Healthcare Reform Literature review

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ReformingoftheUSHealthcareSystem.pptx

Reforming of the U.S. Health Care System

Overview

The United States needed to reform health care because the cost was too high.

The rising of health care costs threatened to consume the entire federal budget.

It made the cost of preventive care unaffordable. That sent many low-income people to the emergency room, raising costs even higher.

High costs made the U.S. health care system cost twice as much per person compared to any other developed country.

The impact of the Health Reform in the Hispanic Community

Hispanics make up the most substantial and fastest-growing minority group in the U.S.

Hispanics live longer and have lower death rates from heart disease, cancer, and many of the other leading causes of death than non-Hispanic white residents

Despite having social disadvantages, including lower incomes and worse access to health coverage.

The new health reform law will significantly expand access to affordable health coverage which is especially important for “Latinos”. In 2008, nearly 31 percent of “Latinos” were uninsured compared to a national average for all racial and ethnic groups of 15 percent and 11 percent for non-Hispanic whites.

Affordable Care Act

Other Names

Patient Protection and Affordable Care Act – (Officially)

Obamacare – (commonly known)

Primary goals:

Make affordable health insurance available to more people.

Expand the Medicaid program to cover all adults with income below 138% of the federal poverty level. (Not all states have expanded their Medicaid programs.)

Support innovative medical care delivery methods designed to lower the costs of health care generally.

Health Reform Actions

Expanding Medicaid

Medicaid coverage was expanded to cover children and adults with incomes up to 133 percent of the federal poverty level—roughly $14,403 for an individual and $24,352 for a family of three in 2010.

This Medicaid expansion provided coverage to many Latino individuals and families.

Health reform increased funding to the Territories, such as Puerto Rico

Health Reform Actions

Create New Marketplaces

The creation of a state health exchanges for individuals who do not qualify for Medicaid or who cannot get affordable coverage from their employer started in 2014.

These exchanges allowed individuals to shop for insurance and compare prices and benefits.

To ensure the affordability of the health insurance, the law provided refundable tax credits to offset a portion of the cost of health insurance premiums.

Health Reform Actions

Eliminates Discrimination Due to Pre-Existing Conditions

The health reforms offered protection to individuals who have pre-existing conditions today, as well as to those who are healthy, but who may develop a health problem in the future.

No individual with a pre-existing condition will be denied coverage, charged a higher premium, or sold a policy that excludes coverage of essential health benefits, just because she or he has a pre-existing condition.

Pre-existing conditions – DM, Ca, HTN, HF, Obesity, CRF, HIV

Health Reform Actions

Increases Funding for Community Health Centers

Community Health Centers play a critical role expanding access of health services to communities of minorities or ethnic groups.

Typically located in medically underserved areas, community health centers provide culturally and linguistically appropriate care to all residents regardless of insurance status, citizenship status, or ability to pay.

Between 2011 and 2015, the health reform law provided $11 billion to community health centers for services, construction and renovations.

Community Health Centers play a very important role giving access to care to our most vulnerable populations.

Health Reform Actions

Improves Data Collection

It is well known that disparities in health exist across racial and ethnic minority groups, but there are limited coordination, documentation, and analysis of data that examine the nature of health disparities by race and ethnicity.

Collecting and reporting these data are crucial for identifying and monitoring the health problems that exist among vulnerable populations and for developing the proper solutions to eliminate disparities in these communities.

The health reform law collect and report data by race, ethnicity, sex, disability, and the primary language of participants for all federally conducted or supported health care or public health programs.

Health Reform Actions

Improves Data Collection (cont.’)

It is crucial for identifying and examining variations between subpopulations, especially ethnic minorities.

It will help to generate reliable estimates of populations for surveillance, research, and analysis purposes.

Data and analyses will also be available to agencies within the Department of Health and Human Services (HHS), as well as to other federal agencies, nongovernmental organizations, and the public.

Promotes Culturally and Linguistically Appropriate Services Effective communication among patients, health care providers, and insurance companies.

Health Reform Actions

Supports Community Health Workers

Community Health workers provide a link between members of the community and health care services. They provide information and resources in a culturally appropriate manner.

The law provides funding for training, supervision, and support of community health workers.

Health Reform Pros and Cons

Health Care Reform

It is essential to remember that the Affordable Care Act is not the only process of reform to consider.

Since the 1970s, many of the world’s developed nations have reformed their health care in numerous ways.

The goal is to improve care access.

References

Estes, C. L, Chapman, S. A., Dodd, C., Hollister, B. & Harrington, C. (2013). Health Policy: Crisis and Reform. (6th Ed). Boston: Jones and Bartlett Learning

https://www.govinfo.gov/content/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf

https://www.healthcare.gov/glossary/affordable-care-act/

PROS’ CONS’

1. Reforms attempt to address deficiencies

within the system

1. It may create negative results instead of

positive results

2. It can reduce health care costs 2. There is always a financial cost to pay for

reforms

3. Health care reform change which services

are received

3. Reforms tend to gut the existing systems

that are in place

4. Reforms allow people to manage their

expenses wisely

4. Health care reforms tend to cost more at the

individual level over time

5. It allows for continued access to the health

care market

5. It changes the structure of how care is

delivered

6. Reforms can change who is permitted care

access under specific plans

6. Reforms create uncertainty

7. It can remove benefit expirations 7. It may create penalties to keep people in

compliance

8. It may improve medication access 8. Health care reforms take a lot of time to

implement

9. Reforms can change the access point for

care received