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BHA FPX 4003 Assessment 1
The Affordable Care Act and Beyond
In the United States, the ACA considers the current and the future of health care delivery. ACA and MACRA (Affordable Care Act and Medicare Access and CHIP Reauthorization Act) have different objectives as well as different history. The goals that will be discussed in this study are those.
In addition, it will be discussed how these projects are related, how they are transforming the American health care system at present and what might be their implications for the future health care policy and services.
Sources Addressing the Affordable Care Act
Buchmueller, T. C., & Levy, H. G. (2020). The ACA’s impact on racial and ethnic disparities in health insurance coverage and access to care. Health Affairs, 39(3), 395–402.
https://doi.org/10.1377/hlthaff.2019.01394
This source claims that ACA has played a role in assisting the US in reducing gaps in health insurance coverage and access. Specifically, disparities in insurance have decreased mainly due to the fact that a number of non-Hispanic Blacks and Hispanics gained insurance compared to whites.
This good result depicts the healthcare system evolving to be fairer in the course of time. Despite the changes that have been made, not everyone has health insurance. Although the process of getting health care services has been made easier through the Affordable Care Act, the issue of healthcare equality may not be easily attained because black and Hispanic people are still vulnerable to lack of health insurance compared to their white counterparts.
Gruber, J., & Sommers, B. D. (2019). The Affordable Care Act’s effects on patients, providers, and the economy: What we’ve learned so far. Journal of Policy Analysis and Management, 38(4), 1028–1052. https://doi.org/10.1002/pam.22158
The literature review of the last ten years reveals that the ACA’s measures such as the expansion of Medicaid and the creation of health insurance exchanges have increased the number of insured individuals. Since the law expand the possibility of accessing health care for more people, it is quite possible that health status improved.
Despite the concern, there are still issues on the entry of providers, the number of workforce, and the financial requirement on the state governments. Looking forward to the ACA’s tenth anniversary, it is becoming clear that it played a significant role in improving the availability and quality of healthcare.
Lantz, P. M., & Rosenbaum, S. (2020). The potential and realized impact of the Affordable Care Act on health equity. Journal of Health Politics, Policy and Law, 45(5), 831–845.
https://doi.org/10.1215/03616878-8543298
According to Lantz and Rosenbaum (2020), pursuant to the ACA, health care has become more affordable and quality of care has gone up, and therefore, race based disparities in access to care has gone down. The study thus reveals that the health care performance has greatly improved since the ACA became a decade old. The law has also assisted in the accessibility of insurance, visiting of primary care physicians, and insurance utilization.
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This has had the effect of decreasing the incidences of racism and economic discrimination. The ACA has also allowed community health centers to expand the scope of services that they can provide and the types of services which has in turn helped them generate more revenues. Thus, Section 1557 of the ACA enhanced human rights in health care to address the issue of fairness.
How exactly the increase of Medicaid has impacted health outcomes and health equity is not well understood; however, it has been quite effective in reducing some social determinants of health, including mortality and preterm births. This indicates that through the ACA, healthcare became better and accessible to many people in so many aspects.
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Sources Addressing the Medicare Access and CHIP Reauthorization Act (MACRA) (2015)
Abodunde, B., Slater, C., & Coustasse, A. (2020). MACRA and accountable care organizations. Journal of Ambulatory Care Management, Publish Ahead of Print (9).
https://doi.org/10.1097/jac.0000000000000350
This paper focuses on the transformation of the goals and functioning of Accountable Care Organizations under MACRA. The statistics prove that MACRA has improved healthcare for the better as ACOs have been seen to succeed. Thus, MACRA has assisted ACOs that typify collaboration and that generate low returns. The law might require cut in Medicare hospital and doctors’ visits, which would have been cost saving. Thus, the study reveals that MACRA reduces costs and improves the quality of ACO care.
Cheng, J., Kim, J., Bieber, S. D., & Lin, E. (2020). Four years into MACRA: What has changed? Seminars in Dialysis, 33(1), 26–34.
https://doi.org/10.1111/sdi.12852
Therefore, the Medicare workers receive a certain amount of money from the program, depending on what they spend and the quality of service. MACRA’s Advanced APM and the Merit-based Incentive Payment System requires that providers give good care at a cost that is affordable to the patients.
First Results from Different Payment Models with a Strong Academic Base (ESRD) It is stated that integrated service companies have low cost and high quality. The 2019 executive order also mentioned new medicines, home dialysis, and organ transplants as measures of controlling the prices and enhancing the outcomes of kidney diseases.
Politicians, nephrology professionals, and patient support groups should be involved in this process to ensure that measures being taken for changing the structure of care delivery do not harm the patients and actually beneficial for them.
Soylu, T. G., Goldberg, D. G., Cuellar, A. E., & Kuzel, A. J. (2020). Medicare Access and CHIP Reauthorization Act in small to medium-sized primary care practices. The Journal of the American Board of Family Medicine, 33(6), 942–952.
https://doi.org/10.3122/jabfm.2020.06.200142
Macra has been described by Heart of Virginia Healthcare as having altered the standards and ease of access of primary care for small and medium size practices in the following ways. Although independent practices were more conscious of MACRA, various practices had different levels of knowledge.
There are problems even with practices, especially private ones, that attempt to implement MACRA. Thus, the authors recommend that the lawmakers pay attention to the unintended consequences of payment reform policies and to ensure that they help to smooth the transition to the new payment model in the healthcare system. Thus, both availability and quality of the care will be sustained to be able to meet the needs of the population.
Impacts of the ACA and The Medicare Access and CHIP Reauthorization Act (MACRA) (2015) on the U.S. Health Care Ecosystem
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Affordable Care Act Overview
The Patient Protection and Affordable Care Act commonly known as the ACA was signed into law by President Barack Obama in 2010 (Zhao et al. , 2020). It started with solving such problems as high levels of the uninsured population, increasing healthcare costs, and inequalities in the quality of care. Obamacare or the Affordable Care Act is a healthcare law that seeks to expand the health insurance coverage, decrease the costs, and enhance the quality of care.
The Affordable Care Act is a bill designing the transformation of the American healthcare system with the help of several strategies. Measures such as offering health insurance marketplaces for individuals and small businesses, offering medical cover to more low income individuals and businesses, and protecting the consumer by banning exclusion on the basis of pre-existing conditions are crucial (Zhao et al. , 2020).
BHA FPX 4003 Assessment 1 The Affordable Care Act and Beyond
The Affordable Care Act (ACA) required the insured population to obtain health insurance and offered them essential health benefits that include preventive care services that are affordable or even free. This paper will also argue that through the ACA more people will be able to access quality healthcare services.
Zhao et al. (2020) mentioned that the Affordable Care Act (ACA) enhanced insurance status, reduced the rate of uninsurance, and offered healthcare services to individuals and families via the expansion of medicaid and the establishment of insurance marketplaces.
This paper focuses on the Medicare Access and CHIP Reauthorization Act (MACRA) (2015) The MACRA (Medicare payment reform act) of 2015 made a change to the payment systems of this programme. The optimization of a more sustainable and value based system of healthcare delivery is the purpose of its development. The Medicare Access and CHIP Reauthorization Act (MACRA) started a new payment system to encourage efficient and high quality health care replacing the Sustainable Growth Rate formula that determined Medicare physician payments.
MIPS and the Advanced APMs are critical in MACRA’s bid to reward physicians as it seeks to achieve its aim. In the study by Jones et al. (2019), MIPS assesses the quality of care delivery and the level of resource utilization by the healthcare providers. However, APMs support the new care models that involve risk and reward of payment to doctors on the basis of efficient and quality services.
It is necessary to note that the main idea of MACRA is to change the payment model of services provided under Medicare from fee-for-service to value-based care. MACRA aims at enhancing patient’s secession, integration of care and reducing costs through re-aligning the payment rewards with the quality and efficiency indicators (Jones et al. , 2019). Health care organizations are urged to adopt new payment methods that focus on the management of populations and on the value of services. It is the legislation that seeks to transform Medicare into a sustainable and patient focused system of MACRA.
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Effects on the United States Health Care Environment
To a large extent, MACRA was designed by the ACA. First and foremost, MACRA focuses on the value-based care and quality improvements of services, as the ACA does (Chernew et al. , 2020). The ACA also shifted the payment model away from the fee-for-service, with value-based purchase and ACOs.
Second, MACRA could depend on the technological framework that the ACA’s emphasis on health information technology and electronic health records provided (Chernew et al. , 2020). The legislation that is MACRA focuses on improving the quality of care delivered to patients with the help of EHRs and the ACA’s meaningful use provided the impetus for this goal.
The effects on American healthcare due to the ACA and MACRA are far reaching. The Affordable Care Act has brought about expansion of the insured population, reduction in the rate of the uninsured citizens, and improvements in preventive health care.
The ACOs as well as other ACA measures have been useful in improving the quality of healthcare as well as care coordination. Chernew et al. (2020) have pointed out that MACRA has encouraged the value-based payment and quality reporting through MIPS and APMs.
The ACA’s emphasis on early health care and insurance may encourage other endeavors towards the attainment of equal health care access and a decrease in health disparities (Chernew et al. , 2020). MACRA’s focus on value-based payment and the use of the alternative payment models creates a foundation for future work of alignment of the payment incentives with the obtained quality outcomes (Chernew et al. , 2020).
The newly released MACRA rules with an emphasis on interoperability and health information exchange are well positioned to address next generation of healthcare technology and data sharing thus laying down foundation for more coordinated and patient centered care delivery models.
Conclusion
The US healthcare system has a lot to look forward to owing to the ACA and the MACRA. These laws have completely shifted the system depending on the part of the world that one is from. Due to such rules, the system is prepared for the value-based care, more people can obtain it, and the uninsured population has decreased.
Value-based payment methods and responsible care organizations demonstrate how people are cooperating for the improvement of the healthcare system. Interoperability and health IT are two of MACRA’s new concepts connected to the reimbursement program.
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References
Abodunde, B., Slater, C., & Coustasse, A. (2020). MACRA and accountable care organizations. Journal of Ambulatory Care Management, Publish Ahead of Print (9).
https://doi.org/10.1097/jac.0000000000000350
Buchmueller, T. C., & Levy, H. G. (2020). The ACA’s impact on racial and ethnic disparities in health insurance coverage and access to care. Health Affairs, 39(3), 395–402.
https://doi.org/10.1377/hlthaff.2019.01394
Cheng, J., Kim, J., Bieber, S. D., & Lin, E. (2020). Four years into MACRA: What has changed? Seminars in Dialysis, 33(1), 26–34.
https://doi.org/10.1111/sdi.12852
Chernew, M. E., Conway, P. H., & Frakt, A. B. (2020). Transforming Medicare’s payment systems: Progress shaped by the ACA. Health Affairs, 39(3), 413–420.
https://doi.org/10.1377/hlthaff.2019.01410
Gruber, J., & Sommers, B. D. (2019). The Affordable Care Act’s effects on patients, providers, and the economy: What we’ve learned so far. Journal of Policy Analysis and Management, 38(4), 1028–1052.
https://doi.org/10.1002/pam.22158
Jones, R. T., Helm, B., Parris, D., Grubbs, S. S., Choy, H., & Kapetanovic, K. (2019). The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) made simple for medical and radiation oncologists. JAMA Oncology, 5(5), 723.
https://doi.org/10.1001/jamaoncol.2018.5631
Lantz, P. M., & Rosenbaum, S. (2020). The potential and realized impact of the Affordable Care Act on health equity. Journal of Health Politics, Policy, and Law, 45(5), 831–845.
https://doi.org/10.1215/03616878-8543298
Soylu, T. G., Goldberg, D. G., Cuellar, A. E., & Kuzel, A. J. (2020). Medicare Access and CHIP Reauthorization Act in small to medium-sized primary care practices. The Journal of the American Board of Family Medicine, 33(6), 942–952.
https://doi.org/10.3122/jabfm.2020.06.200142
Zhao, J., Mao, Z., Fedewa, S. A., Nogueira, L., Yabroff, K. R., Jemal, A., & Han, X. (2020). The Affordable Care Act and access to care across the cancer control continuum: A review at 10 years. CA: A Cancer Journal for Clinicians, 70(3).
