How will the ACA change the health care delivery system?
How the ACA Will Change the Health Care Delivery System - The Impacts of the Affordable Care Act on Preparedness Resources and Programs - NCBI Bookshelf Key features of the Affordable Care Act (ACA) are access to health care through expanded coverage, improved quality and efficiency and lower health care costs, and consumer protections.
How does the Affordable Care Act (ACA) affect hospitals?
And starting in 2015, hospitals with a high rate of preventable hospital-acquired conditions were also subject to reduced payments under a provision of the ACA. Both of these measures encourage patient safety and quality control in hospitals, along with better utilization of the tax dollars that fund Medicare.
What is the difference between Medicaid and the ACA marketplaces?
The ACA specified Medicaid as the mechanism to insure low-income individuals and Marketplaces as the mechanism to insure those closer to the middle of the income distribution.
Will the Affordable Care Act change Medicare?
In the end, the Affordable Care Act prevailed, and the federal government quickly prepared to unroll a raft of changes and improvements to Medicare.
How has the Affordable Care Act affected health care delivery in the US?
The ACA has helped millions of Americans gain insurance coverage, saved thousands of lives, and strengthened the health care system. The law has been life-changing for people who were previously uninsured, have lower incomes, or have preexisting conditions, among other groups.
How does the ACA affect the US health care system and Medicare?
The ACA reduced the annual increases in payments to hospitals under the traditional Medicare program. It also reduced payments to Medicare Advantage plans. Partly because of these measures, increases in Medicare expenditures have been 20 percent lower than projected since the law was enacted.
How did the ACA affect care delivery and what was the impact on nursing?
The groundbreaking Patient Protection and Affordable Care Act (ACA) compels nurses to continue innovation, transformational leadership, and care coordination as major stakeholders in provision of the next generation of cost containment, quality advances, and patient access improvements.
Will the Affordable Care Act improve healthcare delivery system in the US?
A second report examined the ACA's reform to the U.S. health care delivery system. The ACA has reduced the number of uninsured people to historically low levels and helped more people access health care services, especially low-income people and people of color.
What are the effects of the Affordable Care Act?
The ACA enabled people to gain coverage by 1) expanding the publicly funded Medicaid program to cover adults with annual incomes up to 138% of the federal poverty level; 2) establishing the Health Insurance Marketplace for individuals and small businesses, allowing them to purchase private health insurance (PHI); and 3 ...
What are the problems with the Affordable Care Act?
The Problem: Affordability The ACA set standards for “affordability,” but millions remain uninsured or underinsured due to high costs, even with subsidies potentially available. High deductibles and increases in consumer cost sharing have chipped away at the affordability of ACA-compliant plans.
How does ACA affect nursing care?
The Affordable Care Act and Its Impact on the Nursing Profession. The ACA places a greater focus on outcomes, with more pressure on nurses to show they can give effective care. This means the demand for advanced practice nurses (APNs) and nurse practitioners (NPs) has also increased.
How can nurses influence the costs and delivery of health care services?
Another way nurses can help influence organization costs is by advocating against unnecessary treatments or medications. For example, nurses can be diligent at documenting and reporting symptoms and patient progress which would help clinical decision-making by physicians.
How has the Affordable health care Act impacted the nursing profession?
Clearly, a lot has changed since the inception of the Affordable Care Act. New reward systems that track quality indicators, new ways of measuring in-hospital quality of care, increased collection of patient-centered feedback, and new methods of care transition for patients have reshaped the nursing field.
What Effect Will health care reform have on health care services in the United States?
We estimate that, on net, the combination of provisions in the new law will reduce health care spending by $590 billion over 2010–2019 and lower premiums by nearly $2,000 per family. Moreover, the annual growth rate in national health expenditures could be slowed from 6.3 percent to 5.7 percent.
How has the Affordable Care Act improved public health?
The ACA addressed public health goals in three ways: It expanded public health capacity by establishing new programs and structures that focused on public health objectives and enhanced funding for existing programs; it increased access to clinical preventive services; and it provided new incentives for prevention and ...
What is one example of how the ACA will increase access to health care?
The Affordable Care Act will give all Americans, including LGBTQ+ Americans, improved access to health coverage through an expanded, stronger Medicaid program and new Affordable Insurance Exchanges, marketplaces for quality, affordable health insurance.
Why were people over 64 excluded from the ACA?
Individuals older than 64 years were excluded because the ACA was not intended to affect their health care coverage. Our sample starts in 2011 because this is the first year in which the BRFSS included cell phones in its sampling frame. A 2011-2016 sample period gives us 3 years of pretreatment data and 3 years of posttreatment data.
What effect did the third year of the health insurance policy have on the health insurance coverage?
We find that gains in health insurance coverage and access to care from the policy continued to increase, while an improvement in the probability of reporting excellent health emerged in the third year, with the effect being largely driven by the non-Medicaid expansions components of the policy .
How long did the Affordable Care Act last?
While the Affordable Care Act (ACA) increased insurance coverage and access to care after 1 (2014) or 2 (2014-2015) postreform years, the existing causally interpretable evidence suggests that effects on self-assessed health outcomes were not as clear after 2 years.
How many variables are used in the outcome of a health care study?
We utilize 9 outcome variables. The first 3 relate to access to care: indicators for any health insurance coverage, having a primary care doctor, and having any care needed but foregone because of cost in the past 12 months. The remaining outcomes relate to self-assessed health status. These include dummy variables for whether overall health is good or better (ie good, very good, or excellent), very good or excellent, and excellent, as well as days of the last 30 not in good mental health, not in good physical health, and with health-related functional limitations. Subjective self-assessed health variables such as these have been shown to be correlated with objective measures of health, including mortality.31-33
Which states have expanded Medicaid?
Pennsylvania, Indiana, and Alaska expanded Medicaid in January, February, and September of 2015, respectively. Montana and Louisiana expanded Medicaid in January and July of 2016, respectively. States are classified as part of the Medicaid expansion treatment group beginning the month/year of their expansion.
Does the ACA affect mental health?
With respect to self-assessed health, we find that the ACA increased the probability of reporting excellent health and reduced days in poor mental health. In contrast, a recent article with only 2 posttreatment years found no evidence of gains in these outcomes despite also using BRFSS data and the same identification strategy.18The emergence of an impact on the probability of having excellent self-assessed health appears particularly gradual, as the effect of the full ACA was small and insignificant in 2014, 1.9 percentage points in 2015, and 2.7 percentage points in 2016. Improvements in self-assessed health at lower points of the distribution also emerge in 2016. Most of these gains appear to come from the non-Medicaid-expansion components of the law.
How does ACA help the health care system?
ACA promotes health and wellness for beneficiaries by emphasizing prevention, quality, and care coordination. It also benefits the families of Medicare beneficiaries by extending access to health insurance coverage to millions of uninsured individuals, and by protecting everyone against insurance company practices that deny health insurance coverage to people when they need it.
When did the Affordable Care Act become law?
Since the landmark Affordable Care Act (ACA) was signed into law on March 23, 2010, [1] it has increased access to needed health services, reduced costs and improved care for millions. Yet, as this progress continues and the law’s most impactful provisions near implementation, threats to the law continue, through repeal efforts, budget cuts and legal challenges.
Is the ACA good for Medicare?
As the Center has said since it was signed into law, ACA is good for Medicare and good for families that depend on it. It is saving older and disabled Americans thousands of dollars a year and strengthening the solvency of Medicare.
What did the ACA do to Medicare?
Payment reductions. The ACA reduced the annual increases in payments to hospitals under the traditional Medicare program. It also reduced payments to Medicare Advantage plans. Partly because of these measures, increases in Medicare expenditures have been 20 percent lower than projected since the law was enacted.
What is the impact of the ACA?
While evidence for the impact of the ACA’s payment and delivery system reforms is far from robust, some of the best evidence concerns the relationship between prices and costs throughout the health care system. The effectiveness of payment reductions in Medicare, for example, suggests that private payers could see similar savings if they are able to reduce prices.
What is an ACO?
An ACO is a voluntary organization formed by health care providers that agree to take responsibility for the quality and costs of care for a population of patients. Multiple studies suggest that ACOs have generated modest net savings of up to 2 percent for Medicare while maintaining or improving quality.
What is the ACA experiment?
Primary care. The ACA launched a number of experiments to strengthen the nation’s primary care infrastructure. While most of these experiments produced mixed results, the Independence at Home Demonstration, which provides intensive primary care for homebound patients, had the most promising results. Evaluations showed a significant decrease in emergency department visits and hospitalizations, increased patient and caregiver satisfaction, and a decrease in Medicare expenditures.
What is the positive outcome of the ACA?
The institutionalization of research and development at CMS through the Center for Medicare and Medicaid Innovation has been another positive outcome of the ACA. The program offers hope that CMS can learn from experiments in payment and delivery system reform.
What was the trend in healthcare in 2010?
Trends in cost and quality. From 2010 to 2017, annual average national per capita health care spending increased by 3.6 percent, a relatively modest amount by historical standards. Medicare spending also fell from 2010 to 2018. Although the ACA did not specifically target private sector spending, premiums for employer-sponsored insurance increased at a relatively modest annual average rate. Meanwhile, there were improvements on more than half of the measures that track quality of care. However, linking developments in the cost and quality of care to specific provisions of the ACA is challenging.
What is the Affordable Care Act?
The Affordable Care Act (ACA) launched potentially groundbreaking changes in how health care is paid for and delivered in the United States. In the second of two health policy reports for the New England Journal of Medicine, the Commonwealth Fund’s David Blumenthal, M.D., and Melinda Abrams reviewed the ACA’s major reforms in payment ...
How did the ACA affect healthcare?
The ACA’s coverage expansion in 2014 spurred a spike in spending, as would be expected. These provisions allowed millions of people to get health insurance through the exchanges and through Medicaid expansion. Health care costs increased by 5.3 percent in 2014, from a low of 2.9 percent in 2013. The Office of the CMS Actuary estimated that increased use of health care services accounted for nearly 40 percent of the increase in per-capita health spending. Health costs grew by 5.8 percent in 2015, and preliminary estimates by the Altarum Institute indicate a steady growth rate of 5.4 percent over 2015.
How did the ACA help Medicare?
The ACA provided a regulatory framework for containing costs in Medicare by setting a per capita target for spending growth and creating a 15-member Independent Payment Advisory Board (IPAB) to develop a plan to reduce spending if that target is exceeded. What the board can recommend is constrained: by law, it cannot raise premiums, reduce benefits, or increase cost sharing, meaning that their recommendations are mostly confined to cuts in provider payments. The board’s proposals become law unless Congress explicitly overrides them. Spending did not exceed per capita targets in the ACA’s first three years, and therefore IPAB was not triggered. The IPAB currently has no members, which reflects a congressional majority strongly opposed to its existence. IPAB has been targeted for repeal on a bipartisan basis and is not likely to survive as a cost containment mechanism.
How does the Affordable Care Act affect health care costs?
While the Affordable Care Act (ACA) has been largely defined by its coverage expansions, its authors recognized the need to include mechanisms to slow the growth of health care costs. The law’s provisions took aim at Medicare spending and to a lesser extent, factors that affect costs in the individual and group private market. To understand the law’s impact and potential to “bend the cost curve,” it is important to isolate the effects of the ACA from those attributable to the economic recession and recovery. Although the ACA’s future is in doubt, cost containment will remain a key ingredient of any health reform effort. In this brief, we discuss key ACA provisions and their effects on containing overall cost growth and the cost of ACA-related gains in coverage.
How many ACOs were there in 2015?
For example, the ACA promoted ACOs as both a quality improvement and cost containment mechanism. In 2015, more than 400 ACOs in the Pioneer ACO Model and the Medicare Shared Savings Program generated $429 million in savings, but bonuses paid to high-performing ACOs produced a net loss of $216 million. ACOs with more experience tend to perform better over time.
How did the ACA save money?
One of the most immediate and direct ways that the ACA produced savings was through reductions in provider payment updates and Medicare Advantage (MA) payments. Prior to the ACA, payments to MA plans were 14 percent higher than the cost of covering similar beneficiaries under the traditional Medicare program, according to the Medicare Payment Advisory Commission. The ACA reduced payments to MA plans over six years, and by 2016, payments to MA plans were just two percent higher than costs in the traditional Medicare program. Although critics were concerned that these cuts would mean that plans withdrew from the program, according to Kaiser Family Foundation, enrollment actually increased from 24 percent in 2009 to 31 percent in 2016. The payment reductions produced short-term federal savings of $68 billion between 2011 and 2016.
What is the ACA regulation?
These include a prohibition on lifetime and annual caps on coverage, a mandate to cover “essential health benefits,” premium rate review, and the Medical Loss Ratio (MLR) provision, which required insurers to provide a customer rebate if they spend too high a percentage of premium dollars on non-medical expenditures . It is difficult to tease out the countervailing effects of these regulations on health care costs, especially because the provisions affect the individual, small group, and large group markets differently.
What are some examples of ACA?
Some of the most prominent examples include the Hospital Readmissions Reduction Program (HRRP); Accountable Care Organizations (ACOs) through the Medicare Shared Savings Program and Pioneer Program; primary care medical homes; and bundled payment models. This emphasis on moving to value-based reimbursement dovetails with changes in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which mandated that Medicare move from fee-for-service to alternative payment models, such as those with risk-sharing arrangements or reimbursement tied to quality measures.
How did the ACA affect Medicare?
“The direct effects of the ACA on Medicare payments, Medicaid spending on the newly eligible, and federal subsidies for Marketplace coverage can be reasonably well described and understood. The Congressional Budget Office estimated the direct effects of these changes on the federal budget repeatedly throughout the past decade in projecting the costs of ACA repeal, and it found that the on-budget costs of greater coverage were larger than the payment-related savings in Medicare—although not by much per year in the context of overall health spending. Similarly, there were other major changes in health spending that observers can agree were not triggered by the ACA or that were at most distally related. These changes include innovations in drug therapies, which have a development pipeline as long as or longer than our experience with the ACA to date; higher deductibles for consumers; and higher reimbursement rates for providers as the economy has recovered and providers have consolidated. Research indicates that provider consolidation predated the ACA’s value-based payment models. 55#N#“In the gray area between changes directly related to and unrelated to the ACA lie other reasons for slow growth in health care costs facilitated by the ACA. The most important of these factors may be spillovers from the value-based care initiatives described above and changes in investment decisions. Every day since the passage of the ACA, thousands of decisions have been made by health care providers with a greater awareness that their financial success will depend on delivering value. In our opinion, the increased attention paid to value-based payment by non-Medicare payers—namely, states and private insurers—is likely a key contributor to the slower rate of per capita cost growth that we’ve seen over the past decade.”
How did the ACA affect health insurance?
“The ACA produced broad gains in insurance coverage. A general pattern was that coverage increased most among groups whose members were most likely to be uninsured before the reforms. Initial research, based on the first few years after the ACA reforms took effect, found larger coverage gains for members of racial/ethnic minority groups than for whites. 1,8 Our analysis, which used data through 2017, found that this pattern had become even more pronounced by 2017, causing a further reduction in coverage disparities related to race/ethnicity. Other recent research has found that the ACA significantly reduced disparities in coverage related to other individual characteristics, such as income, age, marital status, and geographic location. 29,30#N#“ACA-related gains in insurance coverage coincided with improvements in standard measures of health care access. Here, too, compared to whites, we saw greater improvements for blacks and Hispanics—who before the ACA were substantially more likely to go without care for financial reasons and lack a usual source of care.”
How did the ACA impact the health care system?
“Collectively, the ACA’s coverage expansions and market reforms generated substantial and widespread improvements in reducing financial barriers to coverage, improving access to health care , and lowering the financial risks of illness. The coverage expansions reduced uninsurance rates, especially relative to earlier forecasts; improved access to health care; and led to measurable gains in the financial well-being of poor Americans. The law’s market reforms reduced the burden of maintaining continuous eligibility for coverage and ensured that people with insurance had true risk protection.#N#“But subsequent court decisions, along with congressional and executive branch actions, have limited the ACA’s reach. The Supreme Court decision in NFIB v. Sebelius has left more than four million of the poorest Americans uninsured six years after the major coverage expansions.#N#“Congress and the administration of President Donald Trump have also chipped away at the law’s market reforms. Congress’s repeal of the individual mandate penalty, which took effect in 2019, is projected to increase the number of uninsured people by seven million over the next decade. 42 The repeal of the mandate penalty dove-tailed with the Trump administration’s loosening of restrictions on insurance alternatives that are not required to comply with the ACA rules, such as short-term plans with risk rating and association health plans that do not cover all benefits. 43 “
How did the ACA affect women?
“The ACA is responsible for some of the most significant advances for women’s health in recent decades through its increased access to health insurance and health care for women. 6,47 These advances affect the health not only of women but also of their families. After the ACA, women were more likely to be insured, to be able to afford health insurance and care, and to receive preventive care. 1,19,26 Expanded coverage of contraception improved its affordability and use. 40–42 The ACA’s Medicaid and insurance expansions were also associated with increased use of prenatal care 6 and improved neonatal outcomes. 50 Nonetheless, health care disparities persist—especially among members of racial/ethnic minority groups and low-income women. 16,18#N#“To expand the ACA-related gains to all women, the ACA’s insurance coverage expansions must be strengthened. This includes expanding Medicaid in all states, maintaining the ACA Marketplace subsidies, and finding a legal way to institute an individual mandate. 1,51 The variability in state requirements for coverage of specific medications and mental health services should be reduced by ensuring broader coverage at the federal level. The standardization of essential health benefits should include coverage for comprehensive reproductive health care. The debate continues regarding employer exemptions from the ACA policy that requires contraception coverage without cost sharing. 52 In 2018 the federal government proposed rules to expand exemptions for employers to include moral objections rather than just religious beliefs. 53 The rules are under a nationwide preliminary injunction, but conflicting federal court decisions are limiting the contraceptive policy’s enforceability. 52 “
What is the health insurance marketplace?
The mechanism for organizing the individual and small group insurance markets and administering subsidies. The health insurance marketplace includes state-based exchanges and a federally facilitated exchange for residents of states not implementing an exchange.
What are the fundamental changes in financing and delivery?
First, is the shift in measurement and payment, moving from discrete fee-for-service transactions (payment for each task or service that is done at each moment) to payment for clinically and economically relevant episodes for patients and providers, referred to as bundled payments . Accountability for care may be spread across provider types and over a period of time, which incentivizes those providers to work together and integrate services and provides some degree of risk transfer.
What is the poverty level for Medicaid?
Medicaid eligibility expansion to include adults under age 65 up to 133 percent of federal poverty level (per Supreme Court ruling, states can refuse to implement this provision without penalty).
What is the ACA?
In addition to its expansion and reform of health insurance coverage, the Affordable Care Act (ACA) contains numerous provisions intended to resolve underlying problems in how health care is delivered and paid for in the United States . These provisions focus on three broad areas: testing new deliver …
What are the provisions of the Affordable Care Act?
These provisions focus on three broad areas: testing new delivery models and spreading successful ones, encouraging the shift toward payment based on the value of care provided, and developing resources for systemwide improvement. This brief describes these reforms and, where possible, documents their initial impact at the ACA's five-year mark. While it is still far too early to offer any kind of definitive assessment of the law's transformation-seeking reforms, it is clear that the ACA has spurred activity in both the public and private sectors, and is contributing to momentum in states and localities across the U.S. to improve the value obtained for our health care dollars.