Why We Need The Affordable Care Act Now More Than Ever

Why We Need the Affordable Care Act Now More than Ever
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This post was co-authored by Melissa Kalensky, DNP, Family Nurse Practitioner and Assistant Professor, Rush University College of Nursing, Chicago, IL @MelissaKalensky

Tuesday was the first day of open enrollment, giving people the option to change health plans made possible by the Affordable Care Act. And persons might want to find cheaper ones, because as we’ve heard earlier this week, premiums in some states are on the rise.

That said, the Affordable Care Act has by no means failed.

Something had to change. We spent more per capita on health care than any of the other 30 most industrialized countries, in fact, three times as much, and even so, our health outcomes left a lot to be desired. The Affordable Care Act was the first major overhaul of federal healthcare legislation in nearly 50 years.

Although democrats and moderate republicans tout the Affordable Care Act’s ability to provide 26 million Americans health insurance by 2017, which we agree was needed, impetus for reform also included lesser publicized issues of cost and quality. Uncontrolled U.S. healthcare spending coupled with less-than-ideal health outcomes could no longer be ignored.

When examining the data, many of the failure claims are largely unfounded. And while Obama’s name has been frequently used as a subtitle for the Affordable Care Act, legislation on this scale most certainly required bipartisan support to pass. Furthermore, despite a seemingly impossible-to-understand scheme of rules and regulations, the Affordable Care Act has three simple goals, all of which have been accomplished since its stepwise implementation just six years ago.

Attenuation of Rising Healthcare Costs

Perhaps surprising, since the institution of governmentally funded healthcare in 1965 (e.g. Medicare and Medicaid), total costs have steadily risen ― every single year. That is, until the Affordable Care Act.

For the first time in 50 years, costs have begun to level off. Although increasing Medicaid coverage may create a short-term rise in expenditures, we’ve already seen some of the practical and financial benefits of allowing more consistent access to healthcare providers nationwide. Annual growth of Medicare spending in particular has decreased from 6.5% in 2000 to just 1.1% since 2010. Likewise, projections by the Congressional Budget Office predict Medicare costs will decrease by 20% over the next 3 years, with a potential cost savings of $160 billion in 2019 alone.

That looks like financial success to us, but what about health outcomes?

Incentivizing Value

Instead of the old system that rewarded providers for the quantity of care they provided (the more tests and procedures performed, the more money providers could bill for), the Affordable Care Act has shifted the incentive to quality. Payment reforms instituted reimbursement for quality of care, which established the definition of success in healthcare delivery as one that mandates quality. For primary care providers, this has launched Accountable Care Organizations, which allow patients more frequent contact with care providers and reward organizations who meet quality standards while saving money. For hospitals, measures to financially penalize institutions for preventable costs have resulted in significantly reduced rates of hospital acquired infection and readmission to the hospital within 30 days of discharge.

The bottom line is that by creating a system that financially rewards quality, we will improve the quality of care that people receive.

Improving Access

Between 2010 and 2015 the Affordable Care Act has decreased the number of uninsured Americans by 43%, resulting in over 20 million people who now have access to healthcare. Many newly insured individuals include women and minorities who historically haven’t had equitable access to care, particularly for preventative services with no out-of-pocket cost. Additionally, insurers are no longer allowed to deny coverage based on preexisting conditions. This included the elimination of prior coverage discrimination based on gender, such as the 92% of plans that charged women more for the same coverage, all while not paying for maternity services or contraception.

In short, today we have more people covered than ever before, and the majority of those people have access to better quality of care, with less out-of-pocket costs.

Flaws in the System

Although a vast improvement over pre-2010 coverage, the Affordable Care Act isn’t perfect. It still leaves approximately 24 million Americans uninsured. Unfortunately, this is often due to high insurance premiums, which sometimes leave those who are self-employed (and small businesses) out in the cold. Medicaid coverage in particular has been a challenge, with 19 states still opting out of expanding coverage, meaning that patients in lower income brackets may lack care they desperately need.

What’s Next?

Although short-term data are optimistic, long-term sustainability will require the entire marketplace to transition to value based care with a clear emphasis on quality. Such a transition will be challenging but necessary to allow the system to balance the cost of care between young healthy people and their older (and often) sicker counterparts.

As Secretary Clinton said in the second presidential debate, the Affordable Care Act has moved the US healthcare system in the right direction and current problems are fixable. Many challenges in healthcare policy lie ahead, however, continued bipartisan support prioritizing America’s healthcare needs has the potential to push forward a system-wide evolution that’ll ultimately benefit everyone. Regardless of what you want to call it, the Obama administration’s Affordable Care Act has improved the system in terms of cost, quality and access.

With one of our county’s most pivotal elections just around the corner, like other healthcare providers, we can only hope leaders place patient welfare at the center of the healthcare coverage argument. With many GOP members in key positions vowing to dismantle the Affordable Care Act, many nurses, physicians and other health care providers will be hoping for democratic wins in November to continue the important policy work necessary to provide our patients with the highest quality care, which they deserve.

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