Week 3 Affordable Care Act Discussion

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Throughout the course, we have discussed the components of the Accountable Care Act (ACA) and its potential influence in reaching the triple aims for health which include:

1. Better care: Improve the over-all quality by making healthcare more patient centered, reliable, accessible, and safe;
2. Healthy people/healthy communities: Improve the health of the US population by supporting proven interventions to address behavioral, social, and environmental determinants of health; and
3. Affordable care: Reduce the cost of quality health care for individuals, families, employers, and government.

Based on what you have learned in this course, please read the below document and identify what you believe are the top two strengths and the top two weakness of the Affordable Care Act (ACA). As a future or current healthcare leader, do you think that this legislation brings value to the process? Explain your reasons for your answer.

The Patient Protection and Affordable Care Act1 (hereinafter referred to as the Affordable Care Act), amended by the Health and Education Reconciliation Act,2 became law on March 23, 2010. Full implementation occurs on January 1, 2014, when the individual and employer responsibility provisions take effect, state health insurance Exchanges begin to operate, the Medicaid expansions take effect, and the individual and small-employer group subsidies begin to flow. Along the way are a series of crucial intermediate steps.

A brief law column can hardly do justice to the Act and its sweep. Interested readers are encouraged to use the Obama Administration’s information portal,3 which provides multiple practical and policy tools related to implementation. Other special search-engine tools also can provide invaluable assistance in understanding the law’s many dimensions and the full range of issues that will arise as implementation moves forward.4

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OVERVIEW AND KEY ELEMENTS
The Affordable Care Act is a watershed in U.S. public health policy. Through a series of extensions of, and revisions to, the multiple laws that together comprise the federal legal framework for the U.S. health-care system, the Act establishes the basic legal protections that until now have been absent: a near-universal guarantee of access to affordable health insurance coverage, from birth through retirement. When fully implemented, the Act will cut the number of uninsured Americans by more than half. The law will result in health insurance coverage for about 94% of the American population, reducing the uninsured by 31 million people, and increasing Medicaid enrollment by 15 million beneficiaries. Approximately 24 million people are expected to remain without coverage.5

Consisting of 10 separate legislative Titles, the Act has several major aims. The first—and central—aim is to achieve near-universal coverage and to do so through shared responsibility among government, individuals, and employers. A second aim is to improve the fairness, quality, and affordability of health insurance coverage. A third aim is to improve health-care value, quality, and efficiency while reducing wasteful spending and making the health-care system more accountable to a diverse patient population. A fourth aim is to strengthen primary health-care access while bringing about longer-term changes in the availability of primary and preventive health care. A fifth and final aim is to make strategic investments in the public’s health, through both an expansion of clinical preventive care and community investments.

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Health insurance coverage reforms
Through a series of provisions that create premium and cost-sharing subsidies, establish new rules for the health insurance industry, and create a new market for health insurance purchasing, the Affordable Care Act makes health insurance coverage a legal expectation on the part of U.S. citizens and those who are legally present.6–8 The Act both strengthens existing forms of health insurance coverage while building a new, affordable health insurance market for individuals and families who do not have affordable employer coverage or another form of “minimum essential coverage” such as Medicare or Medicaid.9 In expanding existing coverage, the Act fundamentally restructures Medicaid to cover all citizens and legal U.S. residents with family incomes less than 133% of the federal poverty level (as measured through a new “modified adjusted gross income” test) and to streamline enrollment.10,11 (Medicaid’s five-year waiting period for legal residents will continue to apply to recently arrived people, who during this time will qualify for tax subsidies and enrollment through a health insurance Exchange.)

The quid pro quo for near-universal legally guaranteed coverage is the duty to secure it, as it is not possible to extend such a guarantee of insurance coverage without an attendant coverage obligation. This duty extends to all U.S. taxpayers, but individuals not legally present in the U.S. are excluded from both the coverage guarantee and the obligation to secure coverage. The law also provides exemptions for people for whom enrollment is contrary to religious belief or remains unaffordable or a hardship.9 But otherwise, the mandate extends to all people; indeed, it is this type of legal mandate that makes universal coverage feasible, because without it, large numbers of healthy individuals, whose presence is essential to the formation of a risk pool, would fail to enroll. Without the mandate, the private health insurance industry would not—and indeed, could not—eliminate discriminatory pricing and coverage practices, as such tactics are the means by which insurers protect themselves against adverse selection. Thus, without the mandate, universal coverage is virtually impossible, as is stabilization of the insurance foundation on which the entire health-care system rests.

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