-021.pdf Read More