Key Provisions under the Affordable Care Act
The Affordable Care Act or “Obamacare” was designed to assure that all Americans regardless of health status have access to affordable health insurance. The Affordable Car Act was signed into law March 23, 2010. The primary goal of this act was to decrease barriers for obtaining health care coverage and allow Americans to access needed health care services. After the legislation is fully implemented in 2014, all Americans will be required to have health insurance through their employer, a public program such as Medicaid and/or Medicare or by purchasing insurance through the health insurance marketplace exchange. I will identify three parts of The ...view middle of the document...
If an individual has a heart disease for example, this new provision allows them to obtain coverage at no additional cost. So now, insurance companies must give that patient coverage in addition to covering all of their medical expenses. I believe that this is a great arena to allow all Americans regardless of health status to receive medical care and quality of services. The purpose of this provision was to allow people with disabilities and /or illnesses to obtain health insurance they otherwise could not afford.
Why did insurance companies charge these individuals with higher rates prior to the Affordable Care Act in the first place? The answer is simply higher cost. Individuals with pre-existing conditions drive up cost for “healthy” populations. It is known that individuals with higher needs will use the system more. Someone has to pay for rising cost and since individuals with pre-existing conditions are expected to incur more medical costs, they are more likely to seek medical insurance. Insurance companies argue that this could acquire a behavior known as “adverse selection.” Adverse selection simply means that a selection of high-risk consumers on an insurance plan will need greater degrees of coverage than average. With the new provisions of Obamacare, insurance companies are now restricted from denying coverage. They are now required by law to follow certain guidelines when providing coverage to individuals with pre-existing conditions.
Volume to value shift in payments
The Affordable Care Act proposed a new provision that would pay physicians on value rather than volume. This specific portion of the Act is effective as of January 1, 2015, which allows physicians time to make the proper shifts. The Affordable Care Act includes a number of provisions designed to encourage improvements in patient quality of care. Greater incentives are given to hospitals, physicians and health care groups based on quality measures. They will now receive payments from the quality of care they provide to their patients. Those with higher based value will receive higher payments than their counterparts. I think this is very important because the healthcare system has been volume driven for so long that quality healthcare has been an issue for quite some time. In addition to value, this would definitely improve quality and efficiency needed for better patient outcomes.
Why is the healthcare system shifting from volume to value based? Why change the requirements now? Well, the traditional fee for service system allowed providers to receive higher pay based on higher patient admissions. It is understood that just because more patients come to you for care does not necessarily mean that they are getting the best care. In fact, providers with increased patients may not be able to give each patient the highest level of care due to heavier workloads and increased patient traffic. The fee-for-service system allows providers to receive payments based on the...