Discussion: Health Care Reform NURS 8100
A Sample Answer For the Assignment: Discussion: Health Care Reform NURS 8100
The enactment of the Affordable Care Act in 2010 heralded reforms in health care that led to more Americans, about 25 million, who did not have health insurance coverage, getting insured. While the reforms from the passage of ACA 2010 led to increased access and quality of affordable care, they did not create universal health coverage to guarantee all Americans, irrespective of their socioeconomic status, access to quality care (Wilensky et al., 2020).
The recent COVID-19 pandemic has illustrated the need for in-depth reforms in the healthcare sector to be spearheaded by state and federal governments. The pandemic demonstrated the importance of having universal healthcare coverage to enhance access to all Americans. The U.S. recorded the highest caseload and fatalities from the COVID-19 pandemic because of the current health system despite being a developed country and spending over $4 trillion or about 12% of its gross domestic product (GDP) on healthcare (Auener et al., 2021).
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Several studies have demonstrated that having universal health coverage would have enabled the U.S. to handle the pandemic better than it did (King, 2020). The purpose of this paper is to present a health reform plan that focuses on the implementation of universal health coverage with a single-payer model.
Conflict Between Federal and State Policies on Healthcare
Federal and state governments have different roles and responsibilities in healthcare provision. As such, there is no uniformity concerning policies between the federal and state governments. The existence of policy variations between these governments can lead to conflicts that require solutions to improve accessibility, reduce costs, and enhance the quality of care. State and federal governments jointly fund health care provision based on existing policies like Medicaid under the ACA 2010 (Wilensky et al., 2022).
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Under this policy, states are free to take Medicaid and increase resources by developing their provisions. Such provisions may conflict with the federal mandates on Medicaid since the federal government hopes to offer access to care through the program (McClellan et al., 2021). However, due to differences in state laws and rules based on their legislations, some states do not have Medicaid programs implying that in such states, Americans cannot access healthcare services under the policy.
According to the Kaiser Family Foundation (KFF), ten states have not expanded Medicaid, implying that over 2.1 million people belong to the “coverage gap” or income level that makes them eligible for the program yet cannot access it due to their state policies (Tolbert et al., 2022).
Such a conflict in policies implies that Americans in the ten states have limited options to access healthcare services. Again, it means that state and federal governments cannot implement a universal healthcare model that will address the coverage and access gaps.
Currently, the federal government funds fully the Medicare program that caters to older Americans, those 65 years and above as well as Americans living with disabilities. Under the program, all state policies align with the provision since they do not fund costs, including prescription drugs.
As such, these conflicts can only be solved through one healthcare plan as demonstrated by the Medicare program or the Veterans Administration (VA) healthcare plan. Conflicting policies as demonstrated by the Medicaid program lead to limited access to health care and reduced resources to fight pandemics when they occur like the recent COVID-19 pandemic and other health emergencies (Hiam et al., 2021).
Therefore, both state and federal governments should embrace a universal model like other developed countries with a single public-payer system where the federal government provides resources based on the state population’s healthcare needs.
Health Preparedness
The proposed health reform plan of having a universal health coverage plan that emphasizes primary care implies that more resources are allocated to the local health facilities within states and counties. Under this proposed plan, states will work with the federal government on the current model of both Medicaid and Medicare services based on the targeted population (Galvani et al., 2022). The plan will entail having Medicaid-like coverage where all people get insured based on the resources that the federal government offers, and the state matches the same amount.
For instance, based on the population levels, states will have different allocations and match half of that by evaluating their demand. The plan will expand access and ensure that populations and individuals previously not eligible become eligible in all states. The policy will ensure that states align their healthcare mandates with the federal government’s direction to improve access and quality of care.
The policy will entail allocating more resources to preventive and primary care interventions in the communities. These resources include investing in healthy food options, physical activities and exercising, giving nutritional information, expanding maternal care, and ensuring that all consultation services and physician visits are free (Wilensky et al., 2022).
Imperatively, the plan is to ensure that Americans can access not just emergency care as provided under the EMTALA provisions but also physician visits and annual routine reviews. The plan will seek to reimburse physicians for value provided and not quantity.
Through these provisions, the proposed plan will enhance health preparedness, especially during public health emergencies as witnessed recently due to the COVID-19 pandemic. Since the plan will focus on primary care, it enhances the level of preparedness as it means that the entire public can access information and emergency services (McClellan et al., 2021).
States would increase their allocation and build more facilities that prepare adequately for any health emergencies. The new plan will ensure seamless sharing of health information, effective coordination, and teamwork based on the expertise and number of healthcare workers who will be deployed in communities.
According to the American Public Health Association (2022), nations that had a universal healthcare system leveraged their models to mobilize resources and ensure the testing and care of their citizens and residents during the COVID pandemic. Universal health coverage would reduce disparities and support vulnerable populations’ access to care. These two factors can help reduce the impacts of pandemics as demonstrated in the country since a majority of those who succumbed to the disease were vulnerable and experienced health disparities.
Percentage of GDP for Health Care
Investing in and rolling out a universal healthcare system would be a critical part of attaining accessibility, reducing overall costs, and improving the quality of care. Currently, models like value-based purchase (VBP) emphasize quality as opposed to quantity implying that the plan does not have to spend more on the GDP but will deploy international best practice standards.
For instance, Canada spends about $9,000 per person on universal healthcare (Geyman, 2021). With a higher GDP than Canada’s, the U.S. can spend about $10,000 per person using this model implying that it will only be about 10% of the nation’s GDP. This figure will allow the federal and state governments to provide comprehensive care to all people who require care throughout the year. States will match the funding by half to close any gaps and reduce bureaucratic aspects that affect the implementation of the program.
Conclusion
Reforming the health system entails developing models that will leverage the limited resources but guarantee high-quality care to Americans and residents. Evidence demonstrates that embracing a universal healthcare model will allow more Americans to access quality care and reduce wastage and additional spending that make it difficult for many to get services.
The proposed plan will ensure that more Americans, especially those experiencing disparities and vulnerability, access care and prepare adequately for public health emergencies like the COVID-19 pandemic and other epidemics like the current opioid crisis.
References
Auener, S., Kroon, D., Wackers, E., Van Dulmen, S., & Jeurissen, P. (2020). COVID-19: a
a window of opportunity for positive healthcare reforms. International Journal of Health Policy and Management, 9(10), 419-422. DOI: 10.34172/ijhpm.2020.66
American Public Health Association (APHA) (2022). Lessons from the COVID-19 Pandemic:
The Importance of Universal Health Care in Addressing Health Care Inequities. https://www.apha.org/Policies-and-Advocacy/Public-Health-Policy-Statements/Policy-Database/2022/01/07/Lessons
Galvani, A. P., Parpia, A. S., Pandey, A., Sah, P., Colón, K., Friedman, G., … & Fitzpatrick, M.
C. (2022). Universal healthcare as pandemic preparedness: the lives and costs that could have been saved during the COVID-19 pandemic. Proceedings of the National Academy of Sciences, 119(25), e2200536119. https://doi.org/10.1073/pnas.2200536119
Geyman, J. (2021). COVID-19 has revealed America’s broken healthcare system: What can we
learn? International Journal of Health Services, 51(2), 188-194. https://doi.org/10.1177/0020731420985640
Hiam, L., & Yates, R. (2021). Will the COVID-19 crisis catalyze universal health reforms? The
Lancet, 398(10301), 646-648. DOI:https://doi.org/10.1016/S0140-6736(21)01650-0
King, J. S. (2020). Covid-19 and the need for health care reform. New England Journal of
Medicine, 382(26), e104. DOI: 10.1056/NEJMp2000821
McClellan, M., Rajkumar, R., Couch, M., Holder, D., Pham, M., Long, P., … & Smith, M.
(2021). Health care payers COVID-19 impact assessment: Lessons learned and compelling needs. NAM Perspectives, 2021. https://nam.edu/health-care-payers-covid-19-impact-assessment-lessons-learned-and-compelling-needs/
Tolbert, J. & Drake, P. (2022). Key Facts about the Uninsured Population.
Wilensky, S. E., & Tietelbaum, J. B., (2020). Essentials of health policy and law (4th ed.).
Burlington, MA: Jones & Bartlett Learning.
Wilensky, G. R. (2022, January). The COVID-19 pandemic and the US healthcare workforce.
JAMA Health Forum, 3(1) pp. e220001-e220001. DOI:10.1001/jamahealthforum.2022.0001
This is an exceptional work on health care reform. I concur with you that cost of care is an important feature of health care system that has great influence on the health policy and reforms. Other than the cost, the other important feature of the US health care system is politics. Politics play a crucial role in the health care affairs, particularly health policy and reforms (Tuohy, 2018). The health care reform discussion in the US has been a political issue centered on reduction of cost, funding, increasing medical coverage, insurance reform, government involvement, and philosophy of its provision.
Health care reforms have been highly contentious among law makers (Haeder, 2020). For instance, President Obama enacted the Patient Protection and Affordable Care Act (PPACA) to increase health coverage to all Americans. However, the Trump administration consistently made efforts to repeal the ACA and adopt alternative policy called repeal and replace approach. This effort to repeal the ACA has been a controversial political topic among the Democrats and Republicans in the Congress (Michener, 2020).
References
Haeder, S. F. (2020). Political science and US health policy in the era of the affordable care act. Policy Studies Journal, 48, S14-S32. https://doi.org/10.1111/psj.12385
Michener, J. (2020). Race, politics, and the affordable care act. Journal of Health Politics, Policy and Law, 45(4), 547-566. https://doi.org/10.1215/03616878-8255481
Tuohy, C. H. (2018). Remaking policy: scale, pace, and political strategy in Health care reform (Vol. 54). University of Toronto Press.
Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to the Medicare patients they serve. Coordinated care helps ensure that patients, especially the chronically ill, get the right care at the right time, with the goal of avoiding unnecessary duplication of services and preventing medical errors.
When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program. The healthcare payment process is undergoing a dramatic transformation as payers and providers shift from volume to value. While stakeholders are currently piloting many different value-based care models, accountable care organizations are among the most popular and successful strategies to date.
Accountable care organizations, or ACOs, are groups of hospitals, physicians, and other providers who agree to coordinate care for patients and deliver the right care at the right time, while avoiding unnecessary utilization of services and medical errors. ACO participants also agree to take on responsibility for the total costs of care for their patients. ACOs that reduce the total costs of care for their patient populations can share in the savings with the payer.
In certain models, they may also be liable to pay back losses if their costs exceed their spending benchmarks (Moore et al., 2017). Policymakers and healthcare leaders believe tying financial incentives to care quality, patient outcomes, and care coordination through ACOs is a key solution for fixing the inefficient fee-for-service system. The programs encourage providers to partner with others across the care continuum.
Some providers are formally acquiring to gain control over a wide range of services, achieve economies of scale, and access the technology, data, and clinical capabilities of their peers. In fact, ACOs are and are likely to continue to be a major player in the value-based care and payment transformation. When all the parts work together, providers in an ACO can bring down costs and improve care quality while earning incentive payments. HMOs, on the other hand, seek to cut costs by setting fixed prices for services, which may encourage providers to reduce utilization or skimp on care in an effort to stay under the cap(Colla et al., 2018).
References
Colla, H., & Fisher, E. S. (2018). Moving forward with accountable care organizations: some answers, more questions. JAMA internal medicine, 177(4), 527-528. https://doi.org/10.1001/jamainternmed.2016.9122
Moore, K. D., & Coddington, D. C. (2017). Accountable care the journey begins. Healthcare Financial Management, 64(8), 57-63. Retrieved from https://www.proquest.com/trade-journals/accountable-care-journey-begins/docview/746684537/se-2?accountid=14872
Feature of U.S. Health Care System and Significance to Health Policy and Reform
The health-care system in the United States is unique in a number of ways, one of which is that the government does not play a central role in its delivery. A variety of payment, insurance, and delivery methods are used to fund health care, both publicly and privately (Shi & Singh, 2017). Privately financed insurance through employers accounts for approximately 57 percent of healthcare expenditures, with the remaining 43 percent financed by the government (Centers for Medicare & Medicaid Services, 2021).
National healthcare spending continues to rise on an annual basis: 2019 saw a 4.6 percent increase, mirroring the previous four years’ growth (Centers for Medicare & Medicaid Services, 2020). Spending is expected to rise significantly over the next six years, raising concerns among researchers about what this means for millions of recipients.
Americans spend considerably more on healthcare than other developed countries, however this does not necessarily equate to better outcomes. The average life expectancy in Switzerland, France, and the United Kingdom is longer by an average of five years compared to the United States; this is attributed to better access to care, use of evolving technology, lower cost of medications, and overall costs of services (Scott, 2022).
Increased costs for Americans arise due to administrative costs for insurers and increased medication prices due to the capitalistic nature of the nation (i.e. supply and demand). These two factors should be a major consideration for future policy and reform; however, many entities feel they are neglected due to powerful forces who receive high-profit shares through their existence.
Challenges to the PPACA and Policy-Making Process
The Affordable Care Act’s (ACA) original goal was to ensure that more people had access to health insurance coverage and that the quality of their health care would be improved; it would also regulate the industry and reduce the cost of health care spending in the United States (Galan, 2020). Under this plan, no one could be denied coverage, which is a significant improvement from the past, when insurance companies could refuse to cover individuals for pre-existing conditions or medical conditions that could develop during the plan’s lifespan.
Children could also remain on their parents’ plans until the age of 26, despite living situations that would have previously disqualified them, such as being out of school, not financially dependent on the parent, and married. This would allow them to complete college and establish themselves in the world without worrying about the cost of medical insurance. They would also have a special enrollment period open on their 26th birthday, and their coverage would not lapse as a result of the timing.
Another advantage was that small businesses would receive government assistance to help fund the cost of providing health insurance to their employees. Following its implementation, uninsured rates for small business employees fell by nearly 10%, and costs for businesses providing coverage were stabilized (Chase & Arensmeyer, 2018).
The evolution of the ACA and increased health care spending generate continued resistance for health care reform. Health care is a multibillion-dollar industry in the United States and there is a large economic interest vested in keeping the current structure working. Until those who make key decisions about change are able to understand the concept of people over profit real health care reform is unlikely to occur.
Reference
Chase, D. & Arensmeyer, J. (2018, October 1). The Affordable Care Act’s Impact on Small
Business. The Commonwealth Fund. Retrieved March 1, 2022, from
CMS Office of the Actuary Releases 2019 National Health Expenditures. (2020, December 16).
Centers for Medicare & Medicaid Services. Retrieved March 1, 2022, from
national-health-expenditures
Galan, N. (2020, September 17). The Affordable Care Act: An update. Medical News Today.
Retrieved March 1, 2022, from https://www.medicalnewstoday.com/articles/247287
National Health Expenditure Data. (2021, December 1). Centers for Medicare & Medicaid
Services. Retrieved March 1, 2022, from https://www.cms.gov/Research-Statistics-Data-
and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData
Scott, M.P. (2022, January 17). Why U.S. Healthcare Spending is Rising So Fast. Retrieved March
1, 2022, from https://www.investopedia.com/u-s-healthcare-spending-rising-fast-5186172
Shi, L. & Singh, D.A. (2017). Essentials of the U.S. Health Care System. Jones & Bartlett Learning.
Discussion: Health Care Reform
After much public and political debate, in March 2010, the Patient Protection and
Affordable Care Act (PPACA) was signed into law by President Barack Obama. The
PPACA is one of many health care reform efforts that have sought to correct key
features of the U.S. health care system such as financing, service delivery, and care
coordination. This week, you will examine the passage of PPACA as a milestone along
the historical continuum of health care reform in the United States.
To prepare:
Review this week’s Learning Resources and media presentation, reflecting on the evolution of
health care in the United States and the public’s response to health care reform efforts
historically and currently.
Consider: What principal features of the U.S. health care system helped or hindered the
enactment of federal health reform in March 2010? What challenges were encountered?
How do these conditions and/or challenges reflect characteristics of the policy process and the
political environment?
By Day 3
Post a cohesive response that addresses the following:
Analyze at least one important feature of the U.S. health care system that is of particular interest
to you. Explain why you think this feature is significant in terms of health policy and reform.
Describe one or more conditions or challenges specifically related to the passing of the PPACA.
Explain how this exemplifies the nature of the policy-making process, and evaluate how it could
relate to the question of why health reform in the United States has been so difficult.
All major policies including the healthcare reforms require a bi-partisan agreement from Congress, with specific and clear policy goals from each party. This becomes both a challenging and complicated battle because both republic and democrats disagree and differ on priorities. The republicans’ goal and priority are to reduce costs, and have a small government over all other goals, while democrats’ goals and priority are to improve health and equity.
They both however have some common ground, and that is the sufficiently challenging task of tackling health care costs, The other barrier is the fundamental conflict, the government’s role in health care provision, and subsidizing tradeoffs between reducing costs and increasing access (Pagel et al., 2017), complicating a complicated process. The only way they can pass the reform policies is to acknowledge each parties’ goals, begin the reform process in the issues which they are all agreeable, and then start to explore and negotiate a compromise on the non-agreeable issues to improve the long due US health system (Pagel et al., 2017).
President Trump defined the Patient Protection and Affordable Care Act (PPACA) as one of the greatest threats, “unsustainable and will lead American into complete insolvency” (Collier, 2017), and had a goal was to repeal it and replace it with cheaper, and better to provide insurance for all. The Republican efforts to weaken or repeal the individual mandate were fruitless and further undermined the individual market’s stability and exacerbate current marketplace trends (Willison, & Singer, 201