The Impact of Affordable Care Act on North Carolina’s Uninsured Population The Affordable Care Act (ACA) which was passed by Congress was implemented to improve the quality of health care and reduce the cost of health insurance in the United State. America spends more on health care than any other industrialized nation in the world. In North Carolina, the governor signed a bill to block the state from extending the ACA which will allow Medicaid to cover group of individuals that are uninsured. North Carolina rank 33rd of the 50 states in population measures in 2012 and rank 38th in health outcome (Siberman, 2013). In 2010-2011 approximately 1.7 million people were uninsured and had barriers to access health care in North Carolina as stated by Siberman, (2013). The North Carolina Division of Medical Assistance (DMA), estimated that the expansion of Medicaid will cover approximately 319, 000 new people during state fiscal year 2014 (Siberman, 2013), but since the refusal of the expansion, these individual are going to be left uninsured. Another group of people who will not qualify are those individuals whose income is below the Federal Poverty level of 138%, but people who make the federal Poverty level of 138% will be eligible for ACA.
Individual who are paying more than 8% of their income on health insurance will be eligible for subsidies to purchase coverage (Siberman 2013). As stated in Milstead, (2013), with expansion of Medicaid, all subgroups will be eligible with the exception of the undocumented immigrants. But in North Carolina, this will have significant impact on about 51% coverage for working adult, 31% on nonworking parents and 0% childless adults. People with income above the limit for premium tax subsidies are not eligible for financial assistance (Siberman, 2013). The federal government will match payment for the newly eligible individuals but not those individual that were eligible under the state Medicaid in 2010. Currently childless, nondisabled, nonelderly adult cannot qualify Medicaid in North Carolina. Due to the restriction, Medicaid only covers 30% of low come adult in North Carolina. Newly eligible people estimated to be about 500,000 will have coverage, federal government will pay 100% of cost 2014-2016 then phase down to 90% (Siberman, 2013).
The Impact of Economics of Providing Care to Patient
The economic impact is significant, health care cost is raising about five times the rate of inflation. Most hospitals in the states that don’t expand Medicaid are facing a lot of challenges of caring for the uninsured and are facing heavy burden of debt. According to Zigmond 2013, the decision for not to accepting the expansion of Medicaid is complicating life for hospitals that serves communities with sizable low income and uninsured populations. According to the report expanding Medicaid in all state would provide hospitals with an additional $294 billion from 2013 to 2022 and reduce the United State uninsured population by as much as 10.2 million people by 2022. In North Carolina it would have created 25,000 jobs with Federal funds and 400,000 uninsured would receive health coverage according to study released by North Carolina Institute of Medicine. The expansion of Medicaid, the state will be saving up to $65.4 million and receive $15 billion from the federal fund according to North Carolina Institute of Medicine. In many rural areas in North Carolina, hospital provides free care to patients who cannot afford heavy medical bill. Without the Medicaid expansion several hospitals may close their doors due to reimbursement from Medicaid as policymakers try to rein in spending (Siberman 2013).
How will patients be affected in relationship to cost, quality and access to treatment? It is not going to cost any money to the state or patient at beginning, the federal government is paying 100% of the cost till 2017, then will transition to covering of 90% till 2020. North Carolina will still have to cover those poor uninsured through their safety net programs, but people are still going to the emergency room for treatment. This is going to lead back to some providers and higher income individuals will pay more taxes to cover the uninsured. Expanded Medicaid coverage also led to decreased rates of delayed care and decreased mortality rates especially among residents of poorer counties (Baron, 2013). North Carolina does not have enough health practitioners to meet the demand of newly enroll population. Workforce shortage limits access to care as well as prevention, and treatment option especially in the rural areas (Siberman, 2013). There should be professional training programs for primary care providers, nurse practitioners, nurses, physician assistants and health care to accommodate the demand or people are going to end up in the emergency room.
If the Medicaid expansion has been implemented, ACA has funds that would have been distributed to all the Universities for the Training Programs. According to Sebelius, (2013) article, Affordable Care Act Incudes steps to improve the quality of health care and lower cost for you and the nation as a whole. This means avoiding costly mistakes and readmissions, keeping patients’ healthy, rewarding quality instead quantity, and creating the health information technology infrastructure that enables new payment of models to work. North Carolina foundation for Advance Health Programs is a model to create and maintain a centralized tracking system to monitor and disseminate new model of payments and delivery of reimbursements. This organization help providers and hospitals to be accountable for quality care. An example is that, hospitals will no longer get paid for treatment of hospital acquired condition or hospitals with excess readmission will receive low Medicaid payment.
Ethical Implication for Organization and Patients
Why is so much controversy over the health reform? Why people don’t have right to health care? According to Sorrell, (20 12) the issue of health care reform brings important ethical issues of justice to the forefront, as individuals, communities, and the legislature struggle with how to provide quality health care without sacrificing the basic rights of even the few, understanding the legislation will help the public examine the why everyone should health insurance. United State having all the medical technology but health care is a controversy. Another issue is due to low reimbursement of Medicare and Medicaid most health providers do not want to accommodate low income patient. Health Professional can go to the urban and rural areas to practice if they are given incentives like loan forgiveness. Americans are afraid the government borrowing funds to finance health care now will push the debt on future children to pay.
If North Carolina will accept to expand Medicaid the people that left will be eligible. This will take the burden of financial cost off the state.I think the public, and health professionals of North Carolina can write to their state senators and representatives to advocate for expansion of Medicaid.
Milstead, J. A. (2013). The economics and finance of health care.(laureate Education, Inc., Health policy and politics: A nurse’s guide (p.202-203). Sudbury, MA: Jones and Bartlett Publishers. Baron, S. (2013). 10 frequently asked questions about Medicaid expansion. Center for American Progress. Retrieved from http://www.americanprogress.org/issues/healthcare/news/2013/04/02/58922/10-frequently-questions-about-medicaid-expansion Zigmon, J.(2013). ‘Death by a thousand cuts’ Hospitals execs say Medicaid expansion needed. Modern Health. 43(34) Sibelius, K. (2013). The affordable care act at three: Paying for quality saves healthcare dollars [Weblog post]. Retrieved from http://healthaffairs.org/blog/2013/03/20/ Sorrell, J. (2012). Ethics The patient protection and affordable care act : Ethical perspective in 21st century health care. OJIN Journal of Issues in Nursing 18(1).doi: 10.3912/OJIN. Vol18No02EthCo101