ACA and Healthcare Outcomes and Costs Paper

December 15, 2022

ACA and Healthcare Outcomes and Costs Paper

Order Number	636738393092
Type of Project	ESSAY
Writer Level	PHD VERIFIED
Format	APA
Academic Sources	10
Page Count	3-12 PAGES

Instructions/Descriptions

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ACA and Healthcare Outcomes and Costs Paper

Instructions: Response must be at least 350 words written in current APA format with at least two academic references cite. References must be within the last five years. Respond by extending, refuting/correcting or adding additional nuance.

All human beings deserve health care coverage, whether they can afford it or not. In today’s U.S. healthcare system, to have good health care, it is not just about having health insurance coverage. It must be affordable and accessible. The Affordable Care Act (ACA), passed in 2010, represents the most extensive reform to the U.S. health care system since the introduction of Medicare and Medicaid in 1965 (Duggan, Goda & Jackson, 2019).

The positive effect on improving health care outcomes is ACA’s main components, which is improving access to care by enabling more Americans to gain health insurance coverage and containment of healthcare costs (Mason, Dickson, McLemore, and Perez, 2016).

By offering the expansion of Medicaid, changes in private (commercial) insurance coverage, the establishment of health exchanges, employer requirements for providing healthcare coverage, and the introduction of the individual mandate (LaFontaine, Vogenberg & Pizzi, 2019).

ACA includes dozens of provisions to expand health insurance coverage, slow the growth rate in health care costs, and reform the market for private health insurance. After implemented many of these provisions in January of 2014, un-insurance rates among nonelderly adults fell substantially, from 20.1 percent in the fourth quarter of 2013 to 15.1 percent by the fourth quarter of 2014 and 12.6 percent by the fourth quarter of 2015 (Duggan, Goda & Jackson, 2019).

Also, ACA seeks to contain Medicare costs and pay for coverage expansion by phasing out extra payments to insurers who offered Medicare Advantage Plans, managed the care of private plans that the older population can choose instead of traditional Fee-for-Service (FFS) Medicare. Medicare pays a lower annual increase and pays less for medical equipment.

Furthermore, by reducing outstanding payment, taxing employers who offer high-cost private insurance plans, encouraging the development of Accountable Care Organizations (ACOs) for Medicare recipients, especially those with costly chronic conditions.

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Penalizing hospital by reducing their reimbursement if they have excessive 30-day readmissions and hospital-acquired infections, implementing aggressive Medicare/Medicaid fraud and abuse prevention measures, establishing an Independent Payment Advisory Board (IPAB), implementing administrative simplification measures, and conducting comparative effectiveness research (Mason, Dickson, McLemore, and Perez, 2016).

To tackle insurance coverage issues, it is essential for healthcare professionals and pharmacy and therapeutics (P&T) or related committees in all practice settings to realize that today’s ACA differs from the original 2010 act. As plan requirements, government funding, and patient affordability change, so too must the plans offered by third-party healthcare payers or purchasers (employers, municipalities, and unions).

ACA established new coverage guidelines on plan eligibility and scope that private insurers must follow. The most well-known policy deriving from the changes prevents insurers from denying coverage to individuals based on pre-existing medical conditions. Another part of the rule made it illegal for insurers to charge a greater fee based on a person’s health status or gender.

Moreover, coverage expanded for young adults, who can claim dependent status on their parents’ health insurance up to the age of 26, with no restrictions regarding their living situation, financial independence, or health insurance options offered by their employer. Insurers are prohibited from imposing lifetime limits on coverage, and this coverage could not be rescinded.

Furthermore, to encourage wellness checks, the act established mandatory minimum coverage standards known as “essential health benefits” and instituted zero-dollar co-payments for many preventive health services (LaFontaine, Vogenberg & Pizzi, 2019).

ACA set out guidelines for employers with more than 50 full-time employees and instituted financial penalties for those who were unwilling to comply. A highly controversial aspect of ACA was the individual mandate. In 2010, the act laid the groundwork for supplementing insurance-risk pools with healthier patients by instituting an individual mandate for health insurance.

Beginning in 2014 and extending through 2016, patients without insurance coverage were required to pay an annual tax penalty. Now: On December 20, 2017, the Tax Cuts and Jobs Act passed by Congress finalized the individual mandate’s permanent repeal, with the penalty phasing out in 2019.

As conversations about the repeal were heating up in 2017, the Congressional Budget Office (CBO) estimated what repealing the mandate would cost: the report concluded that the number of people with health insurance would decrease by four million in 2019 and increase to 13 million by 2027.

To provide patient-centered care in today’s healthcare environment, understanding the system within which patients and providers function is more critical than ever (LaFontaine, Vogenberg & Pizzi, 2019).

ACA and Healthcare Outcomes and Costs Paper

RUBRIC

Excellent Quality

95-100%

Introduction

45-41 points

The context and relevance of the issue, as well as a clear description of the study aim, are presented. The history of searches is discussed.

Literature Support

91-84 points

The context and relevance of the issue, as well as a clear description of the study aim, are presented. The history of searches is discussed.

Methodology

58-53 points

With titles for each slide as well as bulleted sections to group relevant information as required, the content is well-organized. Excellent use of typeface, color, images, effects, and so on to improve readability and presenting content. The minimum length criterion of 10 slides/pages is reached.

Average Score

50-85%

40-38 points

More depth/information is required for the context and importance, otherwise the study detail will be unclear. There is no search history information supplied.

83-76 points

There is a review of important theoretical literature, however there is limited integration of research into problem-related ideas. The review is just partly focused and arranged. There is research that both supports and opposes. A summary of the material given is provided. The conclusion may or may not include a biblical integration.

52-49 points

The content is somewhat ordered, but there is no discernible organization. The use of typeface, color, graphics, effects, and so on may sometimes distract from the presenting substance. It is possible that the length criteria will not be reached.

Poor Quality

0-45%

37-1 points

The context and/or importance are lacking. There is no search history information supplied.

75-1 points

There has been an examination of relevant theoretical literature, but still no research concerning problem-related concepts has been synthesized. The review is just somewhat focused and organized. The provided overview of content does not include any supporting or opposing research. The conclusion has no scriptural references.

48-1 points

There is no logical or apparent organizational structure. There is no discernible logical sequence. The use of typeface, color, graphics, effects, and so on often detracts from the presenting substance. It is possible that the length criteria will not be reached.