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The Patient Protection and Affordable Care Act (ACA): Past, Present, and Future Challenges

Long-term care services

Access the Redshelf book from the Getting Started module of the course. Read Chapters 10 and 13. Chapter 10 discusses long-term care services, including a definition of long-term care (LTC), community-based LTC services, institutional LTC, licensing and certification of nursing homes, other LTC services, Patient Protection and Affordable Care Act (ACA) and LTC, and the nursing home industry and expenditures. Chapter 13 discusses health policy, including a definition of health policy, principle features of U.S. health policy, development of legislative health policy, critical policy issues, and a comparison of international health policy. The Future of the Affordable Care Act and Insurance Coverage Glied, S., & Jackson, A. (2017). The future of the Affordable Care Act and insurance coverage. American Journal of Public Health, 107(4), 538-540. The article describes the patterns of coverage gains associated with the Patient Protection and Affordable Care Act (ACA) expansions and uses these patterns to assess the potential impact of alternative repeal or repeal and replace strategies because Congress and the president are weighing options to repeal or replace the ACA. The Affordable Care Act (ACA): It Gets Personal, Very Quickly Jacobson, G. P., & Pilch, S. (2019). The Affordable Care Act (ACA): It gets personal, very quickly. Journal of the American Academy of Audiology, 30(8), 656-658. The article present’s the authors’ views on the ACA and its role in the health care industry, including how to secure health insurance after retirement became a major issue for individuals; mentions that uninsured individuals may purchase comprehensive health insurance through health insurance marketplaces, or exchanges; and the aim to protect patients with very high costs. Repealing the ACA Without a Replacement - The Risks to American Health Care Obama, B. H. (2017). Repealing the ACA without a replacement - The risks to American health care. New England Journal of Medicine, 376(4), 297-299. In this article, President Barack Obama explains why Republicans’ plan to repeal the Patient Protection and Affordable Care Act (ACA) with no plan to replace and improve it is so reckless: doing so would jeopardize financial security and access to care for tens of millions of Americans. Expected and Unexpected Consequences of the Affordable Care Act: The Impact on Patients and Surgeons–Pro and Con Arguments Rudnicki, M., Armstrong, J. H., Clark, C., Marcus, S. G., Sacks, L., Moser, A. J., Reid-Lombardo, Km., & The Public Policy and Advocacy Committee of the SSAT. (2016). Expected and unexpected consequences of the Affordable Care Act: The impact on patients and surgeons–pro and con arguments. Journal of Gastrointestinal Surgery, 20(2), 351-360. The article provides a synopsis of the “pro” and “con” arguments for the expected and unexpected consequences of the ACA on society and surgeons. Health Care Reform in the United States: Past, Present and Future Challenges Stack, S. J. (2016). Health care reform in the United States: Past, present, and future challenges. World Medical Journal, 62(4), 153-157. The article provides information on aspects related to challenges linked with health care reforms of the U.S., including its past, present, and future. Topics discussed include support provided to citizens through the Patient Protection and Affordable Care Act (ACA) in 2010, costs related to the pattern of care, and access to public health. Improve the Affordable Care Act, Don't Repeal It Toussaint, J. S. (2016). Improve the Affordable Care Act, don't repeal it. Harvard Business Review Digital Articles, 2-6. This article provides a rundown of what should be kept, what should be discarded, and why, regarding the Patient Protection and Affordable Care Act (ACA), including payment system changes, public reporting of quality performance data, and the need to change the exchanges. Future of the U.S. Healthcare Delivery Systems Despite its challenges, the U.S. healthcare delivery system has recorded extraordinary and enviable successes, in addition to technological advancements. Still, according to Young and Kroth (2018), “…successes and accomplishments often have been offset by the system’s evident deficiencies of limited access, high cost, and variation in quality” (p. 372). The most recent effort to address these challenges has only raised more social, economic, and political questions. Some of these questions include the following (Lavin, Knutson, Wiesman, & Padmaja, n.d.; Lightly, n.d.): What is the definition of “value” in healthcare today and what should it be? What would life be like different under a single-payer healthcare system? How do we get prescription medication prices under control? How has removing the individual mandate from the ACA affected healthcare in the U.S.? What’s the biggest “blind spot” in healthcare today? These unanswered questions and ambiguities are evident by the continuous public debates around the fundamental direction of the ever-changing healthcare delivery system. So, where do you go from here regarding healthcare? How do you address issues of access regardless of socioeconomic status or geographic location? Should individuals go bankrupt because of their inabilities to afford the cost of healthcare? Should U.S. citizens be punished and excluded from coverage because of pre-existing conditions? If the system were able to guarantee access and cost-effective care, what might happen to the quality of care patients will receive? Can this country and system guarantee access, cost, and quality without sacrificing one for the other? The only thing certain in healthcare is change. The U.S. healthcare delivery system has been evolving and changing over the last six decades. Some of these changes include, but are not limited to, steadily decreasing mortality rates, adoption of electronic health records (EHRs), the introduction of telemedicine, and the proliferation of healthcare rankings (Becker's Healthcare Editorial Team, 2019; Ramirez, Kamal, & Cox, 2019; Tubbs, 2018). This week, you will examine one of the most notable changes, the implementation of the Patient Protection and Affordable Care Act (ACA) in 2010. This policy was an effort of President Barack Obama and his administration to increase access to high quality and affordable healthcare, which it did for many. In fact, before the ACA, six previous American presidents attempted to implement a universal healthcare system in the United States. Since then, the Act has faced support and scrutiny on both sides of the political front. When President Donald Trump took office in 2017, and with the Republican Party controlling both the U.S. Senate and the House of Representatives, the talk of repealing and replacing the ACA took center stage. One notable change that took place since the ACA was enacted had to do with the individual mandate requiring most Americans to enroll in health insurance. At the time, individuals were required to pay the greater of two amounts if they lacked qualifying coverage: one based on a percentage of income; another based on an inflation-adjusted dollar value. Financial penalties for failing to adhere to the individual mandate were assessed during the individual’s annual tax filing process; payments were made the year after the coverage lapse occurred. In 2017, Congress did away with financial penalties for failing to comply with the mandate (which became effective in 2019) (Eibner & Nowak, 2018, July 11). However, it must be noted that there could be consequences to repealing the ACA, such as new pressures on public health departments from the reduction in coverage gains and a diminished safety net (Glied & Jackson, 2017). The replacement proposals presented thus far could leave numerous Americans worse off than they were before the ACA was enacted. As you prepare your Signature Assignment this week, please keep in mind that for your Week 8 assignment, you will review and respond to the feedback provided for the Week 7 Signature Assignment. You will also reflect on the course content, concepts, and course competencies, and critically analyze and document how these elements impact and/or advance your career interests and degree program pathway. You will use an annotated bibliography to support your ideas in Week 8. References Becker's Healthcare Editorial Team. (2019, December 31). The decade in healthcare: 12 milestones we won't forget. Becker’s Healthcare. Eibner, C., & Nowak, S. (2018, July 11). The effect of eliminating the individual mandate penalty and the role of behavioral factors. The Commonwealth Fund. Glied, S., & Jackson, A. (2017). The future of the Affordable Care Act and insurance coverage. American Journal of Public Health, 107(4), 538-540. Lavin, L., Knutson, L., Wiesman, W., & Padmaja, S. (n.d.). 6 Questions on the future of healthcare with ?bamacare. Medical Alley. Lightly, M. (n.d.). 10 questions about healthcare, answered [blog]. The Sanders Institute. Ramirez, M., Kamal, R., & Cox, C. (2019, April 19). How has the quality of the U.S. healthcare system changed over time? Peterson-KFF Health System Tracker. Tubbs, F. (2018, February 28). Eight advancements that have changed the face of healthcare in the last 10 years. Electronic Health Reporter. Young, K. M., & Kroth, P. J. (2018). Sultz & Young’s health care USA: Understanding its organization and delivery. Burlington, MA: Jones & Bartlett Learning. Weekly Resources and Assignments Review the resources from the Course Resources link, located in the top navigation bar, to prepare for this week’s assignments. The resources may include textbook reading assignments, journal articles, websites, links to tools or software, videos, handouts, rubrics, etc. Assignment Instructions: From the beginning of the course, you have had the opportunity to learn about the many important factors driving the delivery of healthcare in the United States. You have done a deep dive into the characteristics and intricacies of the U.S. healthcare system, analyzed and examined the different sectors of the delivery system, and have learned the impact of different methods and sources of financing and expenditures on the healthcare industry. During President Donald Trump’s administration, the majority of Republicans in the U.S. Senate and the U.S. House of Representatives have tried to repeal and replace the Patient Protection and Affordable Care Act (ACA), signed into law by former President Barack Obama in 2010. As a healthcare administration student, you are doing an externship in the Office of the Chair of the U.S. Senate Committee on Health. During a staff meeting, a senator asks you for your opinion. Your Signature Assignment is to write a policy paper arguing for or against the repeal and replacement of the ACA. In your proposal to the senator, be sure to address the following: Provide a foundation for your position. Address the implications of repealing or sustaining the ACA considering the issues of access, cost, and quality of care. 

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