Affordable Care Act Case Study

The Affordable Care Act, or, “Obamacare” as it has been dubbed by the media and general public was approved on June 8, 2012 when the “The Supreme Court of the United States upheld most provisions of the Affordable Care Act (ACA) by a 5-4 vote” (James, "Affordable Care Act and Pharmacy: Big Changes Ahead?"). This vote and approval has completely reshaped the landscape of the healthcare field, not only from a provider’s aspect, but from a consumer’s aspect as well. The need for healthcare reform was made apparent due to the growing

The cost of health care has been at the forefront of politics for years. It is one of the most talked about topics not just in political venues but also country wide. Every American has an opinion on how our economy can be fixed and they are passionate about health care reform. The price of insurance alone causes many Americans to not have coverage. For those that can afford coverage, the struggle to pay co pays is immensely crippling their bank accounts. Of these burdens on Americans today, the most frightening fact lies in the cost of prescription medications.

At last, the law gave new alternatives and motivating forces to help states rebalance their Medicaid long haul mind programs for group based administrations and backings as opposed to institutional care. All in all, these arrangements have quickened Medicaid advancement effectively in progress in numerous states. Also improved with the ACA besides Medicaid, is Medicare. The Affordable Care Act incorporates a progression of Medicare changes that will create billions of dollars in reserve funds for Medicare and fortify the care Medicare recipients get. The new law secures ensured benefits for all Medicare recipients, and gives new advantages and administrations to seniors on Medicare that will help keep seniors solid. The law likewise incorporates arrangements that will enhance the nature of care, create and advance new models of care conveyance, suitably value administrations, modernize our wellbeing framework, and battle waste, extortion, and mishandle. A big topic that is affected from ACA is businesses. The Patient Protection and Affordable Care Act -- otherwise known as Obamacare -- is putting such a small dent in the profits of U.S. companies that many refer to its impact as 'not material' or 'not significant. Even after a provision went into effect this year requiring companies with 50 or more full-time workers to provide coverage, and after more workers are choosing to enroll in existing company coverage because of another requirement that all Americans get

The Affordable Care Act includes a requirement that all citizens must have some level of health coverage. The primary method through which the mandate is attempting to create 100% coverage in health care is by instilling fear into the minds of hardworking citizens as those who ignore the rule will have to pay a hefty fine. This mandate, unconstitutional according to the law, will deteriorate the quality of health care, hamper economic growth and cause spikes in insurance premiums. The hope of universal health care may or may not arise under the mandate but new dilemmas and hardships on U.S. citizens will undoubtedly surface.

The purpose of this paper is to thoroughly examine the similarities and differences of Medicare and Medicaid managed care plans by comparing and contrasting its strengths, weaknesses, incentives, commitment to access, and risks to the consumer. Medicaid and Medicare are both health insurance programs financed and administered by government entities and are both equivalent in terms of the number of beneficiaries and total expenditures (McCarthy, Schafermeyer, & Plake, 2011). These healthcare programs differ in terms of how they are funded and governed and who they cover. Medicare is an important source of coverage for 65 or older adults, for people under 65 with disabilities, and for people of all ages with End-Stage Renal Disease in the United States. It provides health insurance protection and enables access to medical care for 54 million beneficiaries.

In 2010, the Affordable Care Act created a $250 rebate if the Medicare beneficiary was in the coverage gap. It also expanded coverage to the discounts given on brand name prescriptions. With reforms and improvement comes disadvantage to others. Beneficiaries and patients will be able to start saving more money, but it comes with a decline for the drug providers. According to Health Capital Consultants, “over ten years, closing the coverage gap may ultimately cost approximately $32 billion” and the pharmaceutical industry will be forced to take on most of this burden. These companies are paying for the flexibility they’re been given by MMA. They can “set their premiums, design their own formularies and are free to use cost management tools” and Medicare will reimburse plans for a “share of their drug costs.” (Guterman & Huynh ,

Historically the United States of America took pride in free trade and capitalism. Taxes on goods was a key driving force that began the American Revolution and later developed the power-house country present today. So, it is no wonder that when the Affordable Care Act (ACA) incurred new tax reforms, it was far from a smooth transition. In particular, pharmaceutical companies were hit the hardest. Within a ten year span, the drug industry will collectively have to pay $85 billion to the American government.1

The Affordable Care Act (ACA) has survived both constitutional and statutory challenges which reached the United States Supreme Court. But opponents of the law are far from defeated. A large number of cases are still pending throughout the country.

With the Advent of the Affordable Care Act, came many changes throughout the medical industry, changes happened in hospitals, health insurance, and doctors. Doctors, more than any other group seem to be affected in a number of way, from the amount of patients, from the increased number of people with insurance plans. It also changed the way a doctor interacts with other parts of medicine. There are some questions arising from this such as; would doctors approve or disapprove of these changes along with do these changes affect the doctors' ability to practice. For the most part, there is no difference the way doctors practice or to their income, but it does have doctors utilize their abilities towards medicine rather paper pushing which could have doctors prefer the post-ACA medical community rather than before.

The Affordable Care Act (ACA) has been the biggest milestone to date in American health care policy (Saldin, 2011). There is nothing more complex or controversial in recent history than the passing of the ACA in 2010 (Davidson, 2016). The United States Supreme Court ratified the constitutionality of the Patient Protection and Affordable Care Act on June 28, 2012. With this, there were certainly challenges facing the full implementation of the provisions of this act by 2014.

There are over 45 million people in the United States who are uninsured when it comes to healthcare. Many are uninsured due to the expensive health care costs. To combat this, the Obama Care administration created the Patient Protection and Affordable Care Act to provide nationalized healthcare. The Affordable Care Act is meant to expand health coverage, lower health care costs and hold insurance companies accountable. The Affordable Care Act will allow more people to be insured but the issue lies in the question, do the costs outweigh the benefits? The Affordable Care Act will be used in an attempt to lower health care coverage costs for citizens. An example can be seen from a report in the Kaiser Family Foundation. The premium is required

Government influences. The Patient Protection and Affordable Care Act (ACA) is a comprehensive approach to tackle some the challenges in the healthcare industry. The first issue addressed by the legislation was the disparity in access to healthcare. The act created healthcare exchanges, which created the opportunity for previously uninsured Americans to obtain health insurance and access to care(U.S. Department of Health and Human Services, 2014). Researchers estimate the new consumer base has significant chronic health issues that were untreated, as the uninsured population did not have access to healthcare providers (The Henry J. Kaiser Family Foundation, 2011). The newly insured demographic may generate a new market opportunity for the clinic.

By helping to create policies and giving their support and money to healthcare reform, they were able to avoid issues that had plaques their industries for years such as drug importation and the ability to negotiate drug prices for Medicare D. In return, the pharmaceuticals and biotech firms would agree to discount drugs purchased by Medicare beneficiaries, affected by the doughnut hole, of the Part D program by 50 percent (Spatz,

With the law, hospitals have the opportunity to receive increased Medicare payments as long as they increase patient education about care after hospital discharge, provide patients with community healthcare resources, and increase discharge instructions for patients suffering from heart failure (Burton, 2012). The Centers for Medicare and Medicaid Services (CMS) has threatened to reduce hospital payments to one percent if the patient readmission rates of “heart failure, pneumonia, and myocardial infarction” increase past a certain limit (Burton, 2012). State Medicaid agencies will grant providers reimbursement if “comprehensive transitional care” is provided to patients (Burton, 2012). The law also offered $200 million towards projects aimed at increasing the number of advanced practicing nurses in areas including: chronic care, preventive care and primary care (Burton, 2012). Preventive care will allow nurses to reduce the rates of high acuity patients in their hospitals. If the PPACA fails to improve care transitions, the CMS plans to carry out other policies. These policies

The Affordable Care Act expands access to health care coverage and reforms the health insurance, marketplace (Virginia Senate Finance Committee, 2012). The law gives states the choice to expand Medicaid for any individual whose income falls below 138 percent of poverty. In the state of Virginia, there are approximately 1 million uninsured residents. This is often caused by lack of insurance through employer and inability to pay the premiums if offered. According to the Kaiser family foundation, The Virginia’s Governor has included Medicaid expansion as part of his FY 2017 budget proposal. The overall cost to expand Medicaid in Virginia would likely be $220 million beginning in 2016-2018 biennial budgets not including administrator cost. The