The Affordable Care Act’s health insurance marketplaces make it simpler and more cost-effective for people to buy private coverage, and allow young adults to remain on their parents’ policies up until age 26.
The Affordable Care Act also fully implemented Medicare’s pay-for-performance programs, which adjust hospital payments based on quality measures and provide incentives to doctors to be more cost effective.
How Does the ACA Affect Health Care Quality?
The Patient Protection and Affordable Care Act (ACA), passed in 2010, is an unprecedented law to expand health insurance coverage to millions of Americans while reforming the marketplace for insurance plans. Notably, all plans must cover preventive services; lifetime and annual dollar coverage limitations were banned; preexisting condition exclusions were limited and young adults could remain covered up to age 26 without losing coverage through their parents’ plans.
The Affordable Care Act also mandates all insurance providers to disclose prices and benefits through the healthcare marketplace to their consumers, in an attempt to reduce individual healthcare costs while simultaneously improving healthcare quality – cost savings could result in changes to healthcare delivery methods; this remains undetermined at present.
The 80/20 Rule
Most businesspeople are familiar with the “80/20 rule”. This principle states that a small percentage of inputs produce most of their effects; for instance, one customer could account for most sales or one feature may require extra time and effort when developing software applications.
Similar to its counterparts, the Affordable Care Act targets patients who consume 80 percent of healthcare resources through initiatives like accountable care organizations and bundled payment reforms.
Another key aspect of the Affordable Care Act (ACA) is its requirement that insurance companies adhere to a minimum standard for spending on health care; failing this standard, they must refund some portion of consumers’ premium dollars back as rebates.
Expansion of Medicaid
An essential aspect of the Affordable Care Act was its expansion of Medicaid, providing health coverage to individuals whose income falls within 133% of federal poverty line. This change has had numerous ramifications on both health and economic outcomes.
Studies have confirmed that the Affordable Care Act’s Medicaid expansions help lower-income Americans access quality healthcare, thus improving their health and lowering mortality from preventable causes of death while also saving states money by decreasing spending on uncompensated care (Borgschulte and Vogler 2020).
Evidence also points towards the Affordable Care Act’s Medicaid expansions having non-medical benefits and increasing well-being. For example, Michigan, where Medicaid was expanded, has more poor adults seeing regular doctors for annual checkups compared to those not enrolled in Medicaid.
The Patient Protection and Affordable Care Act
The Act includes immediate actions that set forth federal standards for insurers operating in both individual and small-employer group health insurance markets (with some limited exceptions not pertinent to this article). Furthermore, it requires temporary high risk pool programs, reinsurance arrangements and transition to an American Health Benefit Exchange.
The Affordable Care Act also lays down standards designed to foster competition and consumer choice, prohibiting discrimination based on health status or preexisting conditions. Furthermore, it mandates the Secretary to create a National Strategy for Quality Improvement in health care services, patient outcomes and population health which includes measuring performance against comparative effectiveness data and reporting this back.
Under this Act, it is required of the Secretary to award grants to state offices offering consumer assistance programs or health ombudsman programs.
Since its passage, the Affordable Care Act (ACA) has led to significant advancements in both insurance coverage and health care quality. It has strengthened consumer protections while emphasizing wellness programs; reduced unnecessary spending; and enhanced the efficiency of health care delivery. But it has fallen far short of achieving its ambition of providing universal and cost-effective health care coverage. Before that time arrives, we must continue promoting pragmatic proposals to enhance affordability and market stability, such as premium tax credits, cost sharing reduction subsidies, and actuarial value requirements. These and other reforms will make insurance more accessible, secure, and affordable for Americans. In the meantime, we must also work to defend what progress has been made under the ACA; protecting those gains is vital if we want universal coverage at an affordable cost to become reality.