Obamacare and the Effect the ACA Had on Maryland

¶ … government actors discussed in Chapter 10 of the text, Health Policy Analysis: An Interdisciplinary Approach are federal government actors, state governments, and local government. They are the ones that form policy and pass laws that protect and enforce policy. The United States during its infancy formed a system of checks and balances that keep one-sided political agendas from taking over and that can be seen in recent legislature. "The Constitution that took effect in 1789 created a stronger national government, but it established a three-headed state with legislative, executive, and judicial branches and a system of checks and balances to ensure that no one branch would dominate" (McLaughlin & McLaughlin, 2015, p. 28).

ACA or the Affordable Care Act for example, is a step government actors have taken to reduce healthcare spending. States like Maryland have taken action in implementing sustainable ways to curb spending and promote wellness. The 2010 Patient Protection and Affordable Care Act or ACA, essentially requires states to create and maintain a health insurance exchange with a deadline of 2014, or for states to participate in a type of federal exchange. Maryland elected to make Maryland Health Connection because of the act. Maryland Health Connection is a marketplace Marylanders can use to shop for as well as enroll in health plans.

Through ACA people that were normally uninsured, could now be insured. However the actual act itself did not reduce healthcare spending, rather the changes resulting from it passing did. "Changes resulting from the Affordable Care Act can reduce treatment disparities, but the law's provisions do relatively little to restrain runaway costs" (Wartman, 2015, p. 10). People soon began to realize that the need for budget awareness and providing higher quality medical care was high and things had to change to suit that need.

Around the nation, various groups are piloting creative new payment methods and models. One such experiment has been conducted in Maryland where they overhauled the hospital-payment system and delivered huge implications for the hospital the experiment was conducted in, John Hopkins Medicine. "Rates at Maryland hospitals are set by a state agency known as the Health Service Cost Review Commission or HSCRC. Since 1977, Medicare waived payment rules it uses in the rest of the country, paying Maryland hospitals according to HSCRC rates" (Wartman, 2015, p. 10). This action enabled uninsured to receive adequate medical care and made treatment affordable for all. However, the old model of fee-for-service costs provided no real incentive to maintain people healthy or limit health expenses.

Therefore, the new all-payer model, which was approved in January of 2014, provides those that live in Maryland with something more similar to a "population health" system. The passing of the new policy provided the state a way to get a global budget within Maryland. The global or universal budget made hospitals charge the same rate to all patients for the same procedures.

Instead of focusing on getting more patients, now with the new plan, hospitals seek to stay on budget and desire quality and efficiency versus quantity. That means a decrease in preventable conditions and readmissions will go down. The shift then becomes from volume to value. Hopefully in the future, Maryland and other states like it can set an example of a progressive and efficient model for reduction of healthcare spending. The experiment performed on the hospital although hard to implement, is a sign that hospitals and other healthcare facilities are willing to change in order to adapt to current need.

The nongovernmental actors discussed in the text, Health Policy Analysis: An Interdisciplinary Approach are the public, interest groups, the media, and scientists and other experts. These groups often funded by companies and wealthy people, influence the way the government behaves. They may come together and form lobbyists or interest groups in order to convince political figures to vote a certain way or pass policies that deregulate the system. "Interest groups do more than just attempt to sway votes in their favor; they can be critical partners with government actors in policy development from inception to implementation" (McLaughlin & McLaughlin, 2015, p. 282).

Nongovernmental actors like the public could also derail policy by committing fraud and disregarding the rules and regulations of a law passed by the federal government. Maryland complied with the Affordable Care Act. However, shortly after the deadline for implementation of a portal, Maryland experienced problems brought on by nongovernmental actors like contractors. In Baltimore, Maryland for example, people have come under scrutiny by the federal government because of a troubled health exchange.

A top contractor who assisted in building the website stated a federal agency that looked into the issues had asked for internal documents. The contractor stated he is fully complied with the request that came from the inspector general working for the Department of Health and Human Services. Maryland's health exchange website that permits people to sign up for the newly formed Obamacare was overwhelmed with mistakes from the beginning and cost taxpayers millions. Therefore, although governmental actors enacted an act that was aimed at decreasing spending, because of the actions of nongovernmental actors, the act generated extra spending in the form of waste taxpayer money.

People play a vital role in the efficacy and regulation of laws and acts passed by governmental actors. It can either hurt or help a political mission. Although Maryland was compliant in providing their residents with an online health insurance portal, the state failed to deliver one that would perform the appropriate action for those applying for medical insurance.

Maryland Health Connection has been slated to run a modified pilot program during the imminent open enrollment period. The program intends to transfer calls to brokers who then help consumers with understanding and performing the enrollment process once the portal determins a consumer's eligibility for financial assistance. Creation of the program is meant to reduce Maryland Health Connection's previously experienced call-center hold times as well as allow consumers to obtain plan selection advice.