Effects of a Healthcare Reform on Stakeholders

The Accountable Care Act or the Obamacare is an act that has increased healthcare access for many US citizens and has dramatically addressed the gap in n healthcare access and healthcare coverage. The ACA is an act that was enacted in 2010 and was developed to increase access to healthcare insurance by providing subsidies to help lower premiums for individuals with low household incomes. Medicaid expansion is the primary development under the healthcare law reform. Medicaid raised the eligibility for the program to about 137% of the national poverty level and lifted restrictions on having dependents and pregnant mothers’ access to quality healthcare services (McKenna et al., 2018). The Act has various effects on different stakeholders, as shall be discussed in this essay.

Stakeholders Affected by the ACA

The Act affects stakeholders differently. The primary aim was to increase access to healthcare services because financial barriers have been for long the most significant barriers to access quality healthcare services. ACA requires input from the state and federal governments (implementers), patients (consumers/ beneficiaries), and health care providers (Consumers) (McKenna et al., 2018). The state and federal governments are the implementors of the Act. The federal government provides incentives for the acts’ implementation. The state government decides whether to implement the Act and to what extent the Act will be implemented. The healthcare institutions are the providers of healthcare services and have several stipulated roles by the ACA. The Act will impact them directly and indirectly as both implementors and consumers of the Act (McKenna et al., 2018). Patients are the primary beneficiaries of the ACT. As mentioned earlier, the Act will increase access to quality healthcare services which will considerably affect their health. The ACT has succeeded in achieving its objectives variably but has several drawbacks, as this paper will address in subsequent sections.

The Financial Impact of the ACA on Each Group Of Stakeholders

The affordable care act has had various financial implications on the state and federal governments. The first effect was increased healthcare spending because the federal and state governments share the costs implied by the ACA. At the beginning of the program, the federal government covered all costs of the coverage for the newly added individuals from the Mandatory Medicaid savings already documented, and the coverage rates have decreased gradually, leaving up to a 10% burden on the state governments (McKenna et al., 2018). The ACA presents higher spending and fiscal deficits that threaten the program’s sustainability.

The financial institutions have benefitted significantly, including reducing uncompensated healthcare costs by expanding healthcare insurance coverage and healthcare services access. The Act has reduced the financial strain on healthcare institutions by creating a shared pool of funds, allowing institutions to focus on quality and safe patient care delivery (McKenna et al., 2018).

Patients have significantly benefitted from the ACA subsidized healthcare insurance coverage. They also have access to healthcare services for premiums way lower than the usual healthcare costs. However, the Act has led to a rebound increase in taxes to cover the federal and state governments (Caswell, K. J., & Waidmann, 2019).

Benefits of the ACA n Each Group of Stakeholders

The state and federal governments have significantly benefitted from the ACA. The ACA has achieved its primary goal and objective of increasing healthcare insurance coverage. More than 17 million Americans acquired healthcare insurance through the ACA by 2016, a considerable step towards achieving the national coverage targets (Mazurenko et al., 2018). Insurance coverage has helped reduce the federal burden of diseases through their early detection and management. The effects have been reduced healthcare sending of chronic and severe conditions because they are well-managed early in their progression (Mazurenko et al., 2018).

The Act has increased access to and utilization of healthcare services to the patients. The ACA has improved access to emergency care, prescription drugs, mental health, and home care services (Tilhou et al., 2020). These services are also available at affordable costs. Individuals with underlying conditions are protected from insurance coverage discrimination hence access to quality care and better quality of life. The ACA has led to increased quality of patient healthcare services, an added advantage to the patients.

Healthcare institutions, through the ACA, receive incentives to prevent readmissions and improve post-discharge care, thus enhancing the quality of care they provide (Tilhou et al., 2020). They are also compensated depending on the perceived care quality; hence the institutions strive to provide quality care, thus, improving their care delivery processes and patient-care provider relationships. However, conflicting studies claim that the impact has been negligible and, in some instances, negative in some healthcare institutions (Young et al., 2019).

Drawbacks of the ACA on Each Group Of Stakeholders

The major drawback of the ACA to the federal and state governments is the financial implications of the ACT. The ACT has significantly affected the Act’s sustainability, and as identified earlier, the national government has been reducing its incentives, leaving the burden to the state governments. Many state governments have refused the ACA with claims of limited healthcare funding and the program’s unsustainability (McKenna et al., 2018). The high healthcare spending from the government reduces the availability of funds for other government sectors, which may hinder or deteriorate economic development.

The government derives its funding from taxes, which means that individuals are the source of healthcare funding sources. The ACA has been, on many occasions, associated with increased tax burdens to the citizens/patients. Insurance companies also raised their premiums for individuals already in their systems. The minimum essential coverage also saw more than 30million Americans lose their insurance coverage to obtain new insurance that meets the stipulated standards (Caswell & Waidmann, 2019). Thus, despite the high effectiveness of the ACA, it also had various drawbacks that still require amendment. According to Duggan et al. (2022), the Act has addressed insurance coverage but has not addressed the burden of healthcare racial disparities.

Healthcare institutions suffer low compensation, especially when the quality of care is falsely perceived as inferior. The Act has placed unnecessary pressure on healthcare institutions, and the uneven distribution of funds reduces competition and hospital staff morale (Young et al., 2019). The Act has hurt more hospitals, especially for-profit hopsitals than benefitted them in many instances. However, leveraging the current benefits can help improve healthcare institutions and coverage.

Conclusion

The affordable care act provided one of the most extensive healthcare reforms in the United States. The Act has had marked success in its initial goals and objectives, generally improving insurance coverage in the US population. The Act has various financial implications on both the providers (state and federal governments) and the beneficiaries (healthcare institutions and patients). It has both negative and positive effects on the various stakeholders. Various issues such as the sustainability of the Act are stated in debates, and balancing the outcomes to ensure mutual benefits will increase its effectiveness and program continuity. Nurses should be aware of the Act to help the patients access quality care, and institutions comply with the regulations.

References

Caswell, K. J., & Waidmann, T. A. (2019). The affordable care act Medicaid expansions and personal finance. Medical Care Research and Review76(5), 538-571. https://doi.org/10.1177/1077558717725164

Duggan, M., Gupta, A., & Jackson, E. (2022). The impact of the Affordable care act: evidence from California’s hospital sector. American Economic Journal: Economic Policy14(1), 111-51. https://doi.org/110.1257/pol.20190279

Mazurenko, O., Balio, C. P., Agarwal, R., Carroll, A. E., & Menachemi, N. (2018). The effects of Medicaid expansion under the ACA: a systematic review. Health Affairs37(6), 944-950.https://doi.org/10.1377/hlthaff.2017.1491

McKenna, R. M., Langellier, B. A., Alcalá, H. E., Roby, D. H., Grande, D. T., & Ortega, A. N. (2018). The Affordable Care Act attenuates financial strain according to poverty level. INQUIRY: The Journal of Health Care Organization, Provision, and Financing55, 0046958018790164. https://dx.doi.org/10.1177/0046958018790164

Tilhou, A. S., Huguet, N., DeVoe, J., & Angier, H. (2020). The Affordable care act Medicaid expansion positively impacted community health centers and their patients. Journal of General Internal Medicine35(4), 1292-1295. https://doi.org/10.1007/s11606-019-05571-w

Young, G. J., Flaherty, S., Zepeda, E. D., Singh, S., & Rosenbaum, S. (2019). Impact of ACA Medicaid expansion on hospitals’ financial status. Journal of Healthcare Management64(2), 91-102. https://doi.org/10.1097/JHM-D-17-00177

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