American Healthcare System and Affordable Care Act

Issues Driving Change in Healthcare

Healthcare is driven by policy changes like those embedded in the Affordable Care Act, by shifting social norms and attitudes towards healthcare, and by demographic changes such as the aging population. The Affordable Care Act was revolutionary in that it mandated universal coverage but still fell short of transforming the ethos of a market-driven healthcare system. As a result, the Affordable Care Act did not lead to appreciable changes in insurance structuring. The Affordable Care Act did, however, instigate a new dialogue about the ethics, role, and function of healthcare in America. Social norms also drive change in the healthcare system. In fact, the Affordable Care Act itself helped change social norms and values, helping more Americans understand the importance of improved efficiency and reducing healthcare disparities. As social norms and values change, it may be possible to imagine a future in which Americans no longer tolerate the excessively high costs of healthcare that are directly due to insurance bloating. Finally, demographic changes including an aging population and increased diversity throughout the country means that the nature of healthcare delivery is changing. Healthcare change is driven from the top down, through changes to fiscal and healthcare policy, and by the bottom up, by individuals, families, communities, and healthcare workers too.
Two effects of the Affordable Care Act include improved coordination of care, which is also aided by technology, and cost controls. According to Salmond & Echevarria (2017), the Affordable Care Act’s primary goals have been to reduce unnecessary spending at all levels of healthcare management and delivery. A strong self-assessment in the healthcare industry is taking place as a result. The Affordable Care Act has also led to changing values and norms, with more Americans realizing the importance of accessible and fair insurance policies, and easier means to access affordable healthcare services. As more Americans recognize the ways Medicare and Medicaid already function as single-payer systems for seniors, it is also possible that the future of healthcare may include single-payer systems for all residents. The aging population and other demographic changes are also impacting the way nurses are trained, how healthcare is delivered throughout multiple levels of the system, and how costs are managed over time.
How the Affordable Care Act Helps Lower Income Families
The Affordable Care Act was designed in part to address the problem with millions of uninsured or under-insured Americans. Less than ten years after its passing, the Affordable Care Act has already significantly reduced healthcare insurance disparities. One study shows that disparities have diminished particularly in Latin communities (Heintzman, Bailey & DeVoe, et. Al, 2016). Because it creates a government-based insurance program that is available for people who work in precarious or temporary jobs, people who are self-employed, and those who only work part time, all persons who cannot rely on employer-paid insurance plans stand to benefit from the Affordable Care Act. While costs of insurance and healthcare services remain bloated for various reasons, the Affordable Care Act nevertheless did allow countless Americans to have insurance for the first time.
Lower income families were particularly at risk for not having sufficient insurance, if any at all. As a result of being uninsured or underinsured, many lower income families were not receiving annual checkups and did not go to hospital except in case of emergencies. These patterns of usage lead to greater costs: it costs more to treat a major problem than it does to intervene earlier. Health promotion programs also need to become part of the healthcare system. With the Affordable Care Act, lower income families can access preventative care services including healthcare screenings. Preventative care and early interventions can help reduce long-term costs for the individual or family, as well as for the entire system. When people spend less on healthcare, they can spend more on other important areas of life including education.
Three Recommendations and Suggestions For Improving Access to Affordable Healthcare Services
The Affordable Care Act was a first step. More needs to be done in order to improve the status of healthcare in the United States. The first step would be to increase the budget for Health Insurance Marketplaces, allowing the public plan to become far more competitive and thereby driving down overall insurance costs. A second step would be to more strictly regulate the private insurance sector. The private insurance sector is one of the enemies to affordable healthcare to begin with. Many of the inflated costs of healthcare processes, procedures, and medications are due to excessive spending at the insurance and administrative level, which is why the United States remains “dead last” and is the most expensive of all healthcare systems in all other developed countries (Munro, 2015, p. 1). Finally, it is important that nurses and other healthcare workers become the driving forces of future change.
Improving the Affordable Care Act will entail working with both pharmaceutical companies and insurance companies to come up with strategic means of reducing costs. While the Affordable Care Act represents progress and has reduced the overall cost of insurance and insurance spending, the next step would be to improve ethics-driven government regulations (Obama, 2016). Americans often perceive regulations negatively, but when regulations are made with regards to evidence and ethics, it is possible to motivate meaningful change. The current free market-driven method of healthcare is not working; something needs to change if the goal is affordable healthcare. Without regulation, insurance companies are unlikely to alter their policies in any meaningful way, and pharmaceutical companies will also be less likely to budge on their pricing models. Ethics needs to be re-introduced into the very concept of healthcare, so that healthcare becomes more like education. Nurses and other healthcare workers need to advocate on behalf of patients who do not have access to affordable or quality care, thereby improving the normative culture in the healthcare organization and political culture.





References

Heintzman, J., Bailey, S.R., DeVoe, J., et al (2016). In low income Latino patients, post-Affordable Care Act Insurance Disparities May Be Reduced Even More than Broader National Estimates: Evidence from Oregon. Journal of Racial and Ethnic Health Disparities 4(3): 329-336.
Munro, D. (2014). U.S. healthcare ranked dead last compared to 10 other countries. Forbes. 16 June, 2014. https://www.forbes.com/sites/danmunro/2014/06/16/u-s-healthcare-ranked-dead-last-compared-to-10-other-countries/#294c9ee576fd
Obama, B. (2016). United States health care reform progress to date and next steps. JAMA 316(5): 525-532.
Salmond, S.W. & Echevarria, M. (2017). Healthcare transformation and changing roles for nursing. Orthopedia Nursing 36(1): 12-25.