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In your response to at least two peers, discuss what additional difficulties you see in with implementing the revised ACA components addressed in their post. Respectfully agree or disagree with the consequences identified for patients.

PEER 1-CS

Previous to the ratification of the ACA in 2010, the cost of healthcare was at a continuously increasing with stagnant or in some instances decline in the quality and effectiveness of the care being received. The main goals of the ACA were to ensure that the uninsured, underinsured, young adults, and those with pre-existing conditions had access to affordable healthcare insurance options that they previously had been able to obtain due to costs or denial. Some of the components that assisted in obtaining these goals were the expansion of those eligible for Medicaid, mandates on offering insurance for companies of a certain size, requirements and fines for those who are not insured, and the extension for children to remain on their parents insurance until the age of 26 (Goldsteen, Goldsteen, Goldsteen, & Jonas, 2017). A few top reasons critics state reform is needed on the current ACA law are the individual mandate and the unrealized pressures on the medical community. The individual mandate is a sticky one since the government as they are mandating enrollment for individuals, collecting money from them if they enroll, and still collecting money from them via a fine if they do not enroll in an insurance program. Additionally, there has been research that states if the individual mandate went away then 12 million people would not have insurance, however the majority of those would be younger and healthier individuals. This mandate is forcing people to pay for a service that they do not need (Rand Corporation, n.d.). Another effect of ACA has been the increased number of insureds which can be compared to the number of physicians available to treat patients. With the cost of healthcare being so high, some of our sickest population deters getting treatment as they fear the financial burden. With the estimated $20 million newly insured people the access to care is taking some of that potential burden away. In 2016 the AAMC believes that the shortage of physicians by 2025 could reach up to 94,700 with a high concentration being the in the surgical specialty area of expertise. The increase of covered insureds and the influx of baby boomers reaching retirement age for which many ailments are starting to emerge the shortage of physicians may cause significant wait times for treatment which could reduce the quality of care AAMC, 2016).

Association of American Medical Colleges (AAMC). (2016, April 5). New Research Confirms Looming Physician Shortage. Retrieved from https://www.aamc.org/newsroom/newsreleases/458074/2016_workforce_ projections_04052016.html Goldsteen, R. L., Goldsteen, K., Goldsteen, B., & Jonas, S. (2017). Jonas introduction to the U.S. health care system. New York, NY: Springer Publishing Company, LLC Rand Corporation. (n.d.). The Future of U.S. Health Care: Replace or Revise the Affordable Care Act? Retrieved on April 18, 2019 from https://www.rand.org/health-care/key-topics/health-policy/in-depth.html

 

PEER 2-RW

  The Affordable Care Act, ACA, has attempted to address deficiencies in the US Healthcare system that have existed since the 20th century. In particular, the cost of out-of-pocket expenses for prescriptions to the public have sharply increased. Hit particularly hard are the Medicare and Medicaid population. ACA cost containment component aims to provide solutions to this ongoing issue. Another original ACA component that is aimed to provide a benefit is the Prevention and Wellness Program strategy. In attempting to reduce rising healthcare costs and create a healthier nation, new incentives and improving existing wellness programs will strengthen consumer health and address health disparities.

         Revisions made to address the gap in Medicare drug coverage in 2011 required pharmaceutical companies to provide discounts up to 50% on brand name Rx’s and federal subsidies for generic Rx’s filled during the gap period with Medicare Part D (coverage for Rx’s). January 1, 2013, saw federal subsidies start to include brand name Rx’s.   This helped the already financially limited Medicare & Medicaid participants.

 

On June 28, 2011, CMS announced that nearly 500,000 people had received a discount on their brand-name prescription drugs, with an average savings of $545 per beneficiary. As of August 4, 2011, 900,000 Medicare beneficiaries who hit the prescription drug doughnut hole received a 50 percent discount on their prescription drugs. (KFF, 2013).

 

         The National Strategy for the Prevention/Wellness program component of the ACA saw changes that increased the maximum permissible rewards such as premium discounts and waivers of cost-sharing requirements for employer-based wellness programs from 20 to 30% of the cost of health coverage and further increased the maximum reward to as much as 50% for programs that developed to prevent and reduce tobacco use. This change in reward incentivized workplace health programs to promote and provide annual health screenings, immunizations, and healthcare.  It made access to healthcare easier for employees when provided in the workplace.  

 

References:

 

 

Kaiser Family Foundation. (July 8, 2013). Health Reform Implementation Program, 2011 Provision in years.

      Retrieved from https://www.kff.org/interactive/implementation-timeline/