The Affordable Care Act (ACA) has three primary goals; reducing costs, protecting the patients against arbitrary actions by insurance companies, and expanding access to health insurance. The ACA will provide the essential health benefits, which includes the following services; oral and vision care for children, chronic disease management, labs, rehabilitative services and devices, mental health and substance abuse services, drug prescription, maternity and newborn care, hospitalization, emergency care, and ambulatory services. Some of the key stakeholders for ACA include employers, marketplace consumers, health care providers, and states (Housten et al., 2016).
One of the stakeholders of ACA is consumers. Health Capital Consultants (2013) argues that majority of American healthcare consumers may not experience significant changes in health insurance coverage because 32% of the consumers receive health insurance through a government program, while 55% from an employer. Nonetheless, the introduction of ACA in America has led to a reduction of uninsured elderly people from 55 million in 2013 to 29 million in 2017 (Housten et al., 2016). The ACA has also increased the marketing and publicity of health insurance to the younger population. The ACA has not only changed how consumers approach health insurance but have also influenced their approach to shopping healthcare.
ACA is beneficial to the consumers as it avails services that they could not previously have afforded without the cover. According to the Commonwealth Fund, approximately 65% of ACA consumers can access and afford services that they could not have afforded or accessed previously (Gunja, Collins & Bhupal, 2017). The cover assists the consumers seeking medical care. Although ACA has many benefits, it has drawbacks.
One of the major drawbacks of ACA among consumers is high deductible health plans proliferate. Gunja, Collins, and Bhupal (2017) explain that the ACA has increased the out-of-pocket costs and high-deductible health plans, which is disadvantageous to the consumer. Another drawback is an increment of high-deductible health plans particularly in plans sold by ACA’s health insurance exchanges. Hence the ACA has resulted in an increase in the cost of monthly premiums resulting from additional residents healthcare cover, while the current conditions clause is invalid where payers cover the cost of sicker patients.
The ACA has transformed the way in which employers’ offer and buy insurance for employees. Geisinger Caring (2019) explains that the ACA provides an employer shared responsibility provision to employees having more than 50 employees to provide affordable insurance coverage to their employees. This is a disadvantage to the employer as they face a penalty if they fail to pay the cover. Employers face challenges particularly if they go outside the plan’s network, which states that the allowable out-of-pocket exposure is $15,800 for a family and $7,900 for an individual.
Employers, specifically large group employers, face challenges as they do not benefit from tax credits. Housten et al. (2016) explain that employers with a small business with an annual range of less than $50,000 and less than 25 full-time equivalent employees qualify for tax credit. This means that the amount of tax credit is phased out as the number of full-time employees increases. The employers also face tax credit penalties where Federal tax credit is available for individuals and families with low-income hence making them ineligible for Medicaid. The employers are at risk of suffering from play-or-pay penalties. Geisinger Caring (2019) states that employers under ACA may face a penalty for not offering coverage. The employer may face a penalty if money of the full-time employee receives a premium subsidy and credit or if they applied subsidy or credit to receive insurance from public insurance.
Considering the correlation between ACA regulations and new avenues to care delivery, the health provider has undergone varying transformations. As patients continue to take advantage of employer incentives to improve their fitness, use smartphones to upload their blood pressure readings, and local pharmacy for a consultation, the healthcare provider’s mission is to ensure the population remains healthier for longer. The ACA particularly in future will render more health professionals to earn salaries instead of the traditional fee-for-procedure pay model and will attain bonuses if patients remain healthy (Uberoi, Finegold and Gee, 2016). In order to ensure quality care, there will be a need for employing skilled leaders in the health industry.
The Affordable Care Act provides expanded health insurance and is greatly affecting the majority of healthcare providers in the country. The impact is as a result of lower uncompensated care costs for the uninsured, increased patient revenues, and increases in the demand for care. With anticipation to attain higher revenues from care delivery, the ACA expects reductions in Medicaid Disproportionate Share Hospital (DSH) payments, which assist health facilities that serve many and uninsured patients to cover the uncompensated services (Kocher, 2010). The ACA will greatly affect health professionals as it attracts inter-disciplinary teams who will apply sophisticated technology to process more information and dispense care in settings outside health facilities. This is beneficial, as it will open avenues for education and training to prepare the professionals in overcoming these challenges
Geisinger Caring. (2019). What does ACA mean for my business or employer?. Retrieved from https://www.geisinger.org/patient-care/specialty/trusted-advisor/what-does-aca-mean-for-my-business-or-employer
Gunja, M., Collins, S., & Bhupal, H. (2017). Is the Affordable Care Act Helping Consumers Get Health Care?. The Commonwealth Fund. Retrieved from https://www.commonwealthfund.org/publications/issue-briefs/2017/dec/affordable-care-act-helping-consumers-get-health-care
HEALTH CAPITAL CONSULTANTS. (2013). The ACA in 2013: What Can Stakeholders Expect? Retrieved from https://www.healthcapital.com/hcc/newsletter/4_13/ACA.pdf
Housten, A., Furtado, K., Kaphingst, K., Kebodeaux, C., McBride, T., Cusanno, B., & Politi, M. (2016). Stakeholders’ perceptions of ways to support decisions about health insurance marketplace enrollment: a qualitative study. BMC Health Services Research, 16(1). doi: 10.1186/s12913-016-1890-8
Uberoi, N., Finegold, K., & Gee, E. (2016). Health insurance coverage and the Affordable Care Act, 2010-2016. Washington (DC): Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation.
Kocher, R., Emanuel, E. J., & DeParle, N. A. M. (2010). The Affordable Care Act and the future of clinical medicine: the opportunities and challenges. Annals of internal medicine, 153(8), 536-539.
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