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Affordable care act 2012
Eassay affordable care act
Negative effects of obamacare
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More handpicked essays just for you.
Affordable care act 2012
Eassay affordable care act
Negative effects of obamacare
Don’t take our word for it - see why 10 million students trust us with their essay needs.
Prior to the implementation of the Affordable Care Act (ACA), few people anticipated employer-provided health care would disappear as a major player in the United State healthcare arena. However, ACA adoption and has put more than 169 million employees at risk for losing their workplace coverage. Several studies indicate employer-based coverage will decline rapidly over the next decade as the traditional US system is displaced by the healthcare exchange system. While consumers grapple with finding affordable coverage options and providers adjust to the new norms, there is another wrinkle in the mix. In January, Health and Human Services (HHS) Secretary Sylvia M. Burwell announced the agency's push toward value-based and alternative reimbursement models.
The evolution of managed care organizations has created a dramatic change in our health care system. In 1995, about 161 million American citizens, were enrolled into a managed care organization plan. Some of the plans under the managed care are health maintenance organizations (HMO), preferred provider organizations (PPO), point of service plans (POS), and other networks such as Exclusive Provider Organization (EPO), and union plans. All these plans are different from one another in regards to organization structure, reimbursement for providers, types of services, and care access strategies. However, the goals established by managed care are to reduce and control cost of medical and behavioral health services through case management or care
We accomplished this through interviews with clinic leaders. The purposes of these interviews were twofold: Firstly, to evaluate the plausibility of our findings and secondly to understand the key differences between the PCMH and non-PCMH clinics in regards to the availability of the PCMH attributes. Among all the responses, “access to care” was most frequently cited by experts. By operating with extended office hours, including weekends, and a helpline available to their patients, the PCMH clinics offer accessibility to those who would otherwise not have access to care. A good example is people with disabilities for whom they usually need assistance from family members or friends to commute or travel.
As Davis defines a POS as, “POS stands for point of service plan. POS plans resemble HMOs but are less restrictive in that you’re allowed, under certain circumstances, to get care out-of-network like with a PPO. Like HMOs, many POS plans require you to have a PCP referral for all care whether it’s in or out-of-network (Davis,2016). Therefore, with any healthcare decisions, an individual must look at what their essential healthcare needs are. I like many others question this on a daily basis in regards to my healthcare needs.
Socialized medicine is a form of medical insurance that is available to all lawful citizens that the government covers. Throughout the United States 21.3% of the population receive benefits from the government due to their financial situation. Consequently, such benefits are not available for all citizens and may be difficult to qualify for. Moreover, Government-run programs are often cheaper, more administratively efficient, and even of superior quality than privately-run programs at the national level. If the United States began offering socialized medicine, there would be a slight rise in taxes in order to cover the 82 million dollars in costs.
Americans have the opportunity to choose a health care insurance that works best for them. For example, the insurance exchange offers affordable choices of private plans that have to compete with their business which is determined by cost and quality. They also receive a tax credit that helps with the cost of paying for their employees’ health insurance. The Act also considers Medicare as one of their priorities. In order to give the best quality of care for senior adults and lower the cost, the Act saves thousands of dollars in drug costs by closing the coverage gap known as the “donut hole.”
The United States healthcare system is characterized by many payers and strong involvement of the private sector, and health insurance coverage is a major factor that determines whether patients will make use of services. Most people in the U.S. have health insurance through an employer: either his/her employer or some family member. There are also individual private plans, and quite a few government options, most notably Medicare and Medicaid. In this light, the Affordable Care Act (ACA) was to secure wide-based health insurance coverage; yet, despite said efforts, millions of Americans remain either uninsured or underinsured. The result is that staggering is becoming commonplace in healthcare, where the kind and amount of insurance often dictates the time and quality of care.
As a recipient of food stamps, and a beneficiary of the Affordable Care Act (ACA, aka Obamacare), I have a personal stake in these issues. Ohio is one of the 28 states that “opted-in” to Medicaid expansion, and in doing so, provided a safety net for individuals like myself… single male, no income, no dependent children, and no healthcare insurance. Currie discusses the problems of the uninsured, i.e., no primary care provider (PCP), which means no preventive care services, and having to seek medical treatment exclusively through the doors of emergency rooms (ER). This could be problematic, especially for children, who need preventive care services, as their body’s experience growth and change during the maturing process. There is another argument for public healthcare coverage… a possibly reduction in overall healthcare cost.
Fee for Service- The fee for service insurance plan doesn’t have any known restrictions however, the plan does allow you to have the flexibility of which doctors you want to see, and where you want to get medical services but in the long run the premiums are very costly which isn’t beneficial for this kind of insurance plan to utilize. (Fee for Service Plan: Restrictions) Managed Care Plans Having a managed care plan has its perks but also has disadvantages associated with it. If you do have a managed care plan, one of the disadvantages of the plan are that you may not be able to see your physician if they are out of network. Most managed care plans place restrictions on their patients to where they can receive care through the providers that are established with the managed care plan.
In achieving this, the ACA made provisions, investments, and funding opportunities. These provisions allow for more innovations in Medicaid programs including the application of models like patient-centred medical homes which allows for preventive and primary care, increased care for beneficiaries with complex needs, and provided financial incentives for high performance.3 For example, with full federal funding, one ACA provision required that Medicaid programs in every state pay primary care physicians at Medicare rates (a substantial increase in many states) for 2 years.4 Also, as provided by states, one improvement to Medicaid Benefits is the provision of home and community health care for individuals with
A study by McKinsey in 2014 goes much further by defining a narrow network as one that includes 31% - 70% of all hospitals in a participating area and an ultra-narrow network is defined as having less than 30% of all hospitals in a particular area (McKinsey & Company, 2014). While the McKinsey & Company’s study evaluates hospital coverage, a study by Polsky & Weiner assesses physician participation in narrow network plans. Polsky and Weiner find that the majority, i.e. 41% of networks are small or extra small which by their definition means that they include less than 10% of office-based physicians in the area (Polsky & Weiner, 2015). Consumers are incentivized to seek care inside the limited network by the application of a generous in-network benefits in
Patients with certain conditions are often discouraged to enroll in health plans because all or most medications that are used to treat a particular illness have been placed on the formulary tier with the highest co-pays. President and co-founder of Global Healthy Living Foundation, a founding member of DPRP, Seth Ginsberg, had this to
Three Major Criticisms/Drawbacks of Managed Care When it comes to managed care, the rules are extremely rigid. In this system a person’s options are very limited when it comes to selecting one’s own doctor. Even if a person is not content with the care that they are receiving, they may not have another in-network healthcare provider that can be reached through their HMO or PPO. Therefore, if a person wants to seek a second opinion, they are forced to go out of their network, furthermore, their insurance will not pay for that expense (Vittana.org, 2017).
Another efficient advantage is due to the fact that on average primary level health care are less expensive compared to secondary and tertiary health care such as specialists. This means that due to gatekeeping, patients that don’t require specialist (secondary health care) do not get to see them, reducing in cost majorly. For example, a study that was conducted in 2014 found that since Austria is not subjected to gatekeeping, patients in Austria tend to seek specialist 4 times more compared to countries that are subjected to gatekeeping (Laura, 2015). This means that cost is higher due to higher over-utilization of
I also support the individual mandate for health insurance coverage, but the cost containment needs a serious attention to make health care more affordable. Without it, cost sharing will be difficult, and the Affordable Care Act (ACA) will be unsustainable. The U.S. is the highest spender on health care per capita among industrialized nations. My friends and family in Japan are always shocked to hear how much I spend on health care in this country. I learned that the ACA addresses several cost containment strategies, such as patient-centered medical homes, accountable care organizations, bundled payments, and programs to reduce readmissions and hospital-acquired conditions.