The Affordable Care Act's impact on emergency department access in southeastern Massachusetts

Healthcare Reform Revised

We know that the burden of diseases is increasing all over the world. The percentage of people suffering from diabetes, cardiovascular and pulmonary diseases has considerably increased in the last decade. It is noteworthy here that the importance of preventive care now comes at par with the importance of curative care. Considering the prevalence of diseases and the health status of the American population, President Obama introduced a health care reform that is known as the Affordable Care Act or Obama Care. The role of medical care as a determinant for health has not been established as a fact yet it has been proved that early intervention, preventive care and the required management can go on to reduce the severity and even cure chronic disease. Due to this reason, medical care does have a very crucial role to play in the health status of the population. (Bunker, Frazier & Mosteller, 1995)

The purpose of this paper is to analyze the impact of the aforementioned reform on the healthcare facilities that are being provided in the southeastern region of Massachusetts. The target of this study will be a community hospital that is located south of the city of Boston. The emergency room of this hospital has been recorded to have a turnout of 200,000 patients every year.

Role of ACA in Massachusetts

As mentioned earlier, the prevalence of diseases is becoming a global issue of increasing concern. Needless to say, the percentage of people who are suffering from chronic illnesses like diabetes, cardiovascular diseases as well as pulmonary diseases in this area has also increased in the past couple of years. In this part of the paper, we shall focus on impacts of ACA on the health status of the people and whether or not it has been successful in saving the lives of the people. As already mentioned, the target hospital of this study is situated south of Boston; however, we shall be discussing the role of the ACA in Massachusetts, in general.

The patients of this region are covered by insurance under the Commonwealth Care and Medicaid. The aforementioned two forms of insurance are the newly acquired and the most common ones under the ACA. As compared to the privately insured, the people who have been covered by these two systems have reported increased access to the outpatient department. According to the statistics, before the introduction of this reform the people who were covered by Commonwealth Care Type 1 (also known as minimal cost sharing) or Medicaid delayed their visit to the dentist due to the high cost. On the other hand, the percentage of people who were privately insured and delayed their visit at the dentist was significantly lower than the former. Moreover, the people who were covered by Medicaid also had a hard time seeing a specialist because of cost issues. As for the people who were covered by Commonwealth Care Types 2 and 3 (also known as greater cost sharing) were seen to have even more cost related problems in obtaining health care when compared to the ones that were privately insured.

However, after the introduction of the ACA in Massachusetts, the situation has changed and more people now have access to better healthcare facilities, whereas the addition of this reform on the annual budget of the country has only increased by 1%.

According to the Massachusetts Department of Healthcare Finance and Policy, the percentage of uninsured residents of the state has declined from 6% in the year 2006 to 2% in the year 2010.

A study that was conducted by the Urban Institute (Massachusetts Division of Health Care Finance and Policy) in the year 2010 revealed that in that year, 98.1% of the residents of the state were covered by health insurance. As for the year 2009, this figure was 97.3%. The percentage of insured people among seniors and children in the year 2010 was even higher; the values being 99.8% and 99.6%, respectively. 65.1% of the residents of the state were insured by the employers, while 16.6% were covered through Commonwealth Care and other public programs and 16.4% by Medicare. According to Judy Ann Bigby, the Secretary of Health and Human Services, the achievements of the state in health care reform have been extraordinary. She also added that employers as well as the government and the individuals have been playing their role to make this reform a successful one.

At this point it is important for us to look at what good ACA has done for the people of this state. It is therefore noteworthy that almost every resident in the Commonwealth is now covered by health insurance. Moreover, the companies that did not offer insurance to their employees before are now giving health insurance to all the people who are a part of their company. More than 90% of the state population now has access to a primary care physician. However, there are less chances of primary care being delivered in emergency rooms, since the emergency room visits cost more. Apart from curative care, the people of Massachusetts now also have access to preventive care. The health disparities that existed among women, low-income people and minorities have also declined with the introduction of this reform. Analysts agree that the state has become healthier, overall.

The aforementioned were facts that can be concluded from the reports and statistics about the status of health care delivery after the reform in the state. However, the actual stories are even better. To prove this point, I would like to mention two incidents pertaining to the health care reform.

Jaclyn is a young woman and a cancer survivor. When she was interviewed about the quality of health care delivery in the state, she claimed that if it was not for the reform, she would not have survived. She said this because she could not have otherwise afforded to get herself treated. She also went on to say that there was no compromise in the quality of health care that was being given to the residents of the state under the Commonwealth insurance or Medicaid.

Ken is a self-employed man who had been suffering from gastrointestinal symptoms for quite some time. However, he ignored these symptoms for months and years because he did not have the finances to go and see a doctor and bear the cost of the treatments. Under the health care reform he was insured and has now been treated for Stage III colon cancer and is therefore a cancer survivor.

Some of the concerns that still need to be addressed, particularly in the target hospital that is being discussed in this paper, include issues of cultural and ethnic discrimination. Moreover, the population served is predominantly Medicare/Medicaid lower socioeconomic, culturally diverse and elderly (Floyd, 2002). Approximately 20% privately insured and 17% free care. There is also a large population of mentally ill and uninsured people. There is high prevalence of diabetes, cardiac disease, obesity, and pulmonary illnesses with a moderate smoking population. There are often language barriers and the education level is limited.

Affordable Care Act

The objectives of the ACA include the increase in the affordability and quality of health insurance, decrease in the uninsured rate through the expansion of private and public insurance coverage and to decrease the cost of healthcare for the government as well as the individuals. A number of mechanisms have been provided by this act that includes subsidies, mandates and insurance exchanges so that the coverage as well as the affordability could be increased. According to this law, it is mandatory for all the companies to cover their applicants irrespective of their current health conditions or sex. The companies are also required to offer coverage within the latest minimum standards (O'harra, 2013). Moreover, this reform also aims to decrease the cost and advance the health care outcomes by making changes to the system so that quality is preferred over quantity by increasing competition, incentives to rationalize the delivery of healthcare and regulation. According to the Congressional Budget Office, the ACA will have beneficial effects on the future debts as well as spending on Medicare (Obama, 2008).

Under this act, the people with preexisting health conditions will not be denied insurance. Moreover, the people who have chronic and serious illnesses will also not be denied of any health care services by removing them from the insurance plan. Apart from this, the children can stay on the plans of their parents until they get a plan of their own.

Analysis of the reform

The great health care challenge of the country is responsible for the health care costs. Even though the health insurance premiums had been increasing at a faster rate than inflation for the last couple of years before the reform was introduced, the government has now gained control over them. The overall base rates have gone up to over 16% in the last three years, meanwhile the average is less than 2% as of now. A part of this progress has resulted from the mechanisms that were made available and used under the health care reform. In fact, some studies have shown that for some small businesses and individuals, premiums might decrease by 20% because of the ACA.

According to the aforementioned discussion, the healthcare reform has worked and is working in Massachusetts and therefore it will also work in America. There is no other choice for us but making it work. It should be noted that in one way or another, health care has a considerable effect on business government and household budgets. Moreover, it also affects the ability of the people to get a job and that of children to learn. Affordable, accessible and quality care will always improve the lives of the people and would also save the lives of many people. When the health care system is affordable and accessible, the families develop a sense of economic security and have peace of mind. As a result of this reform and improved healthcare facilities and delivery, the productivity of large and small employers will increase. More jobs will be created for healthcare professionals that would in turn improve the economic condition of the country. The ACA can prove to be a powerful statement for the people of Massachusetts, and also of the rest of America.