The Patient Protection and Affordable Care Act - Essay Example

?Running head: PATIENT PROTECTION AND AFFORDABLE CARE ACT Patient Protection and Affordable Care Act: Policy Analysis [Class] 20 August 2011 Abstract Problems in the health care system have long been a matter of public concern in the U.S. Overspending, low efficiency and low insurance coverage have become the main policy priorities in the U.S. The provisions of the Patient Protection and Affordable Care Act hold a promise to improve the health care situation in the United States. In this paper the new policy and its implications for health care provision are analyzed. The main purpose of the given work is to analyze the benefits and drawbacks of the new policy and provide recommendations for improvement. The Patient Protection and Affordable Care Act: Policy Analysis Problems in the national health care system have long been a matter of serious public concern in the United States. Overspending, low efficiency, and the lack of insurance coverage have become the main policy priorities in America. More often than not, politicians and policymakers use health care problems to speed up their political careers. President Obama was probably the first to systematically address the problem of health care from within. The Patient Protection and Affordable Care Act marks a new stage in the evolution of American health care. Its potential benefits for common American citizens cannot be overestimated. Nonetheless, the controversy surrounding the ACA continues to persist, and it is imperative that policymakers address the existing policy inconsistencies, to ensure that the proposed changes benefit the American society. Literature Review Needless to say, health care reforms and problems with health care provision are popular objects of empirical analysis. Much has been written and said about the main problems faced by American citizens and medical professionals. A wealth of strategies and recommendations was developed to improve the quality and efficiency of health care in the United States of America. Nonetheless, most policies provide only short-term solutions to issues surrounding health care provision. In this context, the Patient Protection and Affordable Care Act is believed to have the potential to change the situation to the better. Given the scope of medical care problems in the United States, it is no wonder that the ACA has immediately become the most popular object of policy analysis. Health care professionals and medical practitioners provide their ideas regarding the new policy and evaluate its inconsistencies. Based on their findings, the proposed legal provisions exemplify both a promise and peril of health care in the U.S., depending on the direction American policymakers choose to take in their striving to improve the quality of medical care in America. In their study, Davis et al (2010) evaluate the financial consequences and implications of the new act. The authors analyze how the new law affects the quality, organization, and delivery of health care, financial incentives of health care providers, and its capacity to provide the best health care and improve health care outcomes for everyone (Davis et al, 2010). This study is probably the most successful attempt to reconsider the ACA from a financial viewpoint. Davis et al (2010) state that, prior to enactment of the Act, Medicate expenditures were projected to grow at 6.8 percent every year through 2019; with the ACA, these rates of growth will reduce by 5.5 percent. The fact is that the ACA involves a reform of Medicare, which will enhance the value of health care provided and, simultaneously, reduce the rates of spending growth (Davis et al, 2010). Another problem addressed by the ACA is the rapid growth of health care premiums, which burden millions of American families. With the new policy, including a public health insurance plan, system savings could reach an estimated $3 billion between 2010 and 2020 (Davis et al, 2010). The policy will also relieve the burden of health care premiums on small businesses and individuals (Davis et al, 2010). Employer-based coverage will remain the main element of health insurance systems in the U.S., but new insurance market rules, insurance exchange, and minimum medical loss ratios for insurance plans will reduce the administrative overhead and, therefore, make it easier to develop and implement employer-sponsored plans (Davis et al, 2010). Plans wit unjustified premiums will be rejected before they are implemented; consequentially, the proposed reform will save at least $2,751 in health premiums for families by 2020 (Davis et al, 2010). According to Berenson, “Medicare advantage plans and reduced payment updates for hospitals and most other providers” (Berenson, 2010, p.101). However, the new policy is not merely about financial savings. The ACA will profoundly impact the system of health care from its bottom to the top. For example, Kocher, Emanuel and DeParle (2010) analyze the ACA and its potential effects on clinical medicine. The researchers are confident that the ACA removes two main barriers to providing high-quality care: (1) incentives and (2) information (Kocher et al, 2010). Previously, physicians lacked information to assess changes in health and wellbeing of their patients, but the ACA provides financial and legal support for patient-centered outcomes research (Kocher et al, 2010). The latter will finally provide physicians and patients with the information required to take informed decisions (Kocher et al, 2010). Kocher et al (2010) also suggest that the Act will remove the administrative overhead and favors the integration throughout the continuum of care. Goodson (2010) adds to this information, by saying that the ACA is a promise for primary care: the Act provides support for workforce training and education in primary care; primary care physicians are provided with a 10% increase in payment in the next 5 years; financial incentives will motivate providers to adopt successful models of health care provision. Thorpe & Ogden (2010) point to the most significant changes to take effect in 2012: Medicare will start reducing payments to those hospitals, which have high rates of readmission. In the meantime, those hospitals which meet all quality standards will face higher payments from Medicare (Thorpe & Ogden, 2010). Yet, the proposed policy is not without controversy. Problems with sustainable growth rates present a serious policy challenge (Berenson, 2010; Kocher et al, 2010). Penalties for high-spending states and care providers reflect the lack of objective information regarding territorial and geographic variations in health care spending (Berenson, 2010). Differences between spending rates increase and absolute spending figures make policy analysis an extremely challenging task (Berenson, 2010). Eventually, implementation difficulties can reduce the scope of benefits offered by the ACA: Thorpe and Ogden (2010) provide a brief overview of the main implementation challenges, including the risks of duplication and overlaps in functions across agencies. Therefore, policymakers will have to pass a long way before the policy is successfully implemented. Discussion Apparently, the ACA holds a promise to enhance the quality of health care, reduce administrative costs, and provide financial incentives for hospitals to improve the efficiency of medical care. Many of the ACA provisions are designed as a response to the most urgent issues in present day health care. The ACA exemplifies a multifaceted approach to health care, which addresses all areas and inconsistencies, from primary care to administrative costs in hospitals. However, this very complexity raises the question of efficiency and relevance. Simply put, will the proposed provisions help medical and insurance professionals to achieve the desired result? Most probably, they will, but only if policymakers adopt a new vision and transform their policy implementation approaches. Recommendations To begin with, policymakers must develop an integrated plan specifying how these multiple provisions and ideas will work across various health care agencies, to avoid overlaps and duplication of efforts. The plan must also specify who and how is accountable for implementing and overseeing separate elements of the reform (Thorpe & Ogden, 2010). Furthermore, it is high time the saga of the sustainable growth rate were put to an end. Previous methods of SGR do not fit in the new policy provisions and legislation. Even if policymakers fail to remove the burden of SGR, its principles should be changed. Otherwise, the entire system of health care provision will remain increasingly static. SGR is a serious barrier to improving the quality and effectiveness of medical care. Otherwise, the ACA will fail to induce the desired positive change and move health care provision to a new level of quality. Conclusion Problems in the national health care system have long been a matter of serious public concern in the United States. Overspending, low efficiency, and the lack of insurance coverage have become the main policy priorities in America. Health care professionals and medical practitioners provide their ideas regarding the new policy and evaluate its inconsistencies. Based on their findings, the proposed legal provisions are equally a promise and peril of health care in the U.S. Policymakers must develop an integrated plan specifying how these multiple provisions and ideas will work across various health care agencies. Also, it is high time the saga of the sustainable growth rate were put to an end. These are the best possible ways to induce a positive shift in health care and move the entire system to a new level of quality. References Berenson, R.A. (2010). Implementing health care reform – Why Medicare matters. The New England Journal of Medicine, 363(2), 101-102. Davis, K., Guterman, S., Collins, S.R., Stremikis, K., Rustgi, S. & Nuzum, R. (2010). Starting on the path to a high performance health system: Analysis of the payment and system reform provisions in the Patient Protection and Affordable Care Act of 2010. The Commonwealth Fund. Goodson, J.D. (2010). Patient Protection and Affordable Care Act: Promise and peril for primary care. Annals of Internal Medicine, 152, 742-744. Kocher, R., Emanuel, E.J. & DeParle, N.A. (2010). The Affordable Care Act and the future of clinical medicine: The opportunities and challenges. Annals of Internal Medicine, 153(8), 535-539. Thorpe, K.E. & Ogden, L.L. (2010). Analysis & Commentary: The foundation that health reform lays for improved payment, care coordination, and prevention. Health Affairs, 29(6), 1183-1187. Read More