The need for improved healthcare access, outcomes, and patient safety are tremendous, and the problems related to making those improvements are daunting. The current financial state of this nation has challenged the United States to support the needs of the citizens. The Patient Protection and Affordable Care Act (PPACA), for example, is a major state and federal government healthcare reform initiative that has significant economic implications on health and medical care markets in the United States. What are the basic economic features of the ACA, and how do basic economic principles shape healthcare services and delivery?
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Basic economic features of the Affordable Care Act (ACA) and how it shapes the healthcare services and delivery-
1. ) Expand access to insurance coverage by expanding both private and public insurance.
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-It requires employers to cover their workers, or pay penalties, with exception for small employers.
-It provides tax credits to certain small businesses that cover specified costs of health insurance for employees
-It requires individuals to have insurance, with some exceptions, such as financial hardship or religious belief
-Require creation of state-based (or multi-state) insurance exchanges to help individuals and small businesses purchase insurance. Federal subsidies will limit premium costs to between 2 percent of income for those with incomes at 133 percent of federal poverty guidelines, rising to 9.5 percent of income for those who earn between 300 percent and 400 percent of the poverty guidelines.
-Expand Medicaid to cover people with incomes below 133 percent of federal poverty guidelines
-Require creation of temporary high-risk pools for those who cannot purchase insurance on the private market due to preexisting health conditions
-Require insurance plans to cover young adults on parents’ policies
-Enact consumer protections to enable people to retain their insurance coverage
2. ) Increase consumer insurance protection by enacting several insurance reforms to accomplish the following-
-Prohibit lifetime monetary caps on insurance coverage and limit the use of annual caps.
-Prohibit insurance plans from excluding coverage for children with preexisting conditions.
-Prohibit insurance plans from cancelling (rescinding) coverage, except in cases of fraud.
-Establish state-based rate reviews for “unreasonable” insurance premium increases.
-Establish an office of health insurance consumer assistance or an ombudsman program.
-Establish the share of premiums dedicated to medical services (minimum medical loss ratios)
3. ) Emphasize prevention and wellness It contains provisions intended to prevent illness, including the following-
-Establishes a Prevention and Public Health Fund, to provide grants to states for prevention activities, such as disease screenings and immunizations
-Creates the National Prevention, Health Promotion and Public Health Council to coordinate federal prevention efforts, including those to address tobacco use, physical inactivity and poor nutrition.
-Requires insurance plans issued after March 23, 2010, to cover certain preventive care without cost-sharing, such as immunizations; preventive care for children; and specified screening for certain adults for conditions such as high blood pressure, high cholesterol, diabetes and cancer.
-Increases the federal share of Medicaid payments by 1 percentage point for certain preventive services, for which states do not charge a copayment
-Increases Medicare payments for certain preventive services
-Establishes a federal home-visiting initiative to help states foster health and well-being for children and families who live in at-risk communities
-Requires restaurant chains with 20 or more locations to label menus with calorie information and to provide other information, upon request, such as fat and sodium content.
-Requires Medicaid programs to cover tobacco cessation services for pregnant enrollees
-Requires a federal public education campaign about oral health.
4. ) Improve quality and system performance by-
-Comparative research to study the effectiveness of various medical treatments
-Demonstration projects to develop medical malpractice alternatives and reduce medical errors
-Demonstration projects to develop payment mechanisms to improve efficiency and results
-Investments in health information technology
-Improvements in care coordination between Medicare and Medicaid for patients who qualify for both
-Options for states to create “health homes” for Medicaid enrollees with multiple chronic conditions to improve care; and
-Data collection and reporting mechanisms to address health disparities among populations based on ethnicity, geographic location, gender, disability status and language.
5. ) Promote health workforce development by-
-reforms in graduate medical education training
-increases in health profession scholarship and loan programs
-support for training programs for nurses
-support for new primary care models, such as medical homes and team management of chronic diseases
-increased funding for community health centers and the National Health Service Corps
-and support for school-based health centers and nurse-managed health clinics
6. ) Curb rising healthcare costs by-
–providing more oversight of health insurance premiums and practices
-emphasizing prevention, primary care and effective treatments
-reducing health care fraud and abuse
-reducing uncompensated care to prevent a shift onto insurance premium costs
-fostering comparison shopping in insurance exchanges to increase competition and price transparency
-implementing Medicare payment reforms
-and testing new delivery and payment system models in Medicaid and Medicare.
