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Affordable Care Act and Medicaid Funding
The Affordable Act (ACA) of 2010 expanded Medicaid to ensure it catered to all Americans below 65 years. The family income of those covered had to be at or lower than 138% of the government’s poverty guidelines. The Act assisted in ensuring that more childless adults could benefit from Medicaid. People who became eligible for Medicaid thanks to ACA would be guaranteed full federal financing. The Act seeks to grow the number of persons with health insurance through the provision of different premium tax credits. The premium tax credits will make it easy for Americans to buy private health insurance. ACA helps to eliminate preexisting condition exclusions as well as establish yearly limits related to out-of-pocket costs. The Act is a watershed public health policy consisting of laws that provide a legal context for the country’s healthcare system.
Issues Facing Each Level of Government
The Supreme Court ruled, in June 2012, that states could not be forced to expand their Medicaid eligibility. The federal government agreed to cover the full costs of expanding Medicaid for the first three years and 90% after that. However, only 26 out of the 50 states chose to expand Medicaid (Rice et al. 899). The move meant that nearly half of newly eligible residents could not enjoy Medicaid coverage. Leaders from 23 states argued that they would not expand Medicaid because it would result in a highly indebted government. As a result, it would be difficult for these states to fulfill their promises of subsidizing the future costs of state-level expansion. The increase in medical expenditure by states has been low in the last three years. States may have found it hard to regulate costs as hospitals and physician groups collaborate to expand their market power when negotiating with insurers (Rice et al. 899). The quality-improvement initiatives brought forward by ACA come with a reduction in reimbursements. Lastly, ACA faces political unsustainability due to continued opposition from Republicans.
Reasons for Initiating Changes to the Policy
Several reasons existed for the initiation of changes to the policy. The changes included the addition of provisions that would directly affect Medicaid. The ACA was meant to expand the number of people that had access to health insurance (The National Conference of State Legislatures 1). The expansion was made possible through the provision of premium tax credits to allow people to buy private health insurance with ease. The reforms also affected the private insurance market. The preexisting condition exclusions were eliminated while the yearly limits on out-of-pocket expenses were implemented. The changes enabled young adults to be covered by the insurance plans of their parents until they attained 26 years. Additionally, people were required to have minimum essential coverage. The provisions called for the maintenance-of-effort to prevent states such as Texas from reducing peoples’ eligibility for Medicaid. Last but not least, the ACA contained provisions to streamline enrollment, renewal, and eligibility processes.
Options to be considered
The reforms have to consider several options to streamline the healthcare sector in the United States. The provisions must create premium as well as cost-sharing subsidies and establish new rules to govern the industry. New health insurance purchasing markets must be created, and the health insurance coverage made a legal expectation for the population. The health insurance coverage must be strengthened and complemented with the development of new and cheap health insurance market. As a result, people and families who do not enjoy affordable employer coverage or minimum essential coverage. The states such as Texas have the responsibility to secure the legally guaranteed coverage. It may not be possible to ensure the success of Medicaid in the absence of an attendant coverage obligation.
Pros and Cons of Each Reform
ACA helps to make preventive care free, meaning the population can receive treatment eliminating the need for emergency room services. As a result, the policy helps to slow the growth in health care costs (The National Conference of State Legislatures 1). The provision of free preventive care may result in the loss of employment-based health insurance. Children can be covered by the health insurance plans of their parents until they reach 26 years. It means that insurance companies will earn more profit as they will keep receiving premiums from healthy members of society. However, the increased insurance coverage will raise the overall health care expenses in the short run.
The Best Option Moving Forward
Several features of ACA, such as Medicaid expansion, health insurance exchanges, and accountable care organizations, are works in progress. The state and federal governments have to streamline these features for the policy to have a positive, lasting impact on the population. The political class of the country has to work together to ease the legislation or implementation of policies (Rice et al. 901). ACA needs to implement stringent spending controls to govern the health sector. Lastly, the United States has to introduce substantial federal or global budgeting measures to control the supply of technologies and providers.
Conclusion
The healthcare sector continues to evolve due to regulatory and legal changes. These changes arise from reforms in health legislation such as the ACA. The ACA helps to ensure that previously ignored groups benefit from expanded Medicaid. The program intends to grow the number of Americans with health insurance. As a result, health facilities need to maintain due diligence when implementing the provisions found in the Act.
Works Cited
Rice, Thomas, Unruh, Lynn, Rosenau, Pauline, Barnes, Andrew, Saltman, Richard, and Ewout
van Ginneken. “Challenges Facing the United States of America in Implementing Universal Coverage.” Bull World Health Organ., vol. 92, no. 12, 2014, pp. 894-902.
The National Conference of State Legislatures. Medicaid and the Affordable Care Act. The
National Conference of State Legislatures, 2011, https://www.ncsl.org/documents/health/HRMedicaid.pdf. Accessed 28 Apr. 2020.