Running head: THE PROS AND CONS

The Pros and Cons of the Affordable Care Act

Contemporary Issues in Heath (LDR614)
May 19, 2016
Team A
Anita Altawan
Colette Carter-Hicks
Bernard Godfrey

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Quality - Pros of the Affordable Care Act

A quality initiative that the Affordable Care Act (ACA) promotes is not an individual
approach to healthcare delivery, but a systems approach. The purpose is to increase quality,
efficiency, safety, cost, and speed. The result is patient care that is coordinated across all
conditions, diseases, providers, and care settings, and over time (Belmont, Haltom, Hastings,
Homchick, Morris, Taitsman, and Peisert, 2011, p. 1282). The ACA supports a national strategy
of quality improvement that emphasizes the integration of services for hospitals, providers, freestanding clinics, or other independent providers. This is done through shared electronic records,
guidelines set for clinical purposes, and collective practices. In optimal systems-based care,
each patient's health care needs are evaluated and treated comprehensively as part of a "system"
of care for that person (p. 1283).
Another way the ACA focuses on quality is by pushing for value based purchasing. In
2013, Medicare decreased payments by 1% for myocardial infarction, heart failure, surgical
infection, and pneumonia. It will decrease to 2% in 2017. The money that is left over from these
reductions will be used to reward the hospitals that have done the best job of meeting
the quality benchmarks that CMS will establish annually (p.1283).
The Accountable Care Organization (ACO) and the Patient Centered Medical Home
(PCMH) are other quality initiatives through the ACA. ACOs are organizations that meet
quality metrics, adopt improved care processes, assume risk, and provide incentives for
population health and wellness (Devore, & Champion, 2011, p. 41). They are designed to get
away from the traditional fee for service model and adopt a new fee for value process. Overall,
ACOs are designed to help individuals take control of their own healthcare needsto decrease
waste and get rid of unnecessary spendingmeeting the expectations of the patientsto share in

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the decision making processincrease overall wellness and preventative care of patientsand
patient satisfaction (Devore, & Champion, 2011). Patient Centered Medical Home is a team
based model of care led by a personal physician who provides continuous and coordinated care
throughout a patients lifetime to maximize health outcomes (Sultz, & Young, 2014, p. 173). A
PCMH provides the needs of the patient or arranges the proper care of a patient with other
physicians or providers. It is a relationship between a physician and the patient. Quality and
safety are hallmarks: physicians create care plans with their patients, engage in voluntary quality
improvement activities, and use information technology for optimal care (Sultz, & Young, 2014,
p. 174). They also keep patients engaged in the decision making of their care.
Lastly, the ACA created new public reporting requirements as a quality initiative.
Sections 3015and 10305 say that the secretary of health and human services will make
information public, by way of websites, that pertains to information about healthcare
performance and quality measures (Belmont, et al., 2011). The physician compare website as
well as the hospital compare website have been created. The ACA requires the Center for
Medicare Services (CMS) to reduce Medicare reimbursement to 98 percent of the existing fee
schedule for physicians who fail to submit the mandated data on the quality of their
performance (Belmont, et al., p. 1284). The ACA even has sections that require quality data on a
subject that has typically been hard to measure in terms of quality because its complexity. That
subject is cancer. According to Spinks, Walters, Feeley, Albright, Jordan, Bingham, & Burke
(2011) this will further the development and public reporting of cancer quality measuresimportant steps in improving the delivery of cancer care.
As one can see, the Affordable Care Act has a direct focus on quality improvement.
Whether the focus is a success is yet to be seen.

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Access Pros of the Affordable Care Act

There are many pros and cons when it comes to access of the Affordable Care Act
(ACA). One particular area that has many different opinions and facts are on the access also
known as expanded coverage for the people. This would not be the first country to have
expanded coverage. Many other countries have a system of this type in place. It's a system that
needs work, but in order for it to be successful the government needs to allow input from health
care workers, the general United State population and from the government itself. It is very
important to provide increased patient access to physicians and also to help individuals afford the
costs of health care. President Obama signed the health care reform in March 2010 to implement
it into law and give people affordable and easy access to health care. The Affordable Care Act
makes, preventative care, which includes primary care, family planning and many other services
more accessible and affordable for many Americans.
The impact of expanded coverage has affected many individuals who have health
insurance and it has also affect individuals who have no health insurance. According to the
Center on Budget and Policy Priorities, "The Affordable Care Act extends Medicaid Coverage to
otherwise eligible state residents with incomes below 138% of the poverty line. Over 15 million
uninsured adults could become newly eligible for Medicaid across all states. An Additional 4
million uninsured adults are currently eligible under existing state eligibility criteria, but are not
enrolled; many will likely do so once the requirement to have coverage becomes effective in
2014" (p. 2). The government is assuming that the most people will enroll in a type of health
insurance plan. It is very difficult to say whether or not a majority of people will sign up. It is a
persons free choice that allows them to obtain health insurance. Expanded coverage will
increase many areas in the health care system such as; increasing the amount of individuals with

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health insurance, helping to make sure people are taking care of themselves, and decreasing
hospital readmissions. There are many positives items that the Affordable Care Act can provide
to people.
A few positive points when it comes to the Affordable Care Act on expansion is it will
help significantly with individuals reporting their health status, death rates will decrease which
means the life expectancy will increase and there will be an increase of quality and care access.
With all of these items in place the outlook of patient care looks great. This will help with
decreasing patient hospital readmission. Hospital readmissions are one of the most controversial
items of the Affordable Care Act. According to Kocher and Adashi, "Hospital readmissions have
been the subject of ever-increasing scrutiny. Indeed, they are an important focus of the US
Patient protection and Affordable Care Act (ACA). Identified by the Medicare Payment
Advisory Commission as a major action item for some time, hospital readmissions remain
prevalent, costly, and largely preventable" (p. 1794). Decreasing readmissions for patients is
very important. It not only helps keep cost down, but also can prevent infections in patients.
With the expansion of access, the Affordable Care Act seems to have many benefits.
These benefits not only help patients, but they have planned it to help the government as well.
The Affordable Care Act is expected to generate approximately 2.2 billion dollars in certain
states. There are many ways the Affordable Care Act will help citizens. It has not yet been a
perfected system because everything takes time to develop. The Affordable Care Act (ACA)
access helps many individuals who do not have insurance obtain it and also helps by increasing
revenue within the government body. There are many ways the Affordable Care Act access
expansion will help our country, but more time is needed to learn of the direction it will go.

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Cost - Pros of the Affordable Care Act

The ACA is now 6 years old. In drafting the ACA, policymakers faced delicate and
politically explosive tradeoffs between expanding access to medical care and controlling the
ever-increasing cost of that care (Persad, 2015, p.115). Controlling health care spending was a
key component of this reform. There are multiple ways the United States has focused on
reducing health care spending.
A very promising idea on how to reduce cost was to change the payment methods for
health care services. Instead of fee-for service payments the ACA utilizes a bundled-payment
approach. This method provides a single payment for all services related to a given treatment.
Providers are now responsible for assuming the risk for preventable costs that may arise.
Bundled payment provides a mechanism for reducing both volume of services and the prices
charged for them (Hussey, Eibner, Ridgely, & McGlynn, 2009, p. 2109). Providing high quality
care and collaborating with all parties involved will assist in reducing costs. Utilizing this
method national health care spending can be reduced by 5.4% between 2010 and 2019 (Hussey
et al, p. 2110).
Improving quality and efficiency of care required spending money on infrastructure that
will lead to more efficient delivery of care in the future. The ACA focused on creating Health
Information Technologies (HIT) and creating medical homes to improve primary care delivery.
HIT adoption and expanding retail clinics can reduce costs by improving the continuity of
healthcare services and reducing waste by reducing the number of duplicate interventions
provided. Access to HIT and readily available primary prevention clinics can reduce avoidable,
ineffective, and duplicate services and the amount of money spent on illnesses that go too long
without treatment and end up in emergency rooms.

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Another positive cost saving idea brought to light by the current reform is increased
consumer involvement in their care. Encouraging shared decision-making processes increases
understanding, in turn improving adherence to proposed plans of care. Involving patients in their
care, promoting wellness and prevention will encourage healthy behaviors. Adopting healthy
behaviors will reduce the need for expensive diagnostic tests in the future. The ACA has
encouraged increased funding within the states for wellness and prevention programs. A healthy
population will require less utilization of costly resources in health care.
Controlling health care costs while promoting the best possible health outcomes is a large
responsibility for our country. The ACA has instituted multiple key policies to achieve cost
savings in the future. Encouraging appropriate payments for health care services, ensuring
accurate pricing and adopting innovative models of delivery are just a few positive ideas the
ACA has implemented to decrease cost. Reducing avoidable, ineffective, and duplicate services
and encouraging effective care plans will assist in reducing the amount spent on health care as
well. Last, but not least, the ACA has increased promotion of wellness and prevention in the U.S.
to encourage change in unhealthy behaviors. While these may not be error proof methods of
encouraging cost reduction, they will indeed place more focus on reducing the cost of health
care. Continuous assessment and improvements to health care delivery can assist in positive
ways to reduce healthcare spending overall.

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References

Belmont, E., Haltom, C. C., Hastings, D. A., Homchick, R. G., Morris, L., Taitsman, J., . . .
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DeVore, S., & Champion, R. W. (2011). Driving population health through accountable care
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Hussey, P. S., PhD., Eibner, C., PhD., Ridgely, M. S., & McGlynn, E. A., PhD. (2009).
Controlling U.S. health care spending -- separating promising from unpromising
approaches. The New England Journal of Medicine, 361(22), 2109-11.
doi:http://dx.doi.org/10.1056/NEJMp0910315
Kocher RP, Adashi EY. Hospital Readmissions and the Affordable Care Act: Paying for
Coordinated Quality Care. JAMA. 2011;306(16):1794-1795.
doi:10.1001/jama.2011.1561.
Health Reform's Medicaid Expansion. (2013, October 22). Retrieved May 15, 2016, from
http://www.cbpp.org/health-reforms-medicaid-expansion
Persad, G. (2015). Priority setting, cost-effectiveness, and the affordable care act.American
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Spinks, T. E., Walters, R., Feeley, T. W., Albright, H. W., Jordan, V. S., Bingham, J., & Burke, T.
W. (2011). Improving cancer care through public reporting of meaningful quality

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measures. Health Affairs, 30(4), 664-72. Retrieved from

http://search.proquest.com/docview/864025498?accountid=28644
Sultz, H., & Young, K. (2014). Health care USA: Understanding its organization and delivery
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