The Affordable Care Act: A Case Study

Medicaid is a social health care program that covers nearly 60 million Americans, including children, pregnant women, seniors, parents and individuals suffering with disabilities. Medicaid is the biggest source of funding for health related services and medical needs for the people with low income in the United States. This program is funded jointly by the state and federal level governments, but it is the state’s responsibility to manage this program. The Medicaid program is not a required program that states have to use, but all 50 states have implemented this program. With the introduction of the Affordable Care Act (ACA), and its passing in 2010, the ACA unveiled its plans to expand Medicaid eligibility to nearly all low-income adults as an addition to the other groups that fall into the Medicaid eligibility. The Medicaid program had “many gaps in coverage for adults” because it was only restricted to the low income individuals and other people with needs in their own specific category. In the past, the majority of the states who had adults that did not have children dependent on those parents were not eligible for Medicaid. These low income adults without dependent children would be without medical insurance assistance before the ACA was introduced. Medicaid is now available to all Americans under the age of 65 whose family income is at or below the federal poverty guideline of “133 percent or $14,484 for an individual and $29,726 for a family of four in 2011” (NSCL).

Throughout the early 1980’s and 1990’s the Federal Medicaid program was challenged by rapidly rising Medicaid program costs and an increasing number of uninsured population. One of the primary reasons for the overall increase in healthcare costs is the

In 2010, the President of the United States signed the Patient Protection and Affordable Care Act (PPACA) into law (Luther & Hart, 2014). As written, the PPACA will be the most extensive change in the financing and provision of healthcare in 50 years (Luther & Hart, 2014). The stated purposes of the legislation are to decrease the number of medically uninsured people as well as decrease the cost of insurance and healthcare for those already insured (Shi & Singh, 2015). Medicaid expansion is significant element of the PPACA and is designed to provide health insurance to the lower income population (Vincent & Reed, 2014). The purpose of this paper

Medicaid has grown exponentially after healthcare was expanded under the Affordable Care Act. However, this did not guarantee an increase in access to health care services, as many providers do not accept Medicaid beneficiaries, one of many reasons being low reimbursement rates. This discrepancy in rate reimbursement is further underscored when compared to those

With the implementation of the ACA, many states have expanded their Medicaid programs to include a larger population of low income individuals and families that were not able to obtain health insurance prior to the law. Some of the issues that state legislators struggle with are the overall cost of providing services for the additional recipients, staying within budget, determining an adequate approach of offering quality care, and providing adequate coverage for each recipient. Even though the cost of Medicaid expansion within each state has increased the budget for the program, new appraisals has shown that Medicaid programs spend less per enrollee than commercial health insurance and much of the increase in Medicaid expenses originate from the increase in enrollment in the programs (Coughlin, Long, Clemens-Cope, & Resnick, 2013).

Implementation of the ACA would require an extensive expansion of the Medicaid program to low income adults in each state.³ The Congressional Budget Office projects that a previously 30 million uninsured Americans, approximately 92% of the legal, non-elderly population, will have coverage by 2022.³ The federal government will pay for 100% of the costs of expanding Medicaid programs until 2016, and then gradually fade their contribution to 90% by 2020.³ Currently, expansion of the Medicaid program is voluntary and several states have stated that they intend to turn down their share of the billions of dollars that has been made available to each state solely for the expansion of this program.³ States deciding to not expand their Medicaid program will not only exclude many poor, vulnerable families from access to an important health care program, but will also exclude themselves from an economic stimulus for their state and thereby decrease the strength of their health care delivery systems by not allowing them to be more financially stable for the long

Medicaid provides medical assistance to citizens in the United States who fall within the eligibility requirements. Medicaid has been enacted since 1965 and has faced many changes. One change most recently was the Patient Protection and Affordable Care Act, and the attempt to require states to expand Medicaid coverage to include more citizens. However, Medicaid is a states’ right and therefore Congress decided to leave expansion up to each individual state. As some states decide to move forward with expansion and some do not, this paper will discuss the pros and cons to each option and the financial impact that Medicaid expansion has on healthcare entities.

The Affordable Care Act, also called the ACA or Obamacare, is a health care reform law in America. The Affordable Care Act is a long, complex piece of legislation that attempts to reform the healthcare system by providing more Americans with affordable quality health insurance and by curbing the growth in healthcare spending. The law includes new benefits, rights, and protections, rules for Insurance Companies, taxes, tax breaks, funding, spending, and the creation of committees, education, new job creation, and more. The ACA includes 10 titles that address reform the U.S. healthcare system. Some of the provisions include eliminating lifetime and unreasonable annual limits on benefits. It mandates that EHB (or essential health benefits) must be included on all new plans. These benefits include ambulatory services, emergency care, hospitalization, maternity and newborn care, prescription drugs, mental health and substance abuse services, rehabilitative services and devices, labs, chronic disease management and oral and vision care for children. The new law prevents individuals from being dropped from their coverage for any reason other than fraud. The ACA requires coverage of preventative services and immunizations and of dependents up to the age of 26 years old. The law also provides assistance for individuals with preexisting conditions. The ACA also caps insurances companies’ non-medical and

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.

HCA is a healthcare provider that was established in 1968. Their main focus is on offering cliental with a number of different services to include: inpatient, intensive care, outpatient, diagnostic and emergency services. To achieve these objectives they operate a variety of facilities such as: outpatient, psychiatric, surgery centers, freestanding emergency care facilities, diagnostic / imaging centers and comprehensive rehabilitation / physical therapy centers. They are structured to create increasing earnings for its policy and shareholders. This is achieved by contracting with private doctors to deliver services to its preferred providers members. At the same time, they receive fees from these entities and they negotiate lower group rates.

Prior to the enactment of the Affordable Care Act, many Americans did not have access to health care. According to Shi and Singh, assess is an individual’s ability to obtain health services when necessary (Shi &Singh, 2010). “After implementation of the ACA, the proportion of the U.S. population that was uninsured dropped from approximately 16% to roughly 12% in 2014 (Shi & Singh, 2010, p 11). More low to middle income American are eligible for health care services through the Affordable Care Act. Advancements in health information technology have helped to improve and streamline medical services and have helped with the lower cost of health care. “Essential insurance benefits required by the ACA include preventative and wellness services,

Four years after President Obama signed the Affordable Care Act into law there is still uncertainty regarding how it will affect small businesses. Because there were delays and exemptions granted by the, Obama administration and challenges that were still pending in courts. The effects on small businesses vary from state to state depending on the company size and the composition of the company's workforces. But the large corporations pay their employees medical bills and hiring insurers to administer health benefits. Most small businesses purchase group health insurance from insurers and face cost increasing regulations as they go through the annual ritual of renewing their coverage. While media has focus their attention on the state and federal health exchanges, employers are responsible for the growth in the

The first challenge the ACA faced was with Medicaid expansion. In 2012, the Supreme Court ruled that the Medicaid expansion was unconstitutional (Garfield, Damico, Stephens, & Rouhani, 2014). It is my understanding, the Medicaid expansion was an important concept of the Affordable Care Act, as it bridged the gap of coverage for Americans who were 138% below the poverty level (Cohn, 2016). Also, it was to provide coverage for racial and ethnic minorities who were low-income, many with unmanaged chronic health conditions. If the ACA was to be successful, Medicaid expansion would be a critical factor (Lanford & Quadagno, 2016). This would help in securing the goal of providing affordable, quality health care to all individuals.

Millions of Americans use the services of health care officials on a daily basis. To aid in the increasingly high financial costs of these services, many people rely on the government, insurance companies, and other parties through managed care organizations (MCOs) (Potter & Perry, 2017, p. 15). A MCO “provides comprehensive preventive and treatment services to a specific group of voluntarily enrolled people” (Potter & Perry, 2017, p. 16). With the implementation of the Affordable Care Act (ACA), the government faces ongoing struggles to use valuable resources within the health care system to continually maintain problematic MCOs. Therefore, the administration of health care services has been greatly impacted by the ACA, bringing about

The current US Health Care delivery system Affordable Care Act (Obamacare), allows its citizens access to healthcare by NPs who practice autonomously providing healthcare to underserved rural populations, and in clinical settings, (McClelland, 2014; Stanley, 2011). The term autonomously and under prescriptive authority allows the NP establish realistic outcome measures, prescribe medications to provide secure, real, patient centered, appropriate, effective and reasonable care without a physician. Tiplady and Cook, (2015) stated that “outcome-based practice focuses on what an individual wants to achieve, and not only what the service wants to achieve (p. 406). For example the NP and the San Rafael patient in their relationship establish