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ANALYSIS OF AFFORDABLE CARE ACT Bus 102 November 25, 2016 Jasso Sean Jie Section 21










Contents 1.0 Introduction 3 2.0 Description of the law 4 3.0 Rational for affordable care act 7 4.0 Analysis of ACA efficacy 8 5.0 Implementation 9 6.0 Evaluation 9 7.0 Conclusion 10 8 0 Recommendations 10 9.0 References 12



1.0 Introduction

Quality and affordable healthcare is a basic and constitutional right for every American citizen. However, a realization of this basic need has been a challenge to the federal government. This has resulted in the development of several policies and programs such as the MEDICAID and Medicare programs which aimed at ensuring that most of the citizens get access to the health care services. These programs were initiated and directed towards meeting the healthcare needs of the citizens with limited resources. The programs were designed to allow the collaboration of efforts between the federal and state governments in the form of resource allocation and other expertise to ensure that as many citizens as possible have access to the healthcare. Despite such efforts, healthcare challenges still continued to persist and then there was there was the affordable care act of 2010 that was passed in the Congress to increase the healthcare insurance cover (Hofer, Abraham &Moscovice, 2011).

This assignment will focus on detailed analysis of the affordable care ACT including its rational for enacting and detailed description of what the law entails to achieve. This is a long-term healthcare act that seeks to result in a lot of restructuring of the healthcare sector. A lot of changes are expected to take shape as the Act continue to be fully implemented. The second part of the paper will, therefore, focus on the analysis of the ACT efficacy and the practicability of some of the suggested reforms in the healthcare sector. Implementation brings along a lot of challenges some that were forecasted and planned for but some are emergent and unplanned for and such dynamics will be of importance to focus on the analysis of the Affordable care Act. Finally, the paper will offer some of the recommendations at the tail end based on the content developed in the body part of the paper.


2.0 Description of the law

The long process that culminated in the passage of the Affordable care act started back in 2009 when a group of Democrats in Congress hatched the Obama administration intention to initiate drastic changes in the healthcare sector. The team led by then-speaker of the Congress revealed this plan to the Congress through H.R.3962 which is commonly referred as ACA. Despite the many obstacles that characterized the passage of the bill into law including the death of the leading crusader Senator Kennedy and his replacement with a Republican candidate the bill was finally signed into law by President Obama back in 2010. This was after the bill sailed through both houses of the legislature and met the required numbers to be passed into law (Rosenbaum, 2011).

The main objective of passing ACA was to ensure that all the American citizens have access to quality and affordable healthcare. It also meant that a certain restructuring of the healthcare system to ensure that the costs of providing healthcare services are revised down. It encouraged the collaboration between various healthcare organizations and other stakeholders in the sector to avoid duplication of efforts and hence increase efficiency in the healthcare sector. The Healthcare Act contained nine subtitles with each of it addressing a certain aspect of the reform that will be implemented for the full realization of its benefits.


The first subtitle deals with ensuring that there is affordable health insurance cover for all American citizens. This would require a total transformation of the existing healthcare insurance by encouraging collaboration to increase the coverage while maintaining the current insurance premium. It would take time, but the systematic restructuring of health insurance system will ensure that pre-existing discriminatory practices which left several of the American citizens uncovered are removed. Realization of this goal will mean that all Americans must be part of the insurance system to maintain the premiums while increasing the breadth of the cover. Some of the immediate reforms included the elimination of unreasonable annual restrictions on benefits, offer assistance for those not covered due to pre-existing conditions among several other major initiatives (Huntington, & et al. 2011)

The second title of the affordable act provides for the revisiting the role to be played by the public programs such as the Medicaid in ensuring that all American citizens get access to affordable healthcare. The Act provided for the expansion of MEDICAID program to ensure an expanded cover for people in the lower income levels. The responsibility of meeting such costs is largely shifted to the federal government. The Act also provided for improved cover for CHIP program and even simplified the process of both MEDICAID and CHIP enrollment processes (Kocher, Emanuel &DeParle, 2010). Individuals eligible for the enrollment into the MEDICAID and CHIP programs will have the chance to do so through the state websites and hospitals will be required to offer the health care services during the presumptive eligibility period. The ACT also provides for the state to offer the health care services which were initially available in acute care hospitals to intermediate healthcare facilities, nursing homes, and other community-based care organizations. This would ensure more access affordability and efficiency of the care to eligible citizens across all the states.

The third title of the healthcare ACT also provides for the improvement of the efficiency and quality of healthcare. The ACT recommends the restructuring of the healthcare delivery system to improve the efficiency and effectiveness of the methods employed and especially to the beneficiaries of the MEDICAID and MEDICARE programs. New models of care would be made and driven by the research to analyze its effectiveness based on the research outcomes. This would result in different approaches to treatment and care of the clients. The payments of the healthcare institutions will be linked to the quality of their performance on high-cost diseases such as pneumonia, surgical and cardiac care (Huntington, & et al. 2011).

The fourth title of the affordable care act seeks to prevent chronic diseases. Interagency prevention coordination will be initiated to create a national prevention strategy and policies that ensure that health of the citizens is promoted. The private public partnership will ensure efficient utilization of resources. These initiatives aim at promoting health eating and living awareness campaigns and outreach to ensure healthy living of the citizens and prevent diseases across the entire nation. It also entails increasing access to preventive care services. Act authorize eligibility to access a variety of new programs that are related to the preventive services and care.

Title five of the act aims at improving the quality of healthcare professionals to encourage innovations in the recruitment, retention, and training of the professionals. The Act establish a workforce commission that will help to improve the supply of the healthcare workforce. The provisions also aimed at analyzing the health care workforce needs in the country and so as to realign those needs with the training of the human resource to meet them. The provisions of the act also propose the need for increasing the supply of healthcare professionals. The Act introduce new requirements to offer the public with the necessary health information to help combat fraud and other forms of abuse to private and public programs. The ACT also requires for the availing information about the ownership of nursing facilities under MEDICAID and Medicare programs (Gable, 2011).

The sixth subtitle requires improvement in program integrity and transparency. The bill creates new requirements where the hospitals are required to avail adequate information to the public to ensure that they combat any fraud on public funds. This chapter also provides for increased staff training to facilitate abuse prevention and also add dementia management. This chapter also introduces other requirements and procedures for screening CHIPP, MEDICAID and MEDICARE providers. Such providers will be subjected to a set of new requirements including disclosure of previous and current affiliations with other supplier institutions whose integrity in participating in the Medicare program has been questionable. These include institutions which have uncollected debt or whose payments has been put on suspension dude to different underlying issues. The Affordable care Act also prohibits continued participation of entities or individuals in the Medicaid program if such entities have been terminated or excluded from participating in Medicaid program in any other state.

Title seven provides for privileges to underserved communities and children to have access to affordable medicines. It provides for more access to discounted medicines for inpatients as well as community hospitals, rural referral hospitals and cancer hospitals. Title nine also talks about the taxation procedures and financing of the newly expanded healthcare insurance programs. The provision imposes pharmaceutical manufacturer fee among other mandatory levies.

3.0 Rational for affordable care act

The issue of affordable and quality healthcare has been a major ethical concern in the history of American politics. Healthcare reform that accommodates the needs and covers the less privileged in America is considered an issue of justice and a great step towards the achievement of human rights. The sanctity of life is a valuable aspect of the federal constitution. Individuals, the state, and the federal government have struggled with brainstorming on the best strategies that ensure quality and affordable healthcare for all.

Based on the national statics Access to quality and affordable healthcare services for individuals aged 19-64 had continued to deteriorate from 200-2010 (Hofer, Abraham & Moscovice, 2011). The access to healthcare services for this age group is very critical to the success and development of the nation. It is considered as the productive age that is actively involved in the development and implementation agenda of the country. The statistics indicated deterioration of health especially among those who were not insured under any health insurance cover. Further analysis indicated that although there existed some healthcare cover programs that promoted healthcare access among the marginalized in the society, there was the need to focus on a more comprehensive and affordable approach that puts on board every citizen. The rational for enacting this law was to remove all the obstacles created by pre-existing conditions which made it difficult for all to have access to quality healthcare services. Healthcare is a complex sector and thus addressing just one aspect or program is inadequate. ACA aimed at restructuring the entire healthcare system through several approaches and new initiatives. Key among them included the prohibition of the healthcare insurers from preventing beneficiaries from access to healthcare services due to pre-existing obstacles, subsidizing the healthcare premiums, expanding MEDICAID eligibility.

4.0 Analysis of ACA efficacy

Close analysis of the available health data indicates that Affordable Healthcare Act has had a tremendous positive impact on the access of healthcare services to the American citizens. It seems that the Healthcare Act has achieved strategic milestones five years down the line of its implementation. It has significantly cut down the figures of people who did not have any insurance cover before its enactment. Recent studies indicate that approximately seventeen million individuals have been added to the health insurance cover. The percentage of people above nineteen years without the health cover reduced significantly to 11.9 percent for the first quarter of 2015. Further analysis of the available statistics reveals that there has been a significant increase in the number of people between 19 and 26 years who have been subscribed to one of the health insurance covers. Before the enactment of the law in 2010, approximately one in every three individuals between the age of 19 and 26 had no access to healthcare insurance cover (Koh & Sebelius, 2010). This was largely attributed to high cost of the cover and lack of employer-provided health insurance cover. Currently there more than three million individuals within the above-prescribed age bracket have been subscribed to the health insurance cover as a result of the subsidized premiums. This has been described as one of the most rapid increasing trends of young people gaining an insurance cover.

ACA has also made a significant success in including some communities and races that have been historically marginalized or disadvantaged by the pre-existing health care insurance requirements. These segments of society were at very higher rates of not subscribing to any insurance cover. They include the Latino Americans, African Americans, and people with an extremely low level of income. For instance, the percentage of uninsured Latinos fell by thirteen percent to reach the low levels of approximately 23 percent within the just year of the implementation of the law. The Latinos have been among the greatest winners of health insurance cover since the act came into effect.

5.0 Implementation

Although the affordable care act has a long-term implementation plan covering a longer time interval the impact of its implementation blue print has already started to be felt. Some healthcare restructuring has already being implemented under Obama administration. Many of the key provisions of the act have been effected since 2013. The implementation process may also have had some challenges due to legal battles of the legality of some of its aspects in the Supreme Court. However even as the implementation process continue to be rocked into political and legal conflict heavy and positive impact about accessibility of the healthcare services have already being felt. Increased enrollment into the healthcare insurance cover as well as the subsidization of the healthcare insurance premiums is part of the notable milestones achieved. The reforms of the healthcare delivery system continue to assume center stage. The statistics also indicated that by the close of 15th of February 2015 a total a total of approximately eleven million citizens initially uninsured had already selected their health insurance cover plan. Three million additional covers for people between 19-26 years has already being realized through effecting the ACA provisions which require employers to cover health insurance for their employee’s dependents until the age of 26 years (Cantor, Monheit, DeLia & Lloyd, 2012).

6.0 Evaluation

Much has been achieved through the affordable healthcare especially about the increased access to the healthcare insurance among the American citizens regardless of their race, socio-economic status or any other diversity. Perhaps after the few years of its implementation, the only metrics that has been used to ascertain its effective implementation is only on the number of additional citizens who have been included on the cover. The department of health has estimated that a total of twenty million initially uninsured citizens have been including the cover. Another important evaluation metric is the number is the additional people who have been covered through free-care and subsidized healthcare insurance programs. Through the expanded MEDICAID and Medicare programs, more people have become eligible for cover thus improving its affordability among several American citizens (Koh & Sebelius, 2010). However despite such achievements the implementation efforts have been characterized by heated political debates, court battles that have continued to derail its implementation process. A segment of the American population still feels that the Affordable healthcare Act has been too much restrictive to the individuals and hence against their constitutional liberties. More criticism has been leveled against the Act for its negative of increasing the country burden on debt.

Strengths and weaknesses

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