Obamacare: Affordable Care Act

1. Name two advantages and two disadvantages of the Affordable Care Act (the Obama healthcare plan).
Obamacare has ensured federal fund allocation to all states for the purpose of Medicaid expansion. Outcomes reveal that this expansion, accompanied by the establishment of health insurance exchanges, has resulted in a substantial share of uninsured citizens acquiring coverage. Further, ACA introduced some key healthcare sector reforms including healthcare center accountability that attempts at coordinating care between health centers and achieving shared cost savings. Accountable care organizations intend to decrease the fragmentation the health sector commonly witnesses. The year 2016 saw a deceleration in American healthcare expenditure’s growth rate after 5 years (Gruessner, 2016).
Despite the aforementioned advantages, certain issues surrounding ACA have proven detrimental to healthcare access. Of late, monthly premium rates have spiked, particularly among health insurance exchange plans. The cause for this increase is: a further twenty million individuals are now covered; with the preexistent condition clause being rendered invalid, payers have to cover the more ill population’s expenses, besides covering preventive service expenses. Consequently, they have resorted to hiking premium rates. Secondly, payers’ increased preference for high-deductible care plans has proven detrimental. ACA has played a part in increasing out-of-pocket expenses and high-deductible care plans. While the overall expense has increased owing to more individuals being covered, the rate for individual enrollees is a modest 3% or so. Despite the Act’s obvious advantages, certain shortcomings must be ironed out in the near future (Gruessner, 2016).
2. Describe three examples of how the cost of healthcare has impacted the quality of services offered to patients.
The explosion in healthcare procedures and technology in the past few decades has improved the industry’s capability of preventing, screening, diagnosing, and treating innumerable ailments. The access to, and implementation of, such novel processes and technologies has increased expenditure, pressurizing the already-pressured health budgets. Thus, payers, doctors and lawmakers increasingly have to decide which alternative is most economical or ideal, instead of simply distinguishing between effective and ineffective alternatives (Ginsburg et al., 2009).
America’s healthcare expenditure is the highest in the world, and has been increasing quicker than expenditure in the remaining economy ever since the 60s. Exorbitant healthcare costs increase employer and employee premiums, public program expenses, and out-of-pocket expenses, besides decelerating actual wage growth. Moreover, increasing healthcare insurance premiums imply more citizens are unable to acquire coverage. The increased healthcare expenditure is especially alarming as it isn’t accompanied by improved health results (Ginsburg et al., 2009).
Obamacare included numerous measures for improving care quality, particularly through expanding care access via subsidized insurance obtained from exchanges and Medicaid expansion in participating states. Coverage expansion indeed aids several citizens but a large number of restrictions are imposed on coverage (for instance, high deductibles and copayments, exclusion of benefits and limited networks). Medicaid expansion is largely good for newly covered individuals, but this is not the solution. There is a difference between coverage and care access. Low reimbursement has resulted in a mere 34% of practitioners showing willingness to see new Medicaid enrollees (Geyman, 2015).
3. What recommendations do you suggest to make improvements to the plan? Why or why not?
An in-depth examination indicates that key ACA elements actually work. But its insurance exchanges are its most criticized feature. Insurance costs are influenced by enrollees’ actuarial risk. The ease of enrolment and withdrawing is ACA’s main shortcoming. This tips the risk pool, on the whole, resulting in excessive premium increases. Hence, there is a need to tackle this problem. The foremost recommendation is continuing exchanges as they currently are whilst making penalties roughly equal to the most economical exchange cost policy. Another recommendation is allowing state creation and management of insurance exchanges while permitting regional pooling agreements between states, and creating sound high-risk pools, risk adjustment procedures and reinsurance markets for ‘uninsurable' persons. The last alternative is the public alternative – coverage for all. Directed at individuals without employer-sponsored insurance, this coverage would be administered akin to Medicare. Employers could pay a few covering the majority of employees’ expenses and enroll employees, but this wouldn’t be mandatory (Toussaint, 2017).



References
Geyman, J. (2015). The Affordable Care Act at Age Five: Quality of Care. Retrieved February 13, 2018, from http://pnhp.org/blog/2015/03/16/the-affordable-care-act-at-age-five-quality-of-care/
Ginsburg, J., Neubauer, R., Fleming, D., Bronson, D. L., Centor, R. M., Gluckman, R. A., & Liebow, M. (2009). Controlling health care costs while promoting the best possible health outcomes. American College of Physicians: A White Paper.
Gruessner, V. (2016, September 14). 2 Benefits and 2 Disadvantages of the Affordable Care Act. Retrieved February 12, 2018, from https://healthpayerintelligence.com/news/2-benefits-and-2-disadvantages-of-the-affordable-care-act
Toussaint, J. S. (2017, April 05). Improve the Affordable Care Act, Don't Repeal It. Retrieved February 13, 2018, from https://hbr.org/2016/11/improve-the-affordable-care-act-dont-repeal-it