Essay Sample on ACA Impact on Health Care Org & Fin: Rising Trail of Premiums

Introduction

ACA has impacted the health care organization and finance in various ways. It has influenced and impacted the sector in a vast and wide manner (Cleverley & Cleverley, 2017). One of the greatest impacts of the ACA in innovative legislation is the rising trail of premiums, out-of-pocket charges, and deductibles, especially with the vendor strategies on health insurance. Many requirements of the ACA have made the health payers spend much on the coverage of medical services amongst the sickest populations (Barr, 2016). Furthermore, ACA has resulted in some insurers investing in scale. For example, some payers like Anthem, Humana, Cigna, and Aetna tend to form mergers to stabilize costs existing in the operation of health coverage in the healthcare system that appears to be ever-changing (Gaffney & McCormick, 2017). Despite the higher premium costs existing among health plans, it is evident that there are more payers to invest in implementing the high-deductible health plans. Therefore, ACA has resulted in widespread of out-of-pocket costs and also higher deductibles.

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While the mandate of the individual in the ACA is intended to take healthcare coverage as a large number of appropriate Americans as possible, few regulatory hurdles block numerous potential consumers. In 2012, the Supreme Court passed a ruling which made Medicaid expansion optional under the ACA (Gaffney & McCormick, 2017). Many stakeholders who went for the Affordable Care Act discussion thought that there was coverage for both the poor and older people leaving behind the middle without the coverage.

There were provisions from the ACA that require complete coverage of preventive services, including cancer screenings and immunizations by the health payers. The action abolished the expenses of out-of-pocket for those consumers seeking preventive care while providing a vibrant incentive for patients pursuing preventive medicine. ACA has also resulted in Accountable Care Organizations (ACOs) design and the Medicare Shared Savings Program (Gaffney & McCormick, 2017). Generally, the use of federal legislation like the prior expressive use requirements has led to a greater focus on the healthcare organization reformation into an effective system that enhances the incentivization of quality over the quantity.

How the ACA Incorporated Social Determinants of Health into Health Policy

Firstly, ACA established a Center for Medicare and Medicaid Innovation (CMMI) (Gaffney & McCormick, 2017). It then announced a new "Accountable Health Communities" in 2016, a model focusing on the connection of Medicare and Medicaid beneficiaries together with community services in addressing health-related social needs (DeVoe & Gold, 2016). The model made the provision of funding to test, identify, and address those health-related social needs that exist for CMMI beneficiaries.

Secondly, ACA brought about the State Innovation Models Initiative (SIM), where several states are involved in payment reforms and multi-payer delivery, including focusing on population health and recognition of roles social determinants. SIM initiative provides technical and financial support to states. It is for the state-led expansion and testing, health care payment of the multi-player, and also models of service delivery that purpose in improving the performance of the health system, enhancement in quality of care while decreasing the costs. The ACA also funds the community-based collective networks of safety-net providers as well as health care providers for unified services.

Thirdly, ACA introduced Medicaid initiatives that contain many delivery and payment reform incentives that link health care and social needs. For instance, Colorado and Oregon have started Medicaid initiatives and also delivery models that offer medical care through regional units. They mainly focus on physical, social services, behavioral integration, and also public engagement and collaboration. Medicaid expansion thus helps disadvantaged populations in accessing health services, which in return ease the effects of two social determinants of health namely socioeconomic status and the health care access. The "Delivery System Reform Incentive Payment" (DSRIP) initiatives have been the forum the state Medicaid programs use to support providers to focus on health social determinants (DeVoe & Gold, 2016). In ACA, not-for-profit hospitals are obliged to undertake the Community Health Needs Assessment (CHNA) once per three years to come up with strategies to counter the needs that CHNA finds.

Proposed Changes to the Health Care System Under the Current Administration

Firstly, there is a proposal for Personal and Portable Health Insurance in which employers will be in a position to use an account regarded as Health Reimbursement Arrangement (HRA) (McKee & Stuckler, 2019). It is a change meant to enhance the provision of tax-free funds that staff can comfortably use in buying their private health insurance. Secondly, the administration's purpose of making Medicare open to every direct primary care. In the arrangement, Medicare would, therefore, pay a fixed fee monthly to a physician or a physician group. The system is preferred instead of using the traditional payment, which was fee-for-service (McKee & Stuckler, 2019). Thirdly, there is a proposed change regarding telemedicine access where doctors in the Medicare Advantage plans and also Accountable Care Organizations will bill Medicare by using cell phones, email, or even other technologies in consulting with patients to determine whether they need an in-office visit (McKee & Stuckler, 2019). Also, a separate bill will be sent by the Affordable Care Act plans to enrollees for their premium share in funding abortion coverage, that is not allowed in the public funding.

References

Barr, D. A. (2016). Introduction to US Health Policy: the organization, financing, and delivery of health care in America. JHU Press.

Cleverley, W. O., & Cleverley, J. O. (2017). Essentials of health care finance. Jones & Bartlett Learning. Retrieved from

https://pdfs.semanticscholar.org/8ea2/6ba6d39b18b69c4769b89294f4ecc3d11f02.pdf

DeVoe, J. E., & Gold, R. (2016). Perspectives in primary care: a conceptual framework and path for integrating social determinants of health into primary care practice. Retrieved from

http://www.annfammed.org/content/14/2/104.full.pdf

Gaffney, A., & McCormick, D. (2017). The Affordable Care Act: implications for health-care equity. The Lancet, 389(10077), 1442-1452. Retrieved from

https://www.rootcausecoalition.org/wp-content/uploads/2017/04/The-Affordable-Care-Act-Implications-for-Health-Care-Equity.pdf

McKee, M., Greer, S. L., & Stuckler, D. (2019). What will Donald Trump's presidency mean for health? A scorecard and proposed changes. The Lancet, 389(10070), 748-754.

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