The Affordable Care Act (ACA) became law in 2011 and despite efforts to overturn it, it is still the rule of the land.

  • Find at least two of the provisions of the ACA that influences decision making in health care organizations related to access, quality or cost of care.
  • Describe the provisions.
  • Share your perceptions of their effectiveness.

Submission Instructions:

  • The paper is to be clear and concise and students will lose points for improper grammar, punctuation and misspelling.
  • The paper should be formatted per current APA and 3-5 pages in length, excluding the title, abstract and references page. Incorporate a minimum of 3 current (published within last five years) scholarly journal articlesor primary legal sources (statutes, court opinions) within your work.
  • Complete and submit the assignment by 11:59 PM ET on Sunday.
  • Late work policies, expectations regarding proper citations, acceptable means of responding to peer feedback, and other expectations are at the discretion of the instructor.
  • You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date.

Affordable Care Act Provisions

Title: Impact of Key Provisions of the Affordable Care Act on Decision Making in Healthcare Organizations

Abstract: The Affordable Care Act (ACA) of 2011 introduced significant reforms in the U.S. healthcare system aimed at enhancing access to care, improving its quality, and controlling costs. This paper explores two key provisions of the ACA that influence decision making in healthcare organizations, discussing their provisions and evaluating their effectiveness.

Introduction: Since its enactment in 2011, the Affordable Care Act (ACA) has been a central piece of legislation in the U.S. healthcare system. Despite attempts to repeal or overturn it, the ACA remains in effect, shaping the landscape of healthcare delivery. This paper aims to analyze two provisions of the ACA that impact decision making within healthcare organizations, focusing on their implications for access, quality, and cost of care.

Provisions Influencing Decision Making:

  1. Medicaid Expansion: One of the pivotal provisions of the ACA was the expansion of Medicaid eligibility to cover individuals with incomes up to 138% of the federal poverty level. Prior to the ACA, Medicaid eligibility criteria varied widely among states, leading to disparities in coverage. The expansion aimed to provide coverage to millions of low-income individuals who were previously uninsured.

Under the ACA, the federal government offered funding to states to expand their Medicaid programs. While the federal government initially covered 100% of the costs associated with expansion, the share gradually decreased to 90% by 2020. However, several states chose not to expand their Medicaid programs, citing concerns about long-term costs and the role of the federal government in healthcare.

Effectiveness: The Medicaid expansion has had a significant impact on access to care for low-income individuals. Studies have shown that states that expanded Medicaid experienced greater reductions in the uninsured rate compared to non-expansion states. Additionally, expansion states reported improvements in healthcare outcomes and financial stability for hospitals serving low-income populations.

However, challenges remain, particularly in states that have chosen not to expand Medicaid. Disparities in coverage persist, leaving millions of individuals without access to affordable healthcare. Furthermore, the debate over the long-term sustainability of Medicaid expansion continues, with some questioning the fiscal implications for both states and the federal government.

  1. Accountable Care Organizations (ACOs): Another key provision of the ACA aimed at improving the quality and efficiency of healthcare delivery is the establishment of Accountable Care Organizations (ACOs). ACOs are networks of healthcare providers that collaborate to coordinate care for Medicare patients. They are incentivized to deliver high-quality care while controlling costs through shared savings arrangements.

Under the ACA, ACOs are required to meet quality performance metrics set by the Centers for Medicare and Medicaid Services (CMS). These metrics assess various aspects of care delivery, including patient satisfaction, preventive services, and management of chronic conditions. ACOs that meet or exceed these quality benchmarks are eligible to share in the savings generated from improved care coordination and cost-effective practices.

Effectiveness: The implementation of ACOs has shown promise in improving care coordination and reducing unnecessary utilization of healthcare services. Studies have demonstrated that ACO participation is associated with improvements in patient outcomes, such as reduced hospital readmissions and better management of chronic diseases. Furthermore, ACOs have been credited with slowing the growth of healthcare spending, leading to cost savings for Medicare.

However, the success of ACOs varies across organizations and regions. Challenges such as care coordination barriers, data interoperability issues, and financial sustainability concerns have been reported by some ACOs. Additionally, the long-term impact of ACOs on healthcare quality and costs remains to be seen, as the program continues to evolve and adapt to changing healthcare dynamics.

Conclusion: The Affordable Care Act introduced several provisions aimed at transforming the U.S. healthcare system to be more accessible, higher quality, and cost-effective. Two key provisions discussed in this paper, Medicaid expansion and Accountable Care Organizations, have had significant implications for decision making within healthcare organizations. While both provisions have shown promise in improving access to care and enhancing quality, challenges and uncertainties remain. Continued evaluation and refinement of these provisions are essential to realizing the ACA’s goals of a more equitable and efficient healthcare system.

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