BUSI 523 LU Business Affordable Care Act Timeline Discussion Replies

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Jacob Russell

In the years preceding the Affordable Care Act (ACA), healthcare costs had been rising rapidly, outpacing other components of American citizens’ expenditures. Previous efforts to curtail this included setting up managed care organizations, but while these did much to curtail the rate of rising healthcare costs, they did not extinguish the disproportional nature of these increases. A sizeable chunk of Americans were also uninsured, and insurance was continuing to creep up in price. To remedy this, the ACA established ten different goals, each of which was given its own title number: Providing quality affordable healthcare for all Americans, expanding public programs, improving the quality and efficiency of healthcare, preventing chronic disease and improving public health, augmenting the healthcare workforce, maintaining transparency and healthcare program integrity, improving access to innovative medical interventions, supporting community living assistance services, creating provisions for revenue in the healthcare industry, and reauthorizing the Indian Health Care Improvement Act (Harrington, 2021).

Since its implementation and progressive development, the quality of care that Americans received has been noticeably affected. The realization of the ACA’s ten titles began with the introduction of new consumer protections in 2010, such as improving consumers’ ability to compare insurance coverages, in addition to holding insurance companies’ feet to the fire when they raised their rates. The following year saw the ACA expanded to apply discounts for prescription drugs, as well as focusing on preventative care, home care, and insurance company accountability. 2012 then saw the ACA introducing value-based purchasing and accountable care organizations, which were meant to bolster infrastructure. 2013 focused on improving coverage and starting up the health marketplace, while 2014 saw the ACA rolling out mandates against setting premiums based on a patient’s preexisting conditions; 2014 also saw attempts to give tax credits for the middle class, as well as expanding Medicaid to cover everyone who fell below the middle class. 2015 was when the ACA finally started winding down, shifting to the longer-term goal of improving healthcare quality while reimbursing providers based on the quality of the care they provide (Harrington, 2021). Specific examples of how the ACA has affected others can vary considerably, but there are some more commonly cited examples. For dependents, they could remain covered by their parents’ own health insurance until they turned 26, which was up from the age of 19. Medicaid was also expanded to cover people who were “lower-class,” but not necessarily impoverished. Another notable overhaul was the establishment of the health insurance marketplace, which consolidated insurance plans into a single database that could be tailored to an individual’s needs. Additionally, insurance companies could no longer hinder coverage based on preexisting conditions; a notable exception to this is asking patients if they smoke, which still raises their premium, but curiously fails to lower that patient’s rate of smoking (Zhao et al., 2020).

The inability for an insurance company to recoup risks from taking on individuals with preexisting conditions may seem like a risky proposition, especially if it raises default premiums even higher. This has given the ACA mixed feedback, especially in terms of its popularity (Béland et al., 2019), but the ACA does not leave insurance companies completely defenseless. A process exists for filing appeals for healthcare-related services when they are delayed or denied by an insurance company. First, an insurance company must notify an affected individual in writing that they were denied and the reasons for it, as well as clarify that they have the right to file an appeal as well as request an external review; they must also include resources such as Consumer Assistance Programs to help them debate the matter. Afterwards, if an individual wishes to dispute the denial, they must question the insurance company’s decision in writing. After the company reviews its own decision and compare the rationale against its policies, it may continue to deny the claim, but the individual will be entitled to bring forth a third-party arbitrator for external review. All in all, there were many issues to tackle with the United States healthcare system at the time of implementation, and it is for this reason that the political momentum existed to cobble together such a comprehensive bill. While the individual components can be picked apart, this is not the first time we have encountered an all-encompassing answer to our problems. As we are reminded by Christ Himself in John 16:33, “I have said these things to you, that in me you may have peace. In the world you will have tribulation. But take heart; I have overcome the world” (Crossway, 2001). It is important, therefore, to master ourselves before trying to master the world around us.

Allinson Mejia

The Affordable Care Act (ACA), also known as Obamacare, was signed into law by President Barack Obama on March 23, 2010. The ACA aimed to increase access to quality healthcare for millions of Americans, improve the quality of care, and reduce healthcare costs. To understand the timeline of the ACA and its influence on the quality of care delivered to beneficiaries, as well as the process for filing an appeal for delayed or denied healthcare services. In 2010 the ACA was implemented. In 2011 the ACA established CMMI which tested new payment and service methods. In 2012 the Supreme Court upheld the ACA but allowed states to opt out of the Medicaid expansion provision. This led to a patchwork implementation across the country, with some states expanding Medicaid coverage and others not (Larrat et al.,2013). On January 2, 2013, President Obama signed the American Taxpayer Relief Act (ATRA) into law after a protracted negotiation with Congress to avoid the fiscal cliff of automatic tax increases and cuts in federal expenditures. Two key ACA programs were eliminated (Larrat et al.,2013). In 2015 the CCIIO was formed to assist with implementing state level marketplaces and ongoing ACA reforms. In 2016 the ACA implemented the Merit-Based Incentive Payment System as part of the Quality Payment program. This aimed the promation of value-based care by adjusting Medicare reimbursement based on performance measures such as quality, cost, and practice improvement. In 2017 some changes were made from the Trump administration, and in 2021 the Biden Administration played a role in some changes due to the impact of COVID-19 with the American Rescue Plan Act.

The ACA brought several reforms that aimed to improve the quality of care. One of the programs the ACA made is the Quality Reporting and Payment Programs. The ACA established various programs that incentivized healthcare providers to report on quality measures and improve care. These programs, such as the Hospital Value-Based Purchasing Program and MIPS, encouraged providers to focus on quality, patient safety, and improved outcomes. The ACA promoted the formation of ACOs, which are networks of healthcare providers who coordinate care for patients. ACOs incentivized providers to deliver high-quality care while controlling costs. Programs like the Merit-based Incentive Payment System (MIPS), the Hospital-Acquired Condition Reduction Program, and the Hospital Readmission Reduction Program. These programs emphasize cost, quality, and access to create a healthier population (Shenoy, 2021). In an article they defined MIPS as “the default track for clinician participation in the Quality Payment Program (QPP) that adjusts future payment rates for Medicare Part B services based on composite performance across four measures: Quality, Clinical Practice Improvement Activities, Advancing Care Information, and Resource Use” (Shenoy, 2021).

The process of filing an appeal for a delayed or denied healthcare service has several consumer protections to ensure indivuals have the right to appeal insurance company decisions. The ACA has four key components when dealing with appeals and denials (Pollitz, 2021). The first one is internal appeals which starts with submitting a written appeal and submitting the necessary documentation. The second component is external review which if the internal appeal is unsuccessful then this would play into place. This allows an independent third party to review the case. The ACA also has set up timeline for both internal and external appeals to ensure timely resolution regarding the disputes. The last component is continuation of coverage while states that during the appeal process, beneficiary have the right to continue receiving coverage for their services.