Patient Protection and Affordable Care Act
Patient Protection and Affordable Care Act
Title I of the Affordable Care Act provides individuals, families, and small business owner control over their health care. This Act gives the middle-class the largest tax cut on health care our country has ever seen. Millions of working families and small businesses will benefit from decreased insurance premiums that will produce hundreds of billions of dollars in tax relief. Preventive care will be completely covered without out-of-pocket expense; it will also place a cap on out-of-pocket expenses. Also, if a person wants to keep their current insurance he or she will be allowed to do so. Americans who do not have insurance coverage will have the opportunity to select a plan that is best suitable for him or her in an open, competitive insurance market. This will be the same insurance companies that Congress uses for their own insurance.
Insurance companies will have to compete with each other for the consumer’s business constructed on cost and quality. Small business owners will be given a tax credit to aid in the offsetting of the cost it takes to cover their employees insurance. Insurance companies will not be able to deny coverage based on a person’s pre-existing health conditions. It will also arm consumers with more power to fight against denials to physician ordered treatments covered by insurance. This Act will help eliminate a large amount of insurance company abuse by setting clear and precise rules, which should force companies to do the right thing are be heavily fined.
Insurance companies seem to always manage to find ways to confuse and manipulate the consumer but this bill will help eliminate some of these activities. Not only will an individual be able to keep or select a plan but be provided with unvarying meanings of insurance and medical terms. The bill will also require the language in the summary of benefits and coverage to be comprehensible by the ordinary enrollee, no more than four pages long, and no smaller than 12 font print (“The Affordable Care Act, Section By Section,” 2010).
How Will These Changes Effects Health Care?
A little over two-years-ago, the Patient Protection and Affordable Care Act (H.R. 3590) passed with a vote of 60-39 in the U.S. Senate. According to the “Analysis of the Patient Protection and Affordable Care Act” (2010) based on the COMPARE micro-simulation model used by RAND for the changes of H.R. 3590 between 2010 and 2019, there will be some significant improvements in health care coverage. By 2019, the bill will decrease the amount of uninsured to 25 million, which is a 53% reduction compared to status quo projections. Under H.R. 3590, four million more children would be covered under the employer-sponsored insurance (ESI) and Medicaid.
In 2019 under this bill, the average individual would be younger, healthier, and a higher incomes. H.R. 3590 opens up the opportunity for as many as 28 million new purchasers through the Health Benefit Exchanges by 2019, which consist of four basic plans. For people in lower-income families, premium and cost-sharing grants and aid are available through an Exchange (the non-group market). From 2010-2019, the H.R. 3590 is estimated to increase the U.S. personal health care spending by two percent. It is estimated that revenue generated through penalties from noncompliant individuals and employers of the coverage provisions of the bill will average approximately $87 billion.
Improving Quality and Efficiency of Health Care
Analysis of the Change: Title III
The Patient Protection and Affordable Care Act (PPACA) is aimed at protection of patients and working smarter, not harder as it involves health care. Medicare and Medicaid patients are usually the most affected, due to the ease and confusion in types of billing; what is billed for; a multitude of contradictory qualifications; and human error and greed. By improving payment for services, outcomes will better improve in quality. Investments by the PPACA will lead to better patient care models, better delivery and quality of care, and research for consumer information by teaching different approaches to treatments, and care. Rural healthcare will see improvements for providers and patients; as well as, improvements in payment accuracy. The dreaded “donut-hole” which affects Medicare D prescription drug benefit is to be reduced and an Independent Advisory Board will make recommendations for long term fiscal stability.
A new program will also be developed for community health care teams; supporting homes providing medical care, by providing access to coordinated community based care, for chronic illnesses. Hospitals will launch a purchasing program based on values, linking the Medicare payments to performance quality on cardiac, surgical, and pneumonia conditions, which are high cost. There will be a penalty for all facilities not applying this program by 2014. The President will have the HHS Secretary establish a strategy to nationally improve service in health, patient quality, and health of the population. Those organizations which take responsibility for the quality and cost of care received by the consumers, will receive a share of the savings achieved for Medicare.
By adjusting hospital payments, the dollar value will be based on each hospital’s potential preventable Medicare readmissions. In 2013, home health reimbursements will be based on a current mix of services and intensity of care provided. Medicare Hospice claims forms, and reports of cost will be updated to improve accuracy of payments. The HHS Secretary will establish a program to allow patients eligible for hospice to receive all other services covered by Medicare. The Independent advisory board will give proposals to congress if a Medicare costs is expected to exceed the target amount.
The Boards proposal will take effect unless Congress passes another measure achieving the same savings level. Any proposals made by the Board will not ration care, affect taxes or premiums, change benefits, eligibility, or cost-sharing standards of Medicare participants. The PPACA supports a system research center where research is conducted on health care delivery systems and best practices, which will lead to improvement in the quality, safety, and efficiency in the delivery of health care.
Effect of the Change on Healthcare
The Act will improve the quality of care, and provision of service for those in vulnerable and fee-for-service positions. It also assists in guiding the costs of medical provision and the need for improvements in and for, all patients in all areas of medical care. The hospitals will be in the position of guiding readmissions which might be preventable, with Care Management of the primary admission, with Home health, Short Term Rehabilitation, Extended care facilities, and so on. The rural areas of the country will benefit, from an extended period in which to bring everything up to par, per the
requirements of the government. Community health will also benefit from greater and better developed care delivery systems.
Preventing Chronic Disease and Improving Public Health
Change Analysis: Title IV
Title IV of the Patient Protection and Affordable Care Act focuses on the prevention of chronic diseases and improving the health of the public. It will take official health agencies with programs created to emphasize the importance of disease prevention. This act will empower individuals as well as communities with the needed education on prevention of chronic diseases. Also it will focus on improving the public health. I believe that this change will improve the current American health care system. Prevention of any disease, especially chronic diseases, is the foundation needed to make this change successful. The current infrastructure that we have in place is not working. A new infrastructure is needed. A new council will establish new policies that will promote national health awareness and prevention strategies.
The challenges present to accessing clinical preventive services will be removed (Affordable Care Act, 2010). This act will put into place new programs that will be specific to prevention care and services. These clinical preventive services include the following: education on oral health care, adult immunizations, not requiring coinsurance and deductibles for preventive services, stop smoking programs and pharmacotherapy for pregnant women, and awarding money to states that offer incentives for Medicaid beneficiaries involved in programs that promote healthy lifestyles (Affordable Care Act, 2010).
How Will These Changes Effect Health Care?
The government has seen that there was a need to move the emphasis of health care from illness to wellness. This change will reduce greatly the cost that it takes effectively to manage chronic diseases. “Assuming that its key provisions take effect, the PPACA will significantly expand health insurance coverage in the United States through its individual mandate, premium subsidies, and expanded eligibility for Medicaid” (Harrington, 2010 p.2). When individuals within the community have access to health insurance the promotion of preventive programs and improving the health of the public can be easily introduced nationally. Grants will be awarded to the appropriate agencies that promote individual and community health. Government agencies, such as The Centers for Disease Control and Prevention will work in collaboration with state and local health departments to manage pilot programs.
These pilot programs will evaluate the factors that contribute to chronic diseases to help reduce the risk. They will also help with the organization of adult immunizations. The goal of health care should be empowering and helping individuals to identify their health potential. Likewise communities should be evaluated for competences and empowered to take control of what chronic diseases prevalent to their community. Support for prevention and public health innovation will be provided by the HHS Secretary for funding of research (Affordable Care Act, 2010). New systems will be in place to examine the best practices to help with the prevention of chronic disease and improving public health. The effect on health care will be better management of chronic disease and improvement in the quality of health within communities.
Change Analysis: Title V
There are a multitude of changes occurring in the health care system. The Health workforce guidelines are a crucial element of the health care reconstruction. It is anticipated that the year of 2020 there will be a shortage of approximately 67,000 physicians either in specialty areas or within primary care, such as internal medicine, and pediatric medicine. “ The National Advisory Council on Nurse Education (NACNEP) reports that there will be 10,000 too few nurses in 2020 to meet the nation’s health care needs” (Redhead & Williams, 2010, p. 14). The Patient Protection and Affordable Care Act, has recognized several areas that needed changing within the health care organization, “The Patient Protection and Affordable Care Act will encourage innovations in health workforce training, recruitment, and retention, and will establish a new workforce commission” (Responsible Reform For The Middle Class, n. d., p. 7). Retaining nurses and medical professionals is important.
The younger employees are focused on building relationships outside of the workplace. They are not driven to work long hours and his or her time at their work place. “Employee retention is improved by creating a culture that focuses on employee engagement, empowerment, diversity and inclusion” (Quick Leonard Kieffer, 2008, p. 3). The employees of various health care organizations will be introduced and shown new training procedures and education programs within the health care organization. The areas that will promote innovative work training programs will be internal and pediatric medicine practices, nursing homes, hospitals, and home health agencies, to name a few.
Other areas the Patient Protection Affordable Care Act is making changes to benefit the health care workforce is, through federal student loan programs transformed for easier forms to follow and the student loan program more appealing for his or her applicants. “The Nursing Student Loan Program will be increased and the years for nursing to establish and maintain student loan funds are updated” (Responsible Reform For the Middle Class, n. d. p. 8). There will be an incentive for repaying health loans, if the health care worker agrees to work for the federal, public state or local health care organizations for at least three years the loan will be repaid. There will be changes within mental health and behavioral health services.
How Will These Changes Effect Health Care?
The conditions that will be offered will help improve the supply and demand of health care workers in the United States. “A Primary Care Extension Program is established to educate and provide technical assistance to primary care providers about evidence-based therapies, preventive medicine, health promotion, chronic disease management, and mental health” (Responsible Reform, n. d. p. 9). Recruitment and retention is focused toward the younger generation. The younger generation is focused on outside relationships instead of making relationships within the workplace. Acquiring the recruitment and retention focused on the younger generation will help keep the healthcare worker dedicated and employed longer, which could cut down the cost for new orientations for new employees.
Loan repayment has been extended for students from 2010 to 2015, which would provide help to students on repayment for his or her student loans. Mental health and behavioral health areas are provided instruction and teaching grants to schools, for the understanding to improve and increase teaching programs for health care workers in this field. The areas that will receive the grants will be social work, training programs dealing with child and adolescent mental behavioral disorders, community mental health programs. In the past mental health has been last to receive monies and help in health care, it is an improvement that The Protection and Affordable Care Act has recognized that mental health nursing needs the help that it does. Grants will be provided to support society’s health workforce and to support a constructive health programs in rural areas by supplying health care workers.
Analysis of the Patient Protection and Affordable Care Act. (2010). Retrieved from http://www.rand.org/pubs/research_briefs/2010/RAND_RB9514.pdf Harrington, S. (2010). U.S. Health-Care Reform: The Patient Protection and Affordable Care Act. Journal of Risk and Insurance, 703-708. Redhead, Stephen, C. & Williams, Erin, D. Public Health, Workforce, Quality, and Related Provisions in PPACA: Summary and Timeline. (2010). Retrieved March 12, 2012, from http://www.crsdocuments.com Responsible Reform for the Middle Class. The Patient Protection and Affordable Care Act Detailed Summary. Retrieved March 12, 2012, from Democrats. Senate. Gov/Reform The Affordable Care Act, Section by Section. (2010). Retrieved from http://housedocs.house.gov/energycommerce/ppacacon.pdf Thought Leader Forum, Quick Leonard Keiffer International. (2008). Retrieved March 12, 2012, from http://www.ashhra.org