The ACA and Health Care Costs

The ACA and the U.S. Health Care System
· The Affordable Care Act (ACA) was meant to promote greater quality care through increased implementation of preventive care; but as Lichtenfeld (2011) and Moynihan (2015) have shown, the health care industry remains committed to a course of treatments and tests because both are generally subsidized by the federal government—and, frankly, preventive care does not ensure that customers will keep coming through the door to make the industry money.
· The problem with the ACA has been that it has done little to reduce the putting of profits before people mentality that plagues the health care industry.
· It idealistically identified the right objectives—increasing access to care, increasing quality of care, lowering the cost of care, and increasing preventive care (Obama, 2016).
· However, in practice it failed to ensure that a mechanism was in place to actually enable the achievement of these objectives.
· Premiums began to soar along with deductibles for those purchasing insurance; the number of those covered by Medicare expanded by several million—but this did not necessarily translate into receiving the kind of quality care that patients were demanding. Likewise, the ACA did not “address lack of insurance for some immigrants, and the excluded groups are a large proportion of the Mexican–American community” (Block et al., 2014, p. 179).
· In short, the ACA has not enabled greater access to care on all fronts;
· costs for those purchasing insurance have soared,
· preventive care is still not practiced as much as it should be because treatments,
· and tests are what the government continues to subsidize, which encourages profit-taking to drive the health care market rather than preventive care and people’s actual health.
· The key implementation changes facing state and national policy makers include:
· Ensuring that APRNs are able to practice to the fullest extent of their skill and knowledge by operating independently in primary care facilities, as recommended by the Institute of Medicine (2010) in its Future of Nursing report, so as to increase access of care;
· Getting people to sign up for health insurance through one of the exchanges to ensure that enough money is flowing into the system so that everyone can be effectively covered*
· *The imperative for this change, while still necessary from a market perspective, essentially died for those who do not wish to buy health insurance when the Trump Administration promised not to fine individuals who failed to purchase insurance
· Promoting health education and health literacy throughout communities so as to ensure that preventive care is being pursued both at the national and at the local levels
· Finding a way to reduce the costs of care without removing subsidizations—which, unfortunately, is exactly what needs to be done because by backstopping treatments and tests, the government is contributing to the overdiagnosis of patients (Lichtenfeld, 2011), which goes against the spirit of the ACA and its bid to improve quality of care
References
Block, M. A. G., Bustamante, A. V., de la Sierra, L. A., & Cardoso, A. M. (2014).
Redressing the limitations of the Affordable Care Act for Mexican immigrants through bi-national health insurance: a willingness to pay study in Los Angeles. Journal of Immigrant and Minority Health, 16(2), 179-188.
Institute of Medicine. (2010). The future of nursing. Retrieved from
http://nacns.org/wp-content/uploads/2016/11/5-IOM-Report.pdf
Lathrop, B., & Hodnicki, D. (2014). The Affordable Care Act: Primary care and the
doctor of nursing practice nurse. Online journal of issues in nursing, 19(2).
Lichtenfeld, L. (2011). Overdiagnosed: Making people sick in the pursuit of health. The
Journal of Clinical Investigation, 121(8), 2954-2954.
Moynihan, R. (2015). Preventing overdiagnosis: the myth, the music, and the medical
meeting. BMJ: British Medical Journal (Online), 350.
Obama, B. (2016). United States health care reform: progress to date and next
steps. Jama, 316(5), 525-532.