Affordable Care Act Analysis

The Affordable Care Act (ACA) also known as ObamaCare, has several provisions that are intended to find solutions to underlying issues in the United States as to how the health care is delivered to patients and how the health care provided is paid for. These previsions made in the ACA 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 system wide improvement. An example of a new model for delivering health care is the Accountable Care Organization (ACO). The ACO is a group formed by health care providers ranging from primary care physicians and specialists to hospitals and post-acute care facilities that
agree to take responsibility for the total cost of care for a group of patients. The ACO places a degree of financial responsibility on the health care providers, with a goal of improving care management and limiting unnecessary spending while still providing their patients the freedom to select their medical service. I think congress included ACO’s in the new law to try to save money, but this could mean providers will lose money if they exceed the set amount they are allowed to spend. Being apart of an ACO gives the providers an incentive not to order “unnecessary” tests or procedures. If providers keep the cost down they receive a bonus, so I think that being apart of this organization makes it hard for health care providers to give quality care, because if they do everything they can to care for their patients they may exceed their spending limit and in return they will be out money. I think physicians try to provide quality care to their patients but if the physician is close to reaching their spending limit, they may not order the test or procedure a patient needs because it could mean they will be losing money. This leads me to discuss Medicare and Medicaid.
Medicare and Medicaid are health care programs sponsored by the government in the United States. The two programs differ when it comes to terms of how they are governed and funded, and whom they cover. Medicare is an insurance program primarily for senior citizens 65 years of age and older, although Medicare also covers disabled individuals and those with end stage renal disease of any age, who qualify for social security. Regardless of income, anyone turning 65 can enroll in Medicare as long as they have been paying into a social security fund. Medicare is completely governed by the federal government. Around 15% of the population is on Medicare. While, Medicaid is an assistance program that covers medical costs of low to no income families or individuals; children are more likely to receive coverage. Federal and state governments govern Medicaid. In order to qualify for Medicaid your income must comply with the Federal Poverty Level (FPL), there are very strict income requirements that vary from state to state. Around 20% of the population is on Medicaid and Medicaid covers 40% of all
childbirths. People who qualify for both Medicare and Medicaid are known as “dual eligible” People who are dual eligible may be classified as full benefit or partial benefit. Those with full benefits may obtain the entire array of Medicaid benefits; those with partial-benefits do not receive Medicaid covered assistances, but Medicaid covers their Medicare premiums or cost sharing, or sometimes both. Partial benefit dual eligible recipients have limited income and assets, but their income and assets are not low enough to qualify them for full Medicaid benefits in their state. Medicare coverage for people who are dual eligible includes: hospitalizations, physician services, prescription drugs, skilled nursing facility care, home health visits, and hospice care. Next, I am going to talk about how the use of Obama Care affects doctors. My father is actually a primary care physician and I know that by accepting Medicaid from patients, it has hurt him and his practice tremendously. Doctors aren’t available for Medicaid because it pays them poorly while highly restricting tests and treatments, including prescription drugs. Preventative services such as eye care, hearing and dental care are now being limited by most states. A 2013 study in Health Affairs revealed that only 67% of primary care doctors, and less than half of all specialists, accept Medicaid. Those doctors that do accept Medicaid are very hesitant to do so, and many limit the number of patients they see who have Medicaid. Seeing Medicaid patients also hurt hospitals, they lose approximately 85 cents on every dollar. That is a huge pay cut from seeing people who have Medicaid versus people who have private insurance.
Many primary care physicians were willing to accept a second-rate payment out of a sense of loyalty to their patients, only to find that there weren’t enough specialists willing to work with them as well. For example, it was too difficult to find an orthopedist to treat a patient for a broken bone because they didn’t accept Medicaid insurance, or an ophthalmologist to remove a cataract because they didn’t accept Medicaid insurance either. It makes the work much harder for the physician and they are being paid an insufficient amount. I completely understand why a lot of physicians and specialist don’t except Medicaid insurance because they aren’t gaining anything from it, if anything they are losing money. Physicians went to school a very long time to earn their degree to care for others and doing so is their source of income, so I don’t think they should have to suffer from the short coming of others. Medicaid is a bankrupt system because of overuse, combined with absence of proper networks. The next topic I would like to discuss is how advancing technology has a huge impact on health care. The Internet has become one of the main sources of medical information, more and more people are using the Internet to research their medical issues. This means not only looking up symptoms, but also searching treatments and medicines online. While it is never a good idea to skip out on the doctor completely, the Internet has made patients more enabled to make decisions about what their next step should be. Health care facilities are now reaching out to people through social media also. Healthcare facilities, mainly hospitals, are using social media to create contact with patients, answer questions about practices, launch public awareness campaigns, and perform community outreach. Some sophisticated websites are now proposing immediate chats with nurses and doctors about medical issues, I have even seen commercials on face timing a doctor over the phone, rather than going into the office for a visit.
The most apparent way technology has changed healthcare is by providing new and improved machines, medicines, and treatments that have saved the lives and improved the chances of recovery for billions and counting.
Not only do advanced medical practices help patients heal correctly; new technology has also improved research so professionals can make healthcare even more efficient. Through technology doctors are easier to reach and better at their job. Technology has allowed doctors to access e-mail, texts, videos, and conference capabilities to confer with colleagues from all over the world. This practice, referred to as telemedicine, is specifically useful for doctors and patients in rural and under-developed areas. Without having to move patients, doctors can discuss with experts from all over the world to diagnose, treat, and research conditions without needing access to a high level hospital. Telemedicine was used successfully after the 2010 Haiti earthquake and will no doubt be refined for future
use.