The Affordable Care Act: A Case Study

While our understanding has evolved with respect to certain advantages of MCO’s, our understanding of the disadvantages has also grown. This analysis will evaluate the use of MCO’s as a gatekeeper to controlling health care cost and offerings. It will evaluate the advantage MCO’s provide in a rapidly growing market due to the aging of baby boomers. The analysis will evaluate disadvantages that can arise with relying on MCO’s. These disadvantages work against the insurance company forcing a polarizing balance between how much control the MCO should retain over recommendation and provision of services.

The Affordable Care Act (Obamacare) is a healthcare program created by president Obama’s administration. The goal of the Affordable Care Act is to make sure every United States citizen has health insurance. The Affordable Care Act provides “affordable” health insurance plans to citizens that do not have any and make about $15,000 a year. While the idea of providing health insurance to the millions of American’s that cannot afford it is great, everything comes at a cost. According to Emily Miller, Obamacare is causing people’s health insurance premiums to rise by around 1 to 9 percent (Miller 15-15). Not only are insurance premiums rising, but ever since the Supreme Court declared the Affordable Care Act constitutional approximately 20 tax hikes have been approved (Battersby). All the aforementioned reasons are helping pay for Obamacare. Although providing health insurance for people that cannot afford it is important, the Affordable Care Act should be revoked because it will hurt the economy.

When president Obama signed the Affordable Care Act in March 2010, it came with a lot of new provisions that would vary when they would come into effect. The very first provision was the “Grandfather Clause” which allowed people to keep their insurance plan before the act went into effect. As long as the employer still offered that plan the employee could still maintain it because they were grandfathered into receiving that coverage. If someone bought an insurance plan after March 2010 they would not be considered under the Grandfather Clause. Thus, these individuals would be required to get a new plan by 2014 if their plan did not meet all the criteria, they would need to get a new plan that fills all the criteria. Another major provision of the Affordable Care Act is that patients have a guaranteed issue. This means that insurance companies are unable to deny anybody health insurance based on their health or prior health. This may create a problem because the risk pool of an insurance company may not have the best people. Eventually, this could lead to the majority of the risk pool for an insurance company to have people who are at a greater risk of needing health insurance. This will make the insurance company more vulnerable and the only way that they will be able to cover the losses is by raising the premiums on everyone even though there may be some individuals that are in perfect health. The next provision that was added under the Affordable Care Act is that the

There has been discussion to have universal healthcare system similar to Medicare as a method to have a centralized monitoring system of cost. There have also been other systems tried beginning with HMOs in the 1970s in an effort to streamline access to necessary healthcare services by employing a gatekeeper to their access at the primary care levels. With patient dissatisfaction, PPOs were tried which circumvent the necessity of referrals (Hacker, 1998). Either of these models had substantial effect on healthcare outcomes while the cost of healthcare continued to skyrocket. The US spends more than any other country on healthcare but outcomes are not better (Blackstone, 2016). In 2010, under President Obama’s leadership, Affordable Care Act was passed and one of the promising features is the formation of accountable care

HMOs are usually the least expensive health plans, offer predictable costs for health care, the least administrative paperwork, and cover preventive care (Barsukiewicz, Raffel, & Raffel, 2010). However, HMOs also restrict direct access to specialists by requiring referrals by a PCP, requiring patients to see a provider in the HMO network, and often not covering more costly procedures or care options, because care is managed to control excessive or unnecessary care. Providers gain if they provide less care (Austin & Wetle, 2012). This incentive could affect patient-provider trust.

Over the last five years, the United States has implemented a new policy in which Americans will receive their health care benefits. This policy is known as the Patient Protection and Affordable Health Care Act which was implemented in 2010 through United States federal statue and signed into law by President Barack Obama. The intentions of the reform is to insure that all Americans have affordable access to health care benefits without struggling to afford the cost associated. The reform is broken down into nine title sections that affect all aspects of health care and changes that will be associated. In this paper, I will be discussing each of the title sections and how the changes will affect the field of nursing.

The Patient Protection and Affordable Care Act (ACA) is the 2010 health reform act that could extend insurance coverage to as many as 32 million Americans, which also included policies that affect the quality of coverage insurers must offer (Knickman & Kovner, 2015). In addition to this, the ACA created a range of programs focused on furthering change in how medical care is organized and delivered, with a goal of reducing costs and improving quality and outcomes (Knickman & Kovner, 2015). However, these goals come at a cost. The purpose of this paper is to analyze the impact the ACA had on the population it affected in the United States as a nation, but specifically in the state of North Carolina; describe the impact of economics of providing care to patients from the organization’s point of view; examine how patients were affected by the ACA in terms of the cost, quality, and access to treatment; and explain the ethical implications of the ACA.

During the botched 2010 roll out of the affordable care act, multiple veteran’s agencies marched on Washington with fears of how the Tax/Mandate would affect indigent veterans who could not afford the penalty and could not afford secondary insurance. In their hubris, these agents pushed an agenda that has greatly hurt the veteran population.

The Obamacare/ACA, might have helped numerous of individuals in acquiring health care, but the health professionals are facing a shortage of reimbursement difference for their services. As a result, Hospitals and healthcare providers were force to layoff personal and come up with innovative solutions. This point is proven by the renowned author, Amy Anderson by stating as follows: “The American health care framework has had shortages of personnel for quite some time and would not be prepared to give the adequate service to this amount of patients in need of medical attention. Training new professional health services personnel could take years. There is a shortage of graduates from medical and nursing schools. Doctors, nurses and health professional are sharing responsibilities prospective patients will face a longer wait time”. (Anderson, 2014)

Critics believe that the present functioning of managed-care is degenerative to health care. Managed-care firms control costs by requiring patients to use a “network” of approved doctors and hospitals, and by reviewing the actions of doctors. Patients have to pay more to visit a doctor who does not participate in the “network.” Managed-care firms second-guess doctors, considering only the costs. Patients are often prevented from visiting specialists to reduce costs. A managed-care company might insist that its doctors prescribe inexpensive generic drugs instead of commercial products. Many patients must, also, receive the insurer’s approval before undergoing treatments or operations. HMOs have been criticized for refusing to pay when a patient goes

Health care in the United States is driven by a patchwork of services and financing. Americans access health care services in a variety of ways — from private physicians’ offices, to public hospitals, to safety-net providers. This diverse network of health care providers is supported by an equally diverse set of funding streams. The United States spends almost twice as much on health care as any other country, topping $2 trillion each year. (WHO.INT 2000) However, even with overall spending amounting to more than $7,400 per person, millions of individuals cannot access the health care services they need.(Foundation 2009) So when the Patient Protection and Affordable Care Act (a.k.a the Affordable Care Act or ACA) was passed in the summer

The implementation of the Affordable Care Act (ACA), popularly known as “Obamacare”, has drastically altered healthcare in America. The goal of this act was to give Americans access to affordable, high quality insurance while simultaneously decreasing overall healthcare spending. The ACA had intended to maximize health care coverage throughout the United States, but this lofty ambition resulted in staggeringly huge financial and human costs.

There is an ongoing debate regarding the potency of the new health care reform—Patient Protection and Affordable Care Act—from the outset of its proposal. Many attempts had been presented in the past years but the root of the issue remains prevalent today, that there is a lack of quality in its delivery and the cost of care is continuously increasing beyond national economic edges. In this manuscript, we will discuss several factors that can positively sway the long-term significance, impact, and structure of the United States health care system. Many are wondering whether the Universal Coverage, to which will give more control and

HMOs multiplied rapidly with the new federal giveaways. Managed care, now including PPOs, mushroomed. Employers initially perceived managed care plans as cheaper than traditional fee-for-service insurance. Gradually, they stopped offering a choice of health plans, making individual policies more expensive. HMOs' penetration of the industry had been subsidized into existence. Government had instituted managed care. Today, while overall quality of patient care remains the best in the world, doctors practice medicine in an increasingly intricate web of rationing and regulations: Physicians are stripped of professional autonomy. As patients wander the maze of managed bureaucracy, costs rise and quality deteriorates. Every American dependent on a third party for health coverage is a potential victim of managed care. And state sponsored management of medicine

Eliminating the barriers to access of care starts with the extended health insurance coverage offered through the ACA. The Shortage of healthcare providers in areas- opens a window of