Health Care Delivery System
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The affordable care act
Main features for the provision of affordable care act
In the past one decade, the Affordable care act was passed by the U.S Congress to law. It strategized on almost every aspect of the delivery of healthcare services. It was also formulated in such a way that it would enhance more considerable efforts on the provision and prevention of more quality primary care to encouraged hospitals, doctors, and other healthcare providers to coordinate care through the act (Dolgin & Dieterich, 2011). The act provided that the provision of a more equitable and quality healthcare would be increased through the introduction of a federal level insurance exchange, which provided an online marketing strategy where individuals and small businesses would buy health insurance services (Blumenthal & Collins, 2014). Most of the provisions of the act were administered by the federal government with tax subsidies that were income related.
On matters of consumer protection, several ACA provisions were effected. These included the elimination of lifetime limit to which the coverage was to be restricted. The removal of the on the limits that were to be covered annually, preventing the prohibition to access of coverage except in cases where there was the involvement of fraud, and reforming the existing condition that prevented the inclusion of children from the health care coverage (Blumenthal & Collins, 2014). The act also provided that, all individuals and health plan groups were unconditionally obliged to provide coverage to any applicant, without discrimination (Dolgin & Dieterich, 2011). Before the ACA, health insurance providers that operated in the individual market were allowed had the permission to deny coverage to people based on the conditions of their health risk. The act also provided that all individual health plans and groups were obliged to provide benefits and coverage that is equal to all applicants.
On the coverage of preventive services, the act stipulates that all private health insurance plans are obliged to provide coverage for all preventive health services without demanding any payment from the patients. It also provides that the private health institution must cover for all additional set of preventive health services for women with no cost-sharing requirements. Another provision of the act is the expansion of dependent coverage to young adults. This rule was kept in effect to allow young adults to access healthcare services under the coverage of their parents until they turn 26 (Blumenthal & Collins, 2014). The act also provided different health plan benefit designs. It provided that the act had to make significant changes to health plan benefit designs. It provided uniform standards that were to apply for fro covered benefits and cost sharing in small markets and individuals. In the same case of health plan benefit design, it also provided that the state was the one with the obligation to select an EHB benchmark plan. This plan was the one to be used in the provision of the needed health benefit plans that were supposed to be offered by policies in the states instead of establishing a uniform benefits package that would be offered by all plans.
Leading arguments for and against this act
The Affordable care act have for a long period of time been received more negative than positive messages. This has provided misleading information about the main aims of the Act. The main aim of the ACA is to make healthcare services affordable for all American citizens and make sure that all citizens are provided with care at the best of its quality regardless of health, racial or social status of an individual (Blumenthal & Collins, 2014). For the Congress to offer ACA as an alternative, it had recognized that the high costs of Medicare and Medicaid and that of employee health benefits were becoming a huge budget for the federal government.
The main benefit of ACA is that it makes insurance affordable. Through ACA, middle-class citizens can get tax credits. As recorded in 2017, the act limits individual spending to $7, 150 and $14, 200 for a family plan. The act also increased Medicaid coverage by 187 percent of the federal poverty level, and it can provide the full healthcare coverage to adults for children without children for the first time (Dolgin & Dieterich, 2011). The case is however different from that advocated by the Trumpcare since the Medicaid expansion is to be eliminated by 2020.
In 2014, the federal government provided a provision that required states to have insurance exchanges or use the federal government exchange lessen the burden of getting an insurance plan. With the online insurance platform, health insurance coverage is made easier since all the required information about the service needed and the service provider can be accessed online. By allowing the coverage of young adults up to the age of 26, the Act aided in reducing healthcare cost (Blumenthal & Collins, 2014). The Act also provided that organizations with more than 50 employees were supposed to offer them with health insurance coverage, this aided in making sure that all employees health risks have been fully covered by the organization that they are working for.
Another importance of the ACA is that people with health conditions that were existing before the coverage are also able to get the health insurance coverage (Blumenthal & Collins, 2014). Before the Act was made a law, people with preexisting conditions such as cancer were not able to get health insurance coverage. Most insurance companies denied treatments for such people by providing an exception that the illness or the injury existed or occurred before one was covered by the plan. Under the ACA, everyone is covered regardless of once condition. It is also under ACA that there is no set limit for people with chronic illnesses. Before the act, health insurance companies had set limits on the amount of money that an individual consumer would spend (Dolgin & Dieterich, 2011). It is also only through the affordable act care that the cost of prescribed drugs was lowered. Before the act, many people, mostly the elderly citizens, were unable to cater for their medications. Within the first five years of the administration of Obamacare, a record of more than $16 billion on saving has been recorded.
The implementation of the Affordable Care Act, however, had its side effects. After its application, insurance companies were required to provide a wider range of benefits and were also to cover people with pre-existing conditions (Blumenthal & Collins, 2014). This led to an increase in health premiums for people who had already had health insurance. The act also led to the creation of new taxes to help in its payment. People with higher earnings were subjected to more tax payments while at the same time taking the savings that came from Medicare payment (Dolgin & Dieterich, 2011). Research has also indicated that businesses are reducing the working hours of their patients to avoid higher coverage. This provides a direct implication on job creation.
Leading arguments for and against universal healthcare
The main advantage of universal healthcare in the United States is that it ensures equal access to heal care. Through this health care system, people that are no able to access some healthcare services and care are able always covered. The provision of any healthcare service is always made available to everyone without keeping regard to their social status (Gluckman et al., 2008). Universal healthcare system also aids in the improvement of public health. Healthcare contribution is evenly distributed among the entire population hence, making sure that everyone can access the basic care that they need.
Universal healthcare has a platform that is easily navigated. Healthcare practitioners can concentrate on one patient at a time without being affected by like insurance and other healthcare related problems (Gluckman et al., 2008). The healthcare system also encourages entrepreneurship since people can start their businesses without having to fear the risk of losing their healthcare coverage.
The system, however, has its backdrops. It results in long waiting time, hence making access to care more difficult for others since there might lack enough time to cover all patients. Studies have indicated that the system leads to a socialism like a state (Shi & Singh, 2014). This can be seen in cases where the government raises its taxes to gather enough money for the coverage of healthcare. The government’s action of government increasing the level of taxes indicates a case of socialism where the government is the one that controls the distribution of goods and services. The U.S practices a system of a free market where the delivery of goods and resources is controlled by market forces (Gluckman et al., 2008). This could be an indication of the first step by the government to take control of other aspects of the economy.
The implementation and running of a universal health care system increase government debt and spending. Running a single health care system leads to increase in the level of taxes since the money being used to manage the system is being gained from the public (Shi & Singh, 2014). The current U.S government is spending a huge budget on healthcare more than any other developed country due to some of its programs like the Medicare and Medicaid.
Blumenthal, D., & Collins, S. R. (2014). Health care coverage under the Affordable Care Act—a progress report.
Dolgin, J. L., & Dieterich, K. R. (2011). Social and legal debate about the affordable care act.Gluckman, M. D., Liebow, M., McLean, R. M., Musana, K. A., Nichols, P. M., Purtle, M. W., … & Kathleen, M. (2008). Achieving a high-performance health care system with universal access: what the United States can learn from other countries. Ann Intern Med, 148, 55-75.
Shi, L., & Singh, D. A. (2014). Delivering health care in America. Jones & Bartlett Learning.