According to the US government, the 2010 healthcare reform bill, the Affordable Care Act (ACA), represents arguably the largest and healthiest reformation in healthcare in the history of America. Its substantial law key provisions show commitments to increase access to health care, improve health outcome measures, and optimize control of cost drivers in health care. Many substantive parts of the ACA advance important aspects that contribute to these different goals.
Medicaid Expansion
Through the ACA, the eligibility for Medicaid, a health coverage program, has been increased to include individuals who are capable of working and have an income up to 138% of the federal poverty threshold. Expanding this initiative will protect a large number of low-income persons who previously lacked it, thereby increasing the motivation to monitor these diseases frequently, manage chronic conditions, and access other essential medical services. Based on the research findings, it was observed that Medicaid expansion is associated with lower rates of insurance, improved access to primary care, and better health outcomes (Bellerose et al., 2022). This is especially true in the states that have implemented Medicaid expansion. Expanding Medicaid provides access to healthcare coverage for groups that are at risk, therefore narrowing the disparity in healthcare and enhancing overall health outcomes.
Essential Health Benefits
The ACA requires that all individual and small group market insurance plans cover an array of essential health benefits (EHBs) that include everything from preventive care to maternity care and prescription drugs. Generally, the ACA was meant to blunt such danger in insurance health plans and to secure access to necessary services, not encumbering people by the cost of accessing them. The only explanation over and above could be that the provision sought to support timely disease diagnosis and treatment, reduce the harm of not treating various conditions, and improve the health outcomes of individuals and communities. The standardization of the terms and conditions for coverage in the ACA was also meant to simplify comparison shopping among insurers, a competition that is intended to maintain and keep a low lid on premium rates and overall healthcare costs.
Prevention and Wellness Initiatives
The ACA emphasizes preventive care and health. Vaccinations, tests, and counselling must be covered without cost-sharing by most health insurance plans by law. The ACA promotes preventive care to detect health issues early, intervene quickly, and slow chronic disease progression. By preventing costly treatments for preventable illnesses, preventative services enhance health and lower healthcare costs. The ACA promotes community-based projects to promote healthy habits, address social determinants of health, and increase collaboration between healthcare providers, public health agencies, and community organizations (Marc, 2023).
Accountable Care Organizations (ACOs) and Payment Reform
The ACA also rewards accountable care organizations through payment reforms toward value-based care. ACOs are organizations in which physicians from across different specialities come together to care for patients through payment reforms to decrease care fragmentation and render quality care with fewer services. Additional purposes of ACOs are to ensure care that will be well coordinated in quality and focus on health outcomes, not the volume of services, and to improve the patients’ experiences while using resources most effectively to produce health results at relatively low costs. Other provisions of the ACA provide for payment models, which include bundled and accountable care payment arrangements that encourage quality care improvement by low-cost providers (Chernew et al., 2020). Such a payment reform promises to create a spirit of innovation that will foster the integration of care across the entire healthcare system.
Health Information Technology (HIT) and Electronic Health Records (EHRs)
Health information technology (HIT), including EHRs, is encouraged by the ACA to improve care coordination, patient safety, and data-driven decision-making. EHRs offer real-time patient information access, seamless information exchange, and reduced test and procedure duplication by digitizing health records and facilitating interoperability across healthcare providers. HIT infrastructure also supports population health management, quality reporting, and clinical decision support, supporting evidence-based practices and enhancing care delivery. Technology can improve patient outcomes, save administrative costs, and streamline care processes.
References
Bellerose, M., Collin, L., & Daw, J. R. (2022). The ACA Medicaid Expansion And Perinatal Insurance, Health Care Use, And Health Outcomes: A Systematic Review. Health Affairs, 41(1), 60–68. https://doi.org/10.1377/hlthaff.2021.01150
Chernew, M. E., Conway, P. H., & Frakt, A. B. (2020). Transforming Medicare’s Payment Systems: Progress Shaped By The ACA. Health Affairs, 39(3), 413–420. https://doi.org/10.1377/hlthaff.2019.01410
Marc, C. (2023). Academic Health Centers and Social Determinants of Health: Community Health Improvement – ProQuest. Www.proquest.com. https://www.proquest.com/openview/f196d1c384d12be77cff5981a51f5e62/1?pq-origsite=gscholar&cbl=18750&diss=y
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