Asthma Policy in Affordable Care Act Essay

Introduction

The Affordable Care Act (ACA) is an all-inclusive healthcare reform legislation enacted in 2010 to improve access to health insurance by the people. It offers health consumers with subsidies that ultimately reduce the cost of health for households. Also, it aims to increase the coverage of the Medicaid program and support other creative systems that deliver affordable healthcare (Healthcare, 2018).

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Following the brief above, this presentation provides an analysis of section 2703 of the Affordable Care Act (ACA). Specifically, it describes the provision of the section and identifies the healthcare gaps that the policy seeks to address. Of importance, it provides a rationale for the policy. Using evidence from clinical trials, the paper also evaluates the effectiveness of the policy and assesses the impact of the policy on the US health care system so far.

Purpose

Section 2703 of the Affordable Care Act gives provision for the delivery of care for people with chronic conditions. Asthma is one of the conditions identified under the schedule.

Description of the section

The section prescribes the establishment of a 'health home' which is a designated health provider for the management of asthma (Healthcare, 2018).

The services offered in the health homes include; complete care management, health promotion, transitional support, referral services and incorporation of health information technology in service linkage (Healthcare, 2018).

The program identifies a specific or designated health provider which can be a qualified physician, clinical practitioner, or a community health unit. The provider must have the requisite systems and organizational capacity to offer the home health services (Healthcare, 2018).

The section provides a mechanism for monitoring and evaluation of the policy.

Gaps in the current system

Asthma is a leading chronic pediatric ailment. Statistics show that one in every seven children is affected by the condition (Lyon, Markus, & Rosenbaum, 2013).

Reports from some communities indicate that the prevalence rates are as high as forty percent. Overall, the number of children with chronic asthma has been on a gradual rise (Lyon, Markus, & Rosenbaum, 2013).

Asthma is a costly condition among children and it accounts for approximately 14 percent of all child hospitalization. Also, the condition is linked to a fifty percent rise in the risk that a pediatric call to the ER will result in hospitalization.

Stakeholders with the Medicaid program report that asthma-related expenditures account for the highest proportion of the total expenses on pediatric care (Lyon, Markus, & Rosenbaum, 2013).

Elsewhere, the Centre for Disease Control (CDC) finds that approximately nine people succumb to asthma daily in the United States (Lara, 2013). In addition, the US government spends approximately 56 billion dollars annually in health care costs for the treatment and management of asthmatic conditions. The costs are higher if indirect costs such as missing from school and work are taken into account.

Despite the huge economic burden of the condition and the related negative social impact, there is continued frustration by care providers and patients due to lack of appropriate framework to address the anomaly (Lara, 2013).

Why is this needed?

The policy is needful because it gives an opportunity for the provision of high quality and cost-effective healthcare especially for children living with asthma. Further, the policy is congruent with the primary objective of the Affordable Care Act which is the reduction of medical costs for consumers (Lara, 2013).

Clinical Studies from Literature

The West Michigan Asthma Network entered into an agreement with the community asthma coalition for the management of home visits. The agreement was made under the Medicaid rates. The partnership registered notable success because there was a significant increase in the number of home visits. Moreover, the visits were conducted by registered nurses and qualified respiratory therapists. The partnership also registered a significant reduction in exposure to asthma-causing agents in the environment (Center for Disease Control, 2015).

The data showed a decrease in visits to the emergency room from 72 for every 1000 patients to 40 in 2011. This is estimated to have saved the insurers a total of 1.7 million dollars (Center for Disease Control, 2015).

The CDC also funded a program in Missouri for the prevention and control of asthma in partnership with the University of Missouri. The initiative aimed to support students and school nurses with tools and knowledge to manage asthma. The study focused on the assessment of the severity of asthma and self-care conduct among students (Center for Disease Control, 2015).

Analysis of data from 164 school-going children from Medicaid shows that there was a reduction in the use of emergency room and subsequent hospitalization. This led to a reduction in cost by approximately 1200 dollars for every participant. When there is a synergy between self-care and medical care as envisioned in the ACA, there is potential for greater cost cutting (Center for Disease Control, 2015).

An earlier study showed that children with chronic asthma who were given specialty care cost Medicaid approximately 30 percent less annually. The use of self-care was a vital factor in the management of the condition and overall reduction in costs. The decrease in costs is consistent with the primary objective of the Affordable Care Act (Center for Disease Control, 2015).

The Medicaid also introduced the rule 42 CFR which allowed for the reimbursement of non-licensed practitioners such as community health workers for providing services that are covered under the program. Also, the use of electronic patient referral system has helped healthcare providers to refer patients to medical homes. The mechanisms have shown notable improvement in health outcomes accompanied by a reduction in costs (Center for Disease Control, 2015).

Evaluation Mechanism

The Affordable Care Act provides mechanisms for the evaluation of the policy. According to the schedule, the HHS Secretary can enter into an agreement with an independent organization to carry out evaluation and assessment of the states that offer care through health homes. The aim of the evaluations is to determine the effect of the selection approach to reducing hospitalization, ER visits, and admittances to professional nursing amenities (Healthcare, 2018).

The Secretary is then required to report to the Congress on the status of the assessment especially with regards to the rates of hospital admission, management of chronic diseases, care for people with chronic ailments, evaluation of implementation process, the improvement of quality of clinical results and the estimated savings of cost (Healthcare, 2018).

Impact of policy

The aim of the Affordable Care Act is to make it easier and cheaper for patients to buy health insurance at the marketplace (Asthma and Allergy Foundation of America, 2018).

Evidence shows that the ACA has had a positive impact in the United States (Fitzgerald, 2013). A study examined how the coverage provision of the act affected the use of emergency health departments in California, New York, and Florida. The results show that while the visit to emergency facilities increased for other ailments, the risk of visiting emergency rooms for asthma decreased after the ACA came into effect (Respiratory Health Association, 2017).

It is realistic to conclude that the increased coverage empowered the patients to seek for treatment of asthma and other respiratory ailments in primary health care facilities (Respiratory Health Association, 2017).

References

Asthma and Allergy Foundation of America. (2018, August 28). Health Insurance Programs. Retrieved from Asthma and Allergy Foundation of America: http://www.aafa.org/page/health-care-coverage.aspx

Center for Disease Control . (2015, May 29). Controlling Asthma. Retrieved from Centers for Disease Control and Prevention : https://www.cdc.gov/policy/hst/statestrategies/asthma/index.html

Fitzgerald, G. (2013, October 10). How the Affordable Care Act Impacts Allergy and Asthma Patients. Retrieved from Allergy and Asthma Network Mothers of Asthmatics: https://www.prnewswire.com/news-releases/how-the-affordable-care-act-impacts-allergy--asthma-patients-227280641.html

Healthcare. (2018, August 28). Read the Affordable Care Act. Retrieved from Healthcare: https://www.healthcare.gov/where-can-i-read-the-affordable-care-act/

Lara, M. (2013, November 20). Can the Affordable Care Act Help Asthma Sufferers Breathe Easier. Retrieved from Rand Corporation: https://www.rand.org/blog/2013/11/can-the-affordable-care-act-help-asthma-sufferers-breathe.html

Lyon , M., Markus, A. R., & Rosenbaum, S. (2013). The Affordable Care Act, Medical Homes, and Childhood Asthma. Washington D C: George Washington University.

Respiratory Health Association . (2017). The Affordable Care Act is Good for Lung Health. Chicago: Respiratory Health Association.