Affordable Care Act in the US
Introduction
The safety and general wellbeing of the society significantly rely on the healthcare system used in delivering healthcare services and products. The systems and procedures put in place to facilitate the provisions of health services and products largely impact the efficiency and effectiveness of such a framework. The United States’ healthcare system has been under criticism for long as a result of the level of access individual consumers from diverse groups within the community have to these services. Through this, there have been calls for healthcare reformation within the country to ensure all consumers are able to access the available services and products regardless of their gender, race, ethnicity, and level of income. Johansen & Richardson (2019), Asserts that while the country boasts of well enhanced medical equipment and infrastructure, the majority of these are underutilized as a result of lack of accessibility. Healthcare reformation (HCR) currently dominates political debate headlines and will have a significant influence in the coming presidential election.
Healthcare reformation
The primary factor that elicits a lot of attention from the public towards healthcare reformation is decreasing the cost of healthcare in the country to increase healthcare accessibility for all individuals within the country. In consideration of this Buerhaus (2020), advances four criteria that can be used in assessing the effectiveness of a healthcare reform proposal. The first of these is channeled to establish the manner in which an HCR proposal will enhance the efficiency within healthcare delivery. This criterion considers the significance of efficiency in reducing the cost involved in healthcare delivery. Through this, the criteria is designed to ensure accountability in relation to quality and cost within the healthcare system. The second criterion focuses on establishing the effectiveness of an HCR proposal to increase accessibility to healthcare services and products. The criterion identifies several factors that influence the level of accessibility to healthcare, which include culture, language, geographical barriers, and insurance coverage among other factors. Through this, it considers some courses of action like decreasing the premium charged by private insurers and increasing the level and scope of coverage of Medicare and Medicaid programs.
The third criterion advanced by Buerhaus (2020), in assessing the effectiveness of a healthcare proposal involves establishing the level of emphasis placed on public education and disease prevention. Through this, it focuses on social determinants that impact the health and wellbeing of individuals within the community. The last criteria for assessing healthcare involves establishing how the HCR proposal will impact the financial security and mission of individual healthcare providers as well as their workforce. Some of the healthcare reforms that have existed in the country include Medicare and Medicaid programs. Medicare was proposed in 1965 to provide health insurance for individuals aged 65 years and above. Later it was enhanced to cover individuals below 65 years but with specific disabilities. On the other hand, Medicaid provides insurance coverage for eligible individuals like war veterans. The Affordable Care Act also forms another healthcare reform initiative that has been proposed within the country
The affordable care Act
The Affordable Care Act was signed into law in 2010 by President Barack Obama. It provided significant changes in the country’s healthcare landscape. It focused on addressing the several challenges that hampered the provision of quality and comprehensive healthcare with its primary goal being ensuring an increase in healthcare accessibility (Gaffney, McCormick, Bor, Woolhandle & Himmelstein, 2019). In achieving this goal the Affordable Care Act utilized a combination of both private market strategies and public market strategies. Among the private strategies utilized by ACA include providing a conducive environment that fosters private plans in insurance and creating insurance market places at both state level and federal level. Similarly, public strategies include imposing penalties for individuals without insurance plans, which was meant to ensure every American citizen is subscribed to an insurance coverage plan. Another strategy was to subsidize insurance coverage for individual citizens with low income (Buerhaus, 2020). This was meant to enable subscription among individuals with low income. The other public strategy utilized in this regard was to establish the provision of specific preventive services at no out-of-pocket cost to almost all insured individuals. Lastly, it expanded the level and scope of coverage of the Medicaid program, which ensured a significant number of the country’s population were subscribed to government-sponsored health insurance programs.
Gaffney et al. (2019), observes that the affordable care act significantly increased the level of insurance coverage in the united states. The tear 2014 forms the year in which the goal of increased accessibility of healthcare services was achieved. The reason behind this as observed by …… is that this was the time in which most of the strategies contained within the act were implemented. Through this, the country observed an increase in the number of insurance coverage among its population. There was also an increase in the use of preventive services as well as outpatient services.
The result from the pre-and-post ACA medical ecology study conducted by Gaffney et al. (2019), reveals that the general population of individuals aged 40 years and above increased between the two periods while the population of non-Hispanic individuals decreased. The result also reveals that the country’s population of poorest individuals increased over the two periods, notably between 2008 to 2014. The number of uninsured individuals decreased from 12.8% in 2013 to 7.6% in 2016 (Gaffney et al., 2019). Primary the decrease in the uninsured rate was witnessed among adults aged between 18 years and 65 years. The decrease in the number of uninsured individuals was also witnessed among individuals below 200% of the poverty line and those above the 200% and below 400% of the poverty line (Gaffney et al., 2019). All races and ethnicity including the Hispanics, non-Hispanic whites, and African-American also recorded a decrease in the number of uninsured individuals. However, the Hispanics recorded a significant decrease in this regard. Similarly, there was also a decrease in uninsured individuals based on health status including individuals with good, fair, or poor health status.
There was also an increase in the number of healthcare contact among individuals aged 65 years and above. However, their contact with primary care physicians decreased between the two periods. Similarly, adults aged 18 years and above witnessed a reduction in contact with physicians as compared to children. Additionally, between 2002 to 2016 there was a decrease in the number of individuals who visited physicians and specifically primary care physicians. Gaffney et al. (2019), concluded that though the ACA changed the financing and organization landscape of the healthcare sector in the country, its impact on the medical ecology pattern was minimal. The decrease witnessed in the uninsured population in the country was to enlist an increase in the number of contacts individuals have with physicians, which was not the case.
Johansen & Richardson (2019), also observed that the expansion of Medicaid and Medicare programs as a result of ACA did not have any significant impact on the number of contacts individuals had with healthcare physicians. Johansen & Richardson (2019), advances the supply-induced demand explanation for this phenomenon. The explanation asserts that when supply is constrained individuals with new or upgraded insurance coverage will crowd health centers for services, something that changes when there are few or no constrains placed on supply. Another explanation offered to the decline in physician contact among adults aged above 18 years and below 65 years was that the expansion of Medicare program ensured the elderly i.e. those above 65 years received more visits by doctors within their respective care homes and hospitals (Johansen & Richardson, 2019). This ensured the non-elderly had few contacts with individual doctors. The other explanation offered in relation to a decrease in physician contact was capacity constraints in which the available scarce resources in the form of physicians were over-utilized as a result of the increased number of insurance.
Conclusion
As observed by Gaffney et al. (2019), ACA as a healthcare reform proposal increased the insurance rates among all populations in the country. However, there were no significant changes in the existing patterns within the country’s medical ecology. Through this, the country witnessed a decrease in the number of contacts with physicians, something that goes in contrary to the expectations. An increase in the number of contacts with physicians was expected as a result of a decrease in the number of uninsured individuals in the country. Currently, the only available explanation for this phenomenon as advanced by Johansen & Richardson (2019), includes the capacity constraints, supply-induced demand, and redistribution effect.
References
Buerhaus, P. I. (2020). Demystifying National Healthcare Reform Proposals: Implications for Nurses. Nursing Economic$, 38(2).
Gaffney, A., McCormick, D., Bor, D., Woolhandler, S., & Himmelstein, D. (2019). Coverage Expansions and Utilization of Physician Care: Evidence From the 2014 Affordable Care Act and 1966 Medicare/Medicaid Expansions. American Journal Of Public Health, 109(12), 1694-1701. doi: 10.2105/ajph.2019.305330
Johansen, M., & Richardson, C. (2019). The Ecology of Medical Care Before and After the Affordable Care Act: Trends From 2002 to 2016. The Annals Of Family Medicine, 17(6), 526-537. doi: 10.1370/afm.2462