Affordable Care Act Abstract

The Affordable Care Act (ACA) represents a sweeping health care reform
that seeks to broaden access to health coverage for uninsured. ACA
modifies the non-group insurance market within the U.S by mandating that
most residents possess health insurance, which considerably broadens
public insurance and subsidizes private insurance coverage, increases
revenues from diverse new taxes, and minimizes and reorganizes spending
under Medicare. The paper seeks to answer the research question on the
impact of ACA on the quality of healthcare in the US.
Affordable Care Act
The core focus of the ACA centers on increasing health insurance
coverage and health care access for the citizens and legal immigrants.
The ACA attains these goals through several provisions including an
individual mandate, which demands that adults have health insurance. An
employer mandate, on the other hand, requires that firms with 50 or more
employees avail coverage or pay a fine. States should establish a health
insurance exchange or embrace federally established exchange where
individuals and small business can purchase coverage. ACA also makes
changes geared at cutting cost, and improving the delivery of care.
Various studies have projected that the Affordable Care Act is likely to
be successful when it comes to improving healthcare coverage and
quality. However, some studies on health outcomes for individuals who
received expanded Medicaid coverage has provided ambiguous results,
which make critics, argue that the ACA will not improve the healthcare
Studies demonstrate that lack of health insurance negatively influences
healthcare quality, which makes the expansion of access to care a
significant step in minimizing health disparities. Health insurance
coverage aids individuals to pay for critical health care services,
which in turn, minimizes financial barriers to care. Nevertheless,
health insurance coverage, by its own, is not adequate to guarantee
access since there must be adequate health care practitioners available
to avail services. ACA has played a major role in accelerating efforts
pursuing improvement on the healthcare quality. In addition to
broadening access to insurance, the ACA also details provisions to
enhance the quality of healthcare while controlling health care costs.
ACA can be regarded as one of the efforts to improve quality that
introduces multiple pay-for-performance programs to Medicare in an
effort to herald increased quality within the health care, and enhance
the value in the system. The implementation of ACA has guaranteed that a
majority of Americans has access to high-quality health care for all and
millions of Americans, as well as greater access to primary and
preventive services. The ACA lays a lot of emphasis on enhancement of
the quality of care in hospitals by minimizing complications from
infections. Initially, the demand that all Americans maintain bare
minimum coverage raised critical issues regarding the constitutionality
of such a requirement, especially in the face of the fact that those who
do not satisfy the mandate may be obliged to pay a penalty each month of
noncompliance. Although, some quarters have challenged the
constitutionality of the act, ACA has painted a brighter picture of the
future of small businesses. The ACA has provisions that make the
provision of health insurance very affordable for a majority of
business. The ACA will enable 83% of the presently uninsured small
business owners to gain eligibility for healthcare coverage.
The ACA provides a major opportunity for private companies to innovate
in the manner in which they provide healthcare to employees. Although,
the law is not perfect, it will make health care adequate, affordable,
and available. The new law makes health care affordable by: eliminating
limits on care and benefits and higher charges demanded people who are
sick. ACA also limits the amount that patients must pay in out-of-pocket
costs and deductibles, and aids people and families with low moderate
incomes to purchase health insurance (Silberman, 2013). ACA makes
healthcare provision easier to administer and easier to comprehend by:
ensuring that there is more information available: grouping health plan
as per level of coverage setting standard rules and, awarding patients
with new rights that they can use to appeal denied claims with the
ACA calls for the institution of health insurance marketplaces that will
render it easy to buy insurance coverage. In the article, Silberman
(2013) tracks the system changes that have manifested within last 3
years, coupled with the possible changes that the ACA will herald in the
areas of insurance coverage, quality of care, access to care, rising
health care costs, and overall population health. Silberman (2013)
estimates that, when enacted, ACA was projected to cover close to 33
million of the 60 million uninsured Americans by 2022. The issue of
the constitutionality of both the mandatory Medicaid expansion and the
individual mandate threatened to derail the implementation of ACA
nevertheless, the Supreme Court also ruled that the mandatory expansion
of Medicaid to cover low-income adults unconstitutional, especially with
regard to being coercive to states. The Supreme Court decision
stipulated that states could not be coerced to broaden Medicaid hence,
the expansion of Medicaid is up to the states.
ACA seeks to exploit the potential of guided care model in an effort to
improve the quality of care and life and life of patients suffering from
multiple chronic conditions. Guided Care represents a practical,
interdisciplinary model of health care designed to enhance the quality
of life and efficiency of resource use for patients diagnosed with
medically complex conditions (Bruce & Tracy, 2011). This approach seeks
to avail coordinated, patient-centered, cost-effective care, which is
likely to deliver benefits such as reduced caregiver burden, improvement
of physicians’ professional satisfaction, and reduction in healthcare
costs (Bruce & Tracy, 2011). According to Bruce & Tracy, guided care
patients are twice likely to rate an improvement in their care compared
to patients in the control group (2011).
According to Liang and Mackey (2011), the rapid changes within the
health care policy that have embraced quality and safety mandates have
yielded to programs and initiatives under ACA. Such reforms within the
health care focus on consumerism within the context of price. Quality
and safety efforts, in this case, can be structured through the use of
financial incentives, new delivery models, and best-practices research,
which focus on attaining benchmarks, while at the same time minimizing
costs. The future of healthcare reform and the associated initiatives
are likely to witness a shift in the paradigm of medicine that
integrates quality and safety measurement with financial incentives, and
fresh emphasis on consumerism (Liang &Mackey, 2011).
The implementation of the ACA has significantly impacted on how
employers plan for and provide health insurance to their employees.
The ACA surpasses Employee Retirement Income Security Act (ERISA) in
complexity, overall impact, and the number of requirements (Longobardo,
2013). The ACA will alter almost all elements of the provision of group
health benefits to employees, and also changes the manner in which
employers strategically integrate benefits into a total compensation
package (Longobardo, 2013). Employers, insurance companies, and
providers of health care should work collectively so as to maintain the
private sector health care system, which necessitates maintaining costs
affordable for employers and individuals while simultaneously improving
the quality of care. Longobardo contends that the intention of the ACA
is benevolent in its pursuit to avail affordable health insurance for
all (2013). This ensures that the all the players have an equal platform
across the health insurance industry and the health care delivery system
lowers insurance costs, enhance access to providers, cover the
uninsured, and demand employers to ensure that employees have access to
affordable coverage (Longobardo, 2013).
Brody & Sullivan-Marx argues that no one (including policy makers,
providers, health care professionals, and consumers) can accurately
predict the status of health care services in the coming five years
(2012). Although, the legislation has instituted measures to increase
access to care and generate opportunities for quality, efficiencies,
innovations, and preventive services, it is up to all stakeholders to
shape the future for care. Therefore, all stakeholders, including
geriatric nurses, to understand the changes in the health care law,
which possesses the biggest impact on healthcare practitioners and
patients. This will ensure that the stakeholders can effectively
advocate the best interest of the patients. Statistics indicate that the
49 million Americans who are presently uninsured will be cut by half
following the 2014 implementation of the efforts such as an individual
mandate, broaden in Medicaid eligibility, and safeguard insurers from
declining coverage or charging higher fees based on health status.
The ACA is projected to expand health-care choices and possibly increase
convenience and timelines for care for veterans, but the increase in
health-insurance options can also yield to fragmentation, diminish
continuity and coordination of care, yielding to increases in the
emergency department use, diagnostic interventions, and
hospitalizations. Private practice physicians may be unwilling to treat
conditions that are prevalent among veterans, which may potentially
yield to a reduction in the use of facilities, which in turn, endangers
volume-sensitive services such as intensive care. Physicians are likely
to pay much attention to maintaining a high-value-based payment
modifier, which may distract them availing proper care. Physicians are
also likely to increase their patient volume in an effort to maintain
the income, which carries the potential of compromising quality of care
for patients.
Critics argue that the pay-for-performance model is not the most
effective means to improve the healthcare quality. Past evidence
indicates that such a strategy is ineffective in improving outcomes,
irrespective of its moderate impact on process adherence. The program
awards incentives for hospitals to focus on enhancing their performance
scores devoid of enhancing the quality of patient care. The narrow focus
is likely to make hospitals direct resources and narrow areas of care,
which may reduce the level of improvement within other areas of need.
The critics propose that reforms of Medicare should be market-driven so
as to reward players in the system to strive towards high-quality,
lower-cost care.
The core components of the ACA encompass: wide-ranging private health
insurance regulatory reforms, especially in the small and non-group
markets reductions within the cost-sharing linked to recommended
preventive care. Other components encompass tax credits extended to the
smallest-wage employers for the purchase of health insurance, demand
that non-elderly individuals enroll for health insurance coverage, and a
wide range of initiatives for minimizing costs in the Medicare program.
The experience on health care “reform” is still unfolding, and it
would be premature to state whether it is a success or failure, or a
combination of the two. The ACA carries high potential in broadening
coverage to a majority of uninsured Americans, invest heavily in
prevention, and enhance the quality of care. In addition, ACA is likely
to yield to enhanced quality of care, minimize waste, and improve
collaboration between health care practitioners.
Brody, A. & Sullivan-Marx, E. M. (2012). The Patient Protection and
Affordable Care Act: Implications for Geriatric Nurses and Patients.
Journal of Gerontological Nursing, 38 (11): 3-5.
Bruce, L. & Tracy, V. (2011). It Takes a Team: Affordable Care Act
Policy Makers Mine the Potential of the Guided Care Model. Generations,
35(1), 60-63. 
Liang, B., & Mackey, T. (2011). Quality and safety in medical care: what
does the future hold?. Archives Of Pathology & Laboratory Medicine,
135(11), 1425-1431.
Longobardo, V. (2013). How the patient protection and Affordable Care
Act will affect employers. NCMJ, 74 (4): 321-323.
Silberman, P., Cansler, L., Goodwin, W., Yorkery, B.,
Alexander-Bratcher, K., & Schiro, S. (2011). Implementation of the
Affordable Care Act in North Carolina. North Carolina Medical Journal,
72(2), 155-159.