Overview of the Affordable Care Act’s Impact and Stakeholders
Policy Summary
The United States’ 2008 presidential election featured several crucial topics, including health care reform, which is still a priority for American society and Congress members. The Patient Protection and Affordable Care Act (ACA) was approved by Congress and enacted into law in 2010 (Silberman, 2020). Currently, it is regarded as the most significant piece of legislation ratified during the last decade.
Context
The context surrounding the discussed issue includes years of political debates and the inability of policymakers to propose a solution that would satisfy the needs of the citizens. Individuals did not have access to health insurance before the ACA because of their medical history. The ACA, however, prohibits insurance providers from refusing to provide coverage because of previous illnesses (Silberman, 2020). People who are coping with chronic conditions find this provision greatly helpful. Additionally, before the ACA, many Americans struggled to buy health insurance and faced bankruptcy due to high medical costs. The ACA provides more affordable health insurance coverage to reduce the financial burden of healthcare bills.
Ways to Achieve Goals
There are several ways in which the Affordable Care Act can achieve its goals. The ACA has expanded Medicaid and established insurance exchanges to ensure access to care for all individuals in the U.S. (Silberman, 2020). People who cannot enroll in an insurance plan from their workplace or are not qualified for other government coverage should use them. The ACA’s second recommendation is to lower health care costs. Improvement of care coordination and preventive care are also the recommendations of the ACA (Silberman, 2020). These initiatives are consistent with the purpose of the ACA to improve healthcare coverage for vulnerable people and make medical services more accessible for the population.
Stakeholders and Their Roles
Many issues inspired the decision to develop the ACA with the American healthcare system. Before the ACA, almost 20% of the country’s population did not have health insurance (Neiman et al., 2021). Many other developed countries offer universal health care to all of their residents, making equal access to health insurance one of the citizens’ rights (Neiman et al., 2021). Therefore, the government is equally interested in supporting the image of the United States as the citizens are interested in promoting accessible healthcare coverage. It allows assuming that two significant stakeholders are involved with the ACA: the country’s residents and the state. Other interest groups affiliated with this policy are healthcare workers and health insurance providers.
The role and function of the state in the ACA are based on the need to increase budget expenses on public healthcare. The government is responsible for providing vulnerable populations with adequate access to medical services, which makes the portion of the budget spent on healthcare more significant. The role of healthcare providers is to adapt to the increasing number of patients who can access medical services (Neiman et al., 2021). The function of the patients, in turn, is to use the Affordable Care Act’s options and take care of their health regularly.
Influence
Patients
The relationships between patients and healthcare providers as two significant stakeholders affected by the Affordable Care Act are critical for understanding the policy. Patient motivation is based on the desire to receive adequate medical assistance for their money, and they will promote it as their right on the political level. For example, the demand for long-term care develops as the population ages, and the ACA provides opportunities for these individuals.
The ACA offers financing and programs to guarantee access to long-term care in the community or at home. Section 2402 of the ACA details the State Plan Option for Home and Community-Based Services (McIntyre & Song, 2019). Community First Choice is a provision of the ACA’s Section 2401 that grants federal cash to states that offer person-centered attendant services and support based in the home and community to improve the capacity of people with disabilities to reside in the community (McIntyre & Song, 2019). Section 10202 of the ACA contains specifics regarding the State Balancing Incentive Payments Program (McIntyre & Song, 2019).
Money Follows the Person (MFP), a program that offers individuals long-term assistance and support to leave institutions and live in their own homes or other community-based environments, is one of the programs covered by Section 2403 (McIntyre & Song, 2019). With the help of these programs, the government can deliver better services, make more services available to patients, and target home and community programs to specific populations. These issues are vital for patients as the primary stakeholder in the Affordable Care Act.
Physicians and Nurses
From the perspective of physicians and nurses, the ACA is connected with the instruction of new programs and rules, as was already mentioned. In addition, the growing aging population and patients with access to healthcare make the shortage of medical professionals critical (Brom et al., 2018). The motive of healthcare specialists is to provide patients with high-quality services, which is consistent with the population’s interests. It is only possible to make the public healthcare system function with sufficient physicians and nurses, and their lack is evident even nowadays. According to the estimates, this conflict will aggravate in the future, which emphasizes the need to attract more healthcare specialists to the hospitals, optimize their work, and provide people with the opportunities to receive education in this sphere (Brom et al., 2018). Otherwise, it would be problematic to give all Americans who need medical assistance with professional help in the nearest future, which makes the achievement of the ACA’s goals challenging (Brom et al., 2018). It is especially crucial in the context of the increasing number of older adults in the United States and the overall tendency for population aging.
Impact
The ACA may influence how Americans perceive the public healthcare system. This policy alters both how healthcare services are paid for and how they are provided. For instance, the ACA created a new payment system where payments are made based on “value,” that is, the performance of health care outcomes, rather than “volume,” which refers to the traditional fee-for-service (Bowling et al., 2018). The old system of health care reimbursement, known as “fee-for-service,” in which compensation was given based on the services a patient got, is vastly different from the current one (Bowling et al., 2018). This reform aims to lower healthcare costs without sacrificing quality or efficiency by giving medical practitioners more responsibility for achieving higher performance expectations.
From one point of view, patients benefit from this policy, and medical services become more available. From another perspective, healthcare specialists must adjust to new rules and learn innovative ways of paying for their services. Hospitals and healthcare providers are compensated based on three main categories after the ratification of the ACA that are avoidable readmission rates, patient experience, and outcome indicators (Bowling et al., 2018). Even though these changes do not influence the quality of the nurses’ and physicians’ work, they constitute a new approach to public healthcare coverage that should be considered because they introduce changes to the sphere (Manski, 2019). Therefore, the policy’s positive and negative impacts will become more evident with time.
Sources
Bowling, B., Newman, D., White, C., Wood, A., & Coustasse, A. (2018). Provider reimbursement following the Affordable Care Act. The Health Care Manager, 37(2), 129–135. Web.
Brom, H. M., Salsberry, P. J., & Graham, M. C. (2018). Leveraging health care reform to accelerate nurse practitioner full practice authority. Journal of the American Association of Nurse Practitioners, 30(3), 120–130. Web.
Manski, C. F. (2019). Communicating uncertainty in policy analysis. Proceedings of the National Academy of Sciences of the United States of America, 116(16), 7634–7641. Web.
McIntyre, A., & Song, Z. (2019). The US Affordable Care Act: Reflections and directions at the close of a decade. PLoS Medicine, 16(2), e1002752. Web.
Neiman, P. U., Tsai, T. C., Bergmark, R. W., Ibrahim, A., Nathan, H., & Scott, J. W. (2021). The Affordable Care Act at 10 years: Evaluating the evidence and navigating an uncertain future. The Journal of Surgical Research, 263, 102–109. Web.
Silberman, P. (2020). The Affordable Care Act: Against the odds, it’s working. North Carolina Medical Journal, 81(6), 364–369. Web.