Essay on Affordable Health Insurance Marketplaces: Government Policies for Managing Healthcare

Introduction

The marketplace is a service that makes it possible for people to shop for affordable health. The health insurance marketplaces are organizations located in each state in the United States that act as a medium through which Americans purchase health insurance. The government uses two programs, Medicare and Medicaid, that serve different people. Healthcare policies are implemented by the government in attempts to manage the nation's healthcare system. Healthcare is a vital body that affects the economy, the federal budget, and off course, the individual's wellbeing. Healthcare policies determine costs Americans must pay, and this directly links to the quality of healthcare they receive. The United States has a third-party kind of system, meaning, it's the kind of system that manages and reimburses medical expenses other than the patient and the health giver. This essay elaborates on how government regulations impact the healthcare marketplace.

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Government Policies

Government policies in the United States have sunk competition by reducing service providers and hence reducing the range of services and products that can be offered, resulting in decreased quality of the services given and uneven allocation of resources. Most regulations are not in favor of the consumers as they might be covered by an insurance company, but have to dig into their pocket for procedures not included in the insurance cover. Arrangements like the Health Reimbursement Arrangements (HRAs), however, have been put in place as a relief to the consumer. Third-party payment mechanisms do not allow consumers to pay directly for their healthcare services; rather they rely on an intermedium to do so for them. Although this might be deemed necessary because sometimes healthcare can be expensive, it carries with it its disadvantages; for example, due to the complexity of insurance systems, insurance companies can have a high administrative cost. This allows the consumer to be reimbursed for what they have paid from their pocket by their employer. There also exist policies that restrict entry into the provider's market-leading to the extinction of new, innovative, and cost-effective methods to provide healthcare. Regulations that limit coverage options for the citizens should be modified because they limit the consumer from accessing preferred options, rather they include options that are not necessary for the consumer or highly-priced premiums, leaving out important options. The United States government tends to rely so much on the third-party payment system, leaving Americans with very little incentives to purchase high-quality healthcare at an affordable price. (Kocher, Adashi, 2011).

Affordable Care Act (ACA)

The Affordable Care Act was signed by President Obama in March 2010 and was designed to help insure millions of Americans who were not insured. The law protects families against huge costs related to healthcare. It also covers maternity care, treatment, treatment of substance abuse disorders, and many others that were not included in other policies before. It also mandates private insurance services to cover preventive services without cost-sharing. This ensures the preventive services are not underused. However, it has increased requirements that should be met and has caused premiums to soar. It offers a mandated set of government required benefits but contains hidden charges that would have otherwise be left to be optional for the consumer in insurance packages.

The Medical Loss Ratio (MLR) is a mandate under the affordable care that dictates insurers in the individual and small group markets to spend in the minimum, 80% of premiums on healthcare, leaving only 20% for administrative costs and profits. (Foster, 2016). Policy experts believe MLR regulations may hinder the ability of small insurers to thrive and therefore reducing consumer options. Over 30,000 jobs have gone uncreated, and 37 planned hospitals have also not been constructed, thanks to ACA's restrictions on physician-owned hospitals. The restrictions, also backed by the American Hospital Association, reached to curb patients being referred to the health provider's private clinics. But studies have proved that the physician-owned private hospitals provide better care, and traditional clinics need competition to keep them on their toes. However, the government has put laws that do not favor these clinics.

Entities covered in ACA section 1557, gives Spanish and other multiple language speakers, the right to request translations repeatedly. As this could be seen as consideration of some minority groups and as a positive thing, it increases cost heavily and only favor larger entities. Smaller entities cannot handle the huge cost.

Healthcare Workforce

The United States government has significant restrictions on foreign-trained doctors to practice in the United States, resulting in a limited supply of physicians. (Matsudaira, 2014). State licensing and scope-of-practice (SOP) restrictions are common codes for healthcare professionals. SOP restrictions reduce healthcare competition and increase the chances of the consumer getting harmed.

The government should implement legislative and administrative laws to ensure non-physicians or non-dentists are paid directly if they have administered care. This will enroll more people who can later become professional health givers. State-based licensing requirements counter-movement of service providers and make it difficult to work in a different state. This law should be amended to maximize on the workforce.

Conclusion

It is quite evident that the United States uses a third-party payer system where healthcare providers are paid by insurance or government payers through a system or reimbursement. It is also a crystal that the United States government has a number of regulations ranging from regulations that restrict innovation, competition, and also those that minimize healthcare providers from flocking the market. There also exists the ACA, which is an act that has succeeded in insurance coverage but has a negative blow to small healthcare institutions and physician-owned private hospitals. However, the government strives to improve and modify its policies and regulations in order to enhance better healthcare to its citizens.

References

Foster, A. C. (2016). Household healthcare spending in 2014.https://digitalcommons.ilr.cornell.edu/cgi/viewcontent.cgi?article=2571&context=key_workplace

Kocher, R. P., & Adashi, E. Y. (2011). Hospital readmissions and the Affordable Care Act: paying for coordinated quality care. Jama, 306(16), 1794-1795.

https://jamanetwork.com/journals/jama/article-abstract/1104541

Matsudaira, J. D. (2014). Government regulation and the quality of healthcare evidence from minimum staffing legislation for nursing homes. Journal of Human resources, 49(1), 32-72.http://jhr.uwpress.org/content/49/1/32.short