The Patient Protection and Affordable Care Act (ACA) also known as Obamacare, was designed to achieve lower cost, better quality health care for more people. Change has been driven by several factors; chronic diseases are now the leading cause for death in the United States, the Baby Boomers are now at least sixty- five and many of them have at least one chronic condition. Increasing costs in healthcare without coinciding quality healthcare has also driven change in healthcare (Salmond & Echevarra, 2017). With access to healthcare suddenly given to so many more people, is the ACA worth it overall?
The Affordable Care Act was passed as a law on March 23, 2010 to be fully implemented on January 1, 2014 (Rosenbaum, 2011). It was designed to provide access to healthcare coverage to more people at a fair price. Families or individuals whose income is a certain percentage below the Federal Poverty Level (FPL) will receive a subsidy to assist with offsetting the cost if the annual insurance premiums. A Prevention and Public Health Trust Fund was established to finance community investments that will improve public health (Rosenbaum, 2011). Medicaid coverage was going to be expanded with the implementation of the ACA, but the Supreme Court decided to make it optional. As of January 1, 2014 only 25 states and the District of Columbia expanded their Medicaid coverage (Angier, Hoopes, Gold, Bailey, Cottrell, Heintzman, Marino & DeVoe, 2015). Medicaid coverage is good for the patient, but the payments to the providers are not (Silvers, 2013).
With the enormous increase in people now having access to healthcare that did not previously have access, there may be an increase in patient volume at the primary care clinics which already have a high volume of patients. With some of the insurance plans being high deductible plans, some patients will not be able to afford the payment necessary to see a physician in their office, where payment is required at the time of service. Many of those patients will go to the nearest emergency department for non-emergent illnesses, where they can be seen without payment upfront. This will lead to increased patients and wait times, additional stress on the hospital staff trying to care for them, and the patients potentially getting a large bill from the hospital due to the insurance company refusing to pay as much as the hospital wants or not paying anything because the illness was not emergent. Emergency departments are required by law to see anyone that presents to them so they can’t turn patients away.
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One factor in determining whether or not the ACA is worth it is the increase or decrease in the number of uninsured community health center (CHC) clinic visits from before the Medicaid expansion and after the expansion. A study was conducted and data was analyzed from 156 clinics in the OCHIN practice-based research network, with a shared electronic health record, located in 9 states (5 expanded Medicaid coverage and 4 did not). 333,655 non pregnant adult patients and their 1,276,298 visits were included in this study. It was observed that the states that expanded Medicaid in 2014 had a significant decrease in uninsured CHC visits and the states that opted not to expand Medicaid had maintained a high rate of uninsured visits (Angier, et al., 2015).
Without a doubt, the ACA has changed the healthcare system in the United States, and will continue to do so in the coming years. It is not known if higher value care will be provided efficiently and in the best location at a reasonable price. Within the health insurance market there will be more competition (Silvers, 2013). The full value of the ACA will not be known for a few more years. The answer to the question is “It worth it? “needs more time to be answered.
References
- Angier, H., Hoopes, M., Gold, R., Bailey, S. R., Cottrell, E. K., Heintzman, J., Marino, M., DeVoe, J. E. (2015). An early look at rates of uninsured safety net clinic visits after the Affordable Care Act. Annals of family medicine, 13(1), 10-6. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4291259/
- Rosenbaum S. (2011). The Patient Protection and Affordable Care Act: implications for public health policy and practice. Public health reports (Washington, D.C.: 1974), 126(1), 130-5. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001814/
- Silvers J. B. (2013). The Affordable Care Act: objectives and likely results in an imperfect world. Annals of family medicine, 11(5), 402-5. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3767707/
- Salmond, S. W., & Echevarria, M. (2017). Healthcare Transformation and Changing Roles for Nursing. Orthopedic nursing, 36(1), 12-25. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5266427/
