ACA On Improving Health Care Outcomes and Decreasing Costs

 

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ACA On Improving Health Care Outcomes and Decreasing Costs

Introduction

More than 10 years ago, the Affordable Care Act (ACA) was signed into law. Since then, the ACA has transformed the American healthcare system by expanding health coverage to more than 20 million Americas (HHs.gov, 2021). The primary objective of the Affordable Care Act was to expand coverage, hence, improving access to healthcare and eventually improving health and reducing health disparities. However, ACA is believed to have more advantages than disadvantages. In that regard, the purpose of this paper is to discuss components of ACA that have a positive effect on improving health care outcomes and decreasing costs.

Essential Health Benefits

The ACA requires that all plans offered in the marketplace cover the 10 essential health benefits. These essential health benefits include ambulatory patient services (outpatient care individuals get without being admitted), emergency services, hospitalization, maternal care mental health and substance abuse disorder, and prescription drugs (HHs.gov, 2021). Others include rehabilitative services and devices, laboratory services, preventive and wellness services, chronic disease management, and pediatric services.

These services form the core of patient care because many patients need this category of services. Before the enactment of ACA, insurers had a great deal of discretion with regard to the scope of benefits available under their insurance plans (Neiman et al., 2021). For instance, mental health care and treatment for substance use disorders were not commonly covered and, when they were, the benefits were minimal and they often had an annual and/or lifetime cap. This component of ACA has, therefore, led to improved patient outcomes and reduced costs of healthcare among many Americans.

Pre-Existing Conditions

Under the ACA, health insurance companies cannot refuse to cover individuals and also cannot overcharge them just because they have a pre-existing condition. The ACA recommends that insurance companies should provide health care insurance coverage to everyone regardless of whether an individual had a diagnosed condition, such as diabetes, cancer, depression, or otherwise (Neiman et al., 2021). Additionally, because premiums and out-of-pocket costs were a set amount, they could not charge higher fees, either. The medical bill is one of the reasons why people become bankrupt in the U.S. Therefore, preventing out-of-pocket payments based on medical history reduces the cost of treatment and also improves patient outcomes.

Medicaid Expansions

Another significant element of ACA is the medical expansion law. Medicaid is a federal-state program that provides public health insurance to more than 60 million low-income Americans. It also covers people with disability, including those living with disabling mental health conditions (HHs.gov, 2021). Before the enactment of ACA, many states provided Medicaid services to a selected group of individuals. It excluded, for example, adults who had no children, while also keeping income limits very, very low to reserve access to care to only the poorest of the poor. Medicaid expansion aimed to significantly reduce the number of uninsured people in the US. With Medicaid expansion (in those states that have adopted it), all families and individuals earning less than 138% of the federal poverty level are eligible (Neiman et al., 2021). This provision improves costs of treatment as well as patient outcomes to the beneficiaries.

Conclusion

More than 10 years down the line, the Affordable Care Act remains relevant to the American healthcare system. The influence of the law is still fresh and becoming stronger. The primary objective of the Affordable Care Act was to expand coverage, hence, improving access to healthcare and eventually improving health and reducing health disparities. The main provisions of ACA that have a positive impact on the improvement of patient outcomes and cost reduction include essential health benefits, pre-existing conditions, and Medicaid expansions. All these points have been explained in the body of this paper.

References

HHs.gov. (2021). About the Affordable Care Act. https://www.hhs.gov/healthcare/about-the-aca/index.html

Neiman, P. U., Tsai, T. C., Bergmark, R. W., Ibrahim, A., Nathan, H., & Scott, J. W. (2021). The ACA at 10 Years: Evaluating the Evidence and Navigating an Uncertain Future. Journal of Surgical Research, 263, 102-109. https://doi.org/10.1016/j.jss.2020.12.056.