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Key Provisions of the Patient Protection and Affordable Care Act Essay

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Updated: Aug 5th, 2021

Abstract

With the emergence of new threats to people’s health, the necessity to study the challenges and concerns to which vulnerable groups are exposed, as well as determine the opportunities for assisting the specified demographic, has emerged. The Patient Protection and Affordable Care Act (ACA) has been represented as open to the major steps in the direction of expanding access to care for marginalized groups and underserviced communities in the United States. However, the implications of the ACA are yet to be analyzed in-depth, some of them being rather adverse and affecting the well-being of vulnerable groups directly. By considering the strategies for securing the rights of the identified citizens, one can coordinate the process of the ACA implementation more effectively and reduce the extent of the threat that marginalized communities experience.

At present, three key outcomes of the ACA can be defined as the ones having the greatest impact on American society. The opportunities for rural residents to access care of better quality, as well as the methods of reducing healthcare assistance costs, should be the focus of the policies to be created in the future to address some of the ACA provisions. The problem with the mismanagement of the needs of women and the LGBT community is another matter that deserves thorough consideration and effective management techniques. By expanding the eligibility criteria for ACA and including all groups that may have potential vulnerabilities, one will be able to address a wide range of health issues faced in the current U.S. context.

Introduction

The Patient Protection and Affordable Care Act (ACA) has become an important milestone in addressing multiple concerns in contemporary healthcare. Offering a solution to the problem of healthcare insurance to underserviced members of the American population, ACA has provided the breeding ground for numerous innovative solutions to addressing the health needs of people that have limited access to care (Lipton & Decker, 2015). Nevertheless, the ACA has also entailed several disadvantages that are likely to grow into full-fledged problems shortly. Thus, it is critical to consider the essential provisions of the ACA as a healthcare regulation that has cemented the idea of healthcare coverage for disadvantaged groups as the key concept of modern care.

To embrace the range of outcomes that the ACA entails, one should focus on the outcomes linked to addressing the problem of infrastructure in healthcare, specifically, the lack of physical access to care in rural environments. Afterward, the problem of criteria for inclusion and eligibility as an essential outcome of the ACA should be scrutinized. Finally, the penalties for employers who fail to provide health coverage for their staff members deserve to be addressed as a very likely effect of the ACA integration into healthcare institutions should be analyzed. By exploring the identified issues, one will infer important conclusions that will help to amplify the positive outcomes of the ACA and build the foundation for long-lasting and profound change.

Cost Reimbursements for Rural Hospitals

In the grand scheme of the ACA, one of the breakthroughs that it allows to make concern changes in the rural healthcare system. Having been recognized as underserviced and in need of active support from urban organizations, rural hospitals are expected to receive the required amount of resources. Nevertheless, expecting immediate changes would be wrong given the extent and scale of the described change. Numerous challenges still prevail in the rural healthcare setting despite the implementation of the ACA in rural counties.

For instance, the integration of several of the ACA standards in the selected environment has not contributed significantly to the improvement of access to care. The current situation with a restricted number of health management options is partially explained by the difficulties in the implementation of care compared to the urban environment, According to Williams and Holmes (2018), “Rural adverse selection is related to both rural demographics (e.g., a generally sicker population) and lower rural Marketplace enrollment uptake rates among eligible individuals” (pp. 53-54). Thus, there is a direct need to raise prices for healthcare services in the rural context.

That being said, opportunities for better healthcare service quality have emerged, with the restructuring of costs in the rural healthcare system. As Williams and Holmes (2018) explain, rural hospitals currently face major challenges regarding the introduction of cost-efficient strategies due to the restriction in financial resources. In addition, the fact that rural residents are offered a significantly lesser number of choices concerning the selection of the healthcare insurance options indicates that the management of health-related needs of rural residents remains a major issue in the U.S. healthcare system (Williams & Holmes, 2018). However, the ACA statements indicate that a vast change is expected to take place in rural and underserviced areas. The support from urban areas and the introduction of a more coherent communication system between residents and nurses will help to maximize the access to healthcare services to people living in rural areas (Lipton & Decker, 2015). Therefore, changes in the design of the rural healthcare standards and the focus on introducing cost-efficient measures into the management of rural healthcare facilities to open access to healthcare services for all residents are among the key provisions of the ACA.

Expansion of the Criteria of Eligibility for Care

Nonetheless., one has to admit that the current criteria of eligibility for care as they are defined by the ACA could use vast revisions. Currently, the criteria that the ACA sets for patients’ eligibility for health insurance coverage are far too vague, thus limiting the opportunity for people in need and representatives of marginalized groups and protected classes to access care (Williams & Holmes, 2018). For example, the current standards regarding the coverage that ACA provides may be seen as pliable, which is likely to affect the rights of vulnerable groups once health-related issues are managed by a biased healthcare provider (Lipton & Decker, 2015). Therefore, revisiting the key provisions of the ACA is necessary given the extent of the negative effect that it produces by excluding specific groups from its list of patients who are deemed as eligible for healthcare coverage.

To give credit where it belongs, the ACA standards have been worded in a rather sensible manner. Currently, the ACA statements stand that “Insurance companies cannot deny coverage based on preexisting conditions and can only vary rates based on rating area, family size, tobacco use, and age (but not on health status, previous claims history, or gender)” (French, Homer, Gumus, & Hickling, 2016, p. 1736). Consequently, health support is expected to be provided to as aide a range of social groups as possible, including the ones that are currently critically underserviced due to the presence of a social stigma. At the same time, the ACA descriptions of its target demographic fail to acknowledge the presence of additional spending that patients may have to take regularly even with the household income that does not fully reach the federal poverty line (French et al., 2016). Thus, the described characteristic of the ACA allows suggesting that several vulnerable groups remaining underserviced is, unfortunately, one of its likely provisions.

Arguably, the vagueness in the existing ACA standards may likely extend to the increase in the number of patients that it may embrace in the future. Although the described outcome is a possibility, the process of expanding the potential pool of people who will have the access to healthcare assistance requires a more coherent approach in defining vulnerable groups and including all people that need state protection into it. Therefore, while the expansion of the range of criteria that make people eligible for high-quality care is a likely provision of the ACA, it still should be executed with proper caution so that the target demographic could include all people in need of the specified assistance.

Health Coverage and Employer Fees

The idea of holding organizations and their owners responsible for the health insurance options that they give their employees is another crucial provision of the ACA. According to French, Homer, Gumus, and Hickling (2016), the ACA regulation leads to the immediate increase in employers’ responsibility and, thus, enhances the security of staff members and their health status. Specifically, French et al. (2016) state that “Employers with 100 or more full‐time employees pay a penalty if they fail to offer health insurance coverage (employer mandate)” (p. 1737). Combined with the fact that insurance companies will also accept a wider range of responsibilities concerning the management of health issues of the workforce, the legal aspects of the ACA can be described as quite promising in terms of the benefits that they provide to staff members. Therefore, one should give the ACA credit for setting the stage for further positive changes. Although some of the outcomes of the ACA can be seen s questionable, they are attributed not to the inherent flaws of the regulation but its vagueness and the lack of focus on specific vulnerable groups. However, combined with a profound study of the current health-related and social issues, the ACA principles will entail rather positive provisions.

The implications of the specified change caused by the ACA may include a shift in the dynamics of relationships between an employee and an employer. Making every employer accountable for the healthcare opportunities that their staff members have, specifically, the insurance options with which they are provided, will affect the extent of staff members’ security and well-being, introducing them to a wider range of health management options and reducing the threat of workplace-related health issues. For instance, the increase in the extent of employers’ responsibility for the selection of health insurance and health management options for staff members will allow the latter to check their health status more frequently, thus locating emergent issues before they develop into serious health concerns or chronic illnesses.

Therefore, the long-term effects of the ACA regulation include not only health-related concerns and issues associated with insurance but also a tangible impact on socioeconomic interactions within the corporate environment. On the one hand, the described alterations in the range of responsibilities that an employer will have for their staff members can entail a rise in the levels of security in the workplace. As a result, significant improvements in public health and the general well-being of the workforce are expected to be observed. On the other hand, the described alterations in the employee-employer relationship dynamics may lead to a significant strain in the workplace, which may affect the performance of every participant involved and, thus, hamper economic growth.

The debates around the outcomes of ACA and its impact on certain groups continue to take place in the social and health-related context. Even though the ACA has opened plenty of opportunities for people to receive care and access essential healthcare services, it still requires further adjustments to assist people that are classified as vulnerable groups and are susceptible to the influence of negative health factors. Currently, it is essential to detail the criteria for eligibility for healthcare so that the needs of all groups that are struggling to receive proper care could be satisfied respectively. The described goal will require extensive research and a profound evaluation of the current status of numerous populations in the U.S. However, the focus should be placed on the challenges faced by women and representatives of the LGBT community as far as access to health services is concerned. By creating an environment in which the target demographic will be protected, one can ensure that a wide range of contemporary health concerns will be addressed properly.

References

French, M. T., Homer, J., Gumus, G., & Hickling, L. (2016). Key provisions of the Patient Protection and Affordable Care Act (ACA): A systematic review and presentation of early research findings. Health Services Research, 51(5), 1735-1771. Web.

Lipton, B. J., & Decker, S. L. (2015). ACA provisions associated with increase in percentage of young adult women initiating and completing the HPV vaccine. Health Affairs, 34(5), 757-764. Web.

Williams, D., & Holmes, M. (2018). Rural health care costs: Are they higher and why might they differ from urban health care costs? North Carolina Medical Journal, 79(1), 51-55. Web.

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