Thesis statement
The responsibility of every country under local and international law to provide adequate and affordable health care has been implemented and enforced through a variety of policies and regulations.
One such legislation is the Affordable Health care for America Act which seeks to standardise the minimum health care standards that every citizen must subscribe to (Hulse and Pear 2009).
I will analyse this Act in its merits as a solution to affordable health care and a compromise between the interests of health care providers and the beneficiaries of the health services. I will also evaluate its shortcomings in light of the prevailing health care problems and concerns.
The problems it addresses
The Affordable Health care for America Act which will herein after be referred to as the act was formulated to respond to the rising health concerns in the health care industry especially among low income earning population.
The number of non elderly uninsured whose income is below the federal poverty level is to the tune of 18.6 percent of the total elderly population. Among the working population at least thirty percent of each of the income levels remains uninsured.
This statistic brings the total number of uninsured citizens to nearly 45 million which accounts for at least 15 percent of the total population. 25 % of the uninsured citizens are children therefore at least 12 million American children are uninsured.
Subsequently the annual death toll associated with the lack of an insurance cover is at least 18 000 Americans. This is greatly contributed by the high cost of health insurance alongside other socio-political and economic challenges (Stanton et al 2009).
The problem is expected to become worse with the emergence of new technology and methods of treatment which are more expensive and therefore requiring higher insurance costs.
The implications of these costs on the employers will be to engage cost cutting measures that will be reflected in withdraw benefits to employees while others will be forced to terminate such benefits to shift the burden to the employee entirely.
Among those without insurance there has been a great level of discrimination between Americans of different origins with the highest number being Hispanic Americans and the least being Caucasian Americans.
Further at least 70 % of citizens who file for bankruptcy had some form of health insurance and as a result of high medical bills individuals incomes are exploited to bankruptcy (Mitchell et al 2001).
The Act also seeks to solve the problem of lack of a universal comprehensive health care Act that brings on board all citizens. It goes further to try and address the rigidity of a government based Medicare Act that limits the choice of the citizens in regards to insurance providers.
The enforcement of a purely employer based Act has also limited the job opportunities of citizens who fear losing their cover if they leave certain jobs.
It also looks into the administrative nightmares that citizens incur when they fall sick and have endless procedures before they can claim from their providers or go through endless approval checks before they can receive medical care.
The Act also seeks to address the deteriorating nature of health services that the citizens receive. It makes an attempt at laying emphasis on better relations between patients, physicians and hospitals alike (Fisher et al 2003).
Finally it looks into the manner in which the implementation of such a bold Act will take place. Reform requires huge financial backing therefore the Act must have a self sustaining strategy to ensure its success.
History
The search for a health care act that is affordable dates back to 2009. This was when the act was proposed for the first time to the House of Representatives as a principal legislative proposal. This was in a forum for health reform debate in the 11th congress referred to as the “House Bill”.
It however did not see the light of day in its original form but rather as an alternative Act, The Patient Protection and Affordable Care Act in 2009 (Marmor, Oberlander & White 2009).
The reconciliation process revised again the reform initiative in 2010. As a result, the house abandoned its reform bill. In that case, it adopted an alternative legislative which occurred in the form of the Health care and Education Reconciliation Act of 2010. These two policies would then form the Affordable Care Act of 2010.
Effectiveness of the Act
The Act made four major amendments to the health provision sector. These include insurance company accountability, lowering of costs and improving quality, creating access to choice as well as increasing patient rights and consumer safeguard measures.
From the provider’s perspective before the enactment of the law they had a choice between increasing their premium and losing their clientele or entirely leave the market and close shop due to the unfavourable conditions and economic times.
All these indicators depict a gloom future for the future health care industry unless the status quo on regulation changes. This change can only be brought about through a transformative legal framework in the form of government Act.
The Act is motivated by an all inclusive approach to the health care problem. This does not however mean a static package for subscription by citizens but rather a flexible bare minimum that is all inclusive of members of various ages and levels of income.
It allows members of a family to comfortably use different plans and change to alternative plans. The Act should also take to consideration those who live below the federal level of poverty by offering assistance to them to allow them to enrol to a basic plan.
This is taken care of through government based tax credits and income supplements which will start off these members of the population who have problems enrolling for a basic cover (Peterson 2009).
It has become apparent that the providers of health insurance have been defrauding the beneficiaries by failing to transparently disclose their procedure for rejection or acceptance of liability. They create a long bureaucracy of requirements that must be satisfied before a client can be compensated.
This has created frenzy of unfriendly relations between the companies and insurance providers which leaves hospitals with no option but to install their own approval mechanisms which often cause injustice to the citizens.
It is these sour relations that generated the need for a health care reform Act overhaul to take into consideration the plight of these citizens.
The act was an ambitious attempt at rescuing the future of health care in America. It sought to reduce the ever increasing number of uninsured persons in the population and increase the quality of insurance eservices offered to them.
The restriction of citizens to certain service providers was also addressed by engaging in subsidies that allow the citizens to receive cash assistance in engaging with private providers. The Act should consider the providers perspective by bringing in the input of the various stakeholders in the industry.
As such, it should not be a pure state based system that rigidly controls the standards and bare minimums. The Act has offered a private and public partnership between the various competitors to allow members from the various income levels to embrace the Act and participate in its enforcement and implementation.
This will allow the citizens to meet their basic health care needs through the basic plan while still having the option of paying extra for a supplemental coverage or additional benefits over and above the bare minimums such as is the case with abortion cover (Peterson 2009).
The Act should also meet the current need for variety in insurance cover providers. A purely employer based cover limits the choice of the beneficiaries of the insurance cover providers from whom they receive service from.
The Act addresses the concern by offering the employee a choice between the employer based approach, a contributory approach and an individual cover or plan. The restriction to the employer provider approach causes job rigidity since employees stick to a certain job or employer for the fear of loss of coverage.
This can also be resolved by giving the employees a choice between the job-based health insurance cover and a customised arrangement that will require the employer to send their premium contribution to a regional agency that will be responsible for the formulation of a variety of plans.
The remaining portion of the premiums can be settled through an income subsidy or supplement to cover the premium. The citizen will then organise to have their own medical or health care cover in the same manner they arrange for motor vehicle insurance.
An alternative strategy would be to require that every employer with at least 10 employees down from the current 50 employees requirement, to provide the basic cover or make payments to the regional agency for each of their employees.
The employer will therefore have an option of getting out of the health insurance responsibility and therefore opening the avenues for expansion for the employee. It also allows them to shift the resources allocated to the management and maintenance of insurance benefits to other functions.
The ideal Act should also have an easy to understand execution strategy and plan. It should reduce the bureaucracies involved in the implementation and operationalization of the Act.
This is achieved through specified information technology supplements such as electronic medical records that guarantee security confidentiality and flexibility to allow physicians notes written or dictated to be incorporated into the patient’s records.
The system will also allow for an electronic billing system that will increase the rate at which transfer of funds occurs to allow for a faster response to medical supply as well as medical service.
The system will also reduce the pre approval requirements before medical services are provided by setting best practice requirements and protocols.
These will be embedded in each patient’s medical record and will be available for review by the various providers in case of admission. This will also allow for instant feedback to facilitate immediate response.
The payment plan should also be broken down through the regional agencies that regulate and redistribute the premiums to reflect the median costs of providing health care for persons with specific condition.
These statistics are then used as guidelines in offering benefits to cover subscribers. These statistics and guidelines will be easily adjusted for new entrants and exits into and from a given plan or cover as well as changes in service costs due to structural economic and strategic changes.
The Act should also perpetrate quality in its approach to service delivery. In effect the harmonisation of records through an electronic system will allow patients suffering from a certain condition to keep track of results and outcomes from various medical providers.
This will go towards harmonising the standard and quality of service that the citizens receive from the various providers. The statistics will also be used as a basis for education and reference for the campaign for healthy living.
A good Act should also have a financing strategy and a solid source of revenue to support is implementation. It is apparent that offering health care to all will require a large amount of money.
This Act will rely on the already available funds amounting to 23.5 billion dollars that is already provided by the federal government to pay for the uninsured. In addition it will also utilize savings from reduction in bad debts and charity care by up to 17 billion dollars.
It will also utilize savings from reduction and simplification of the preapproval requirements, billing efficiency which will increase by over fifty percent which together will create savings for insurers, hospitals and physicians an amount totalling up to 53 billion dollars which will be directed towards the implementation of the Act (Peterson 2009).
The most affected group
The Act has affected the providers and the citizens alike. It has created a mandatory duty to the citizen to obtain a health insurance cover failure to which they are liable for a penalty tax or fine. This will compel all citizens to secure an insurance cover whether they like it or not.
Certain benefits have been rendered optional for the citizen such as the abortion coverage to which the citizen will be required to pay an unsubsidised cost over rand above the allowable minimum or basic cover.
The Act also broadens the revenue bracket by increasing taxation on high cost insurance plans, the wealthiest Americans, Medicare taxes as well as indoor tanning tax. The individuals will also be entitled to a tax credit to facilitate their enrolment into a health cover (Anderson et al 2009).
Providers on their part will be influenced by the new standards that will be set as bare minimums for basic covers, they will be required to conjure their products and plans to subscribe to the new regulations.
The citizens have also benefited from better relations with physicians and service providers who have spearheaded the agenda of prevention as opposed to treatment. This is to be achieved through healthy living and proactive steps such as immunisation and early diagnosis.
Future of the legislation
The congressional budget office suggests that the cost of reform of the health Act will cost at least 938 billion dollars by 2022. However this value is expected to reduce to at least 143 billion with the introduction of increased taxes and Medicare payment cuts.
This reform initiative is expected to affect 32 million uninsured Americans as well as all aspects of the health care system including the providers. It intends to reduce the number of uninsured Americans to at least 23 million by 2019 which is better than the expected increase in un-insured Americans to over 54 million by the same year (Conover, 2004).
The Affordable Health care for America Act is a progressive and futuristic Act that goes a long way in rescuing the health system of America. It however still needs amendment to accommodate the issues addressed in this paper.
References
Anderson, G. Reinhardt E., Hussey P., & Petrosyan V. (2009). It’s the prices Stupid: Why the United States is so different from other countries. Health Affairs, Vol 22 (3), 4-85.
Conover, J. (2004). Health Care Regulation: A $169 Billion Hidden Tax”(PDF). Cato Policy Analysis, 527: 1–32.
Fisher et al. (2003). The implications of regional variations in Medicare spending. Part 1: The content, quality, and accessibility of care. Annals of Internal Medicine, 138 (4), 273–287.
Hulse, C., & Pear, R. (2009). Sweeping Health Care Plan Passes House: The New York Times. Web.
Marmor T, Oberlander J., & White J. (2009). The Obama administration’s options for health care cost control: hope versus reality. Ann Intern Med, 150 (7): 485–9.
Mitchell et al. (2001). Effects of Cost Sharing on Care Seeking and Health Status: Results From the Medical Outcomes Study. American Journal of Public Health, Vol 91(11), 123-555.
Peterson, L. (2009). A Comparative Analysis of Private Health Insurance Provisions of H.R. 3962 and S.Amdt. 2786 to H.R. 3590: Congressional Research Service. Web.
Stanton et al. (2009), Health-Care Reform: How the Bills Stack Up. Web.