Capstone Project: Affordable Care Act Health Care Reform

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Affordable Care Act

The Affordable Health Care Act

The hospital industry is comprised of many different sectors including, but not limited to, non-profit and for-profit hospitals, safety net hospitals and teaching hospitals among others. Because the sectors are so varied, it is surmised that the Affordable Care Act, which was enacted in March of 2010, will have different effects for each different sector and individual hospital. There are certain hospitals that have always given either low-cost or no-cost health care to uninsured patients and it is posited that these hospitals will gain the most in relation to the uncompensated care that they have given patients. It is believed that there are substantial provisions within the Affordable Care Act that will have a beneficial effect on recovering unsustainable losses incurred through uncompensated care by a hospital that already provides ample charitable services. To understand some of these provisions within the Affordable Care Act, it is important to review the U.S. health care system's history to understand how the new Act will impact hospitals. It is also necessary to discuss some of the negative impacts of the Act and how these beneficial aspects can outweigh the negative.

Introduction.

The idea of a national health insurance first came about in 1915 when the American Association for Labor Legislation tried to introduce a medical insurance bill to some state legislatures, according to Ramachandran (2010). These attempts, of course, did not work; however, what did work was the fact that the idea about a national insurance came to light and thus a controversy. There were several national groups that supported government supported health care -- including groups like the AFL-CIO, the American Nurses Association, the National Association of Social Workers, the Socialist Party USA, the American Medical Association, and the Life Insurance Association of People (2010).

When President Franklin D. Roosevelt signed the Social Security Act in 1935, medical benefits were not a part of the bill. Roosevelt had considered putting in some kind of national health care clause, but he did not think that Americans were ready for it. President Harry Truman also liked the idea of a national health care and tried to put it into his Fair Deal program. This too was not successful, although Truman was able to put some attention on the need for increased medical care for the elderly (Ramachandran 2010). Eisenhower also supported this argument and created the Ways and Means Committee to bring attention to the cause, but there was never any legislative action that resulted from it. It should be noted that there were a couple of bills that have paved the way for Obama's Affordable Care Act. One of those was the Kerr-Mills Act of 1960 which gave states the authority to decide which patients needed financial assistance and which did not (2010). At the states' decree, the federal government would provide individual assistance. Most of the states, however, did not take part in this Act. There was one other preliminary bill, the King-Anderson Bill, which was created in 1962, that stated some hospitals and nursing home costs for patients 65 and older would be covered. This bill was defeated in committee, although the vote was quite narrow (12-11); this signaled a sort of change in attitudes. This was the what enabled President Johnson to include in his "Great Society" program Medicare and Medicaid programs as part of the Social Security Act of 1965, giving 19 million Americans health care coverage (2010).

The effects of the Medicare and Medicaid on the United States economy is very clear today as overall health care comprises 1/6th of the U.S. economy (Ramachandran 2010) -- that's about $600 billion annually. Obama's Affordable Care Act will cost approximately $940 billion over the next decade. This is a major cost to provide medical care to nearly all U.S. citizens.

Where are we as a nation without healthcare? Why is the Affordable Care Act something so long in the making? During the 2008 elections, an imminent collapse of the American health care system was at hand. There were three "symptoms" (Brown 2008) being discussed: first, without any kind of affordable universal coverage, the system leaves an estimated 47 million Americans without health insurance (2008); second, health care costs are exorbitant ("the United States spends about 16% of its annual & #8230;GDP, or $6,400 per capita, on health care, whereas France…covers virtually its entire population reasonably well at 11% of GDP and half the per capita spending" (2008)); third, the U.S. health care system cannot logically be called a "system;" it is, according to Brown (2008), "an incoherent pastiche that has long repulsed reforms sought by private and public stakeholders" (2008).

The question still remains, why now? The answer may be due to the fact that the American Medical Association and the pharmaceutical industry supported the Act to a certain extent. There isn't anything in the new Act that fundamentally threatens their livelihood. If there was, it is doubtful that the bill would have passed today -- nearly 70 years after Roosevelt's first glimmering idea of a national health care system. President Obama seemed to have learned something from Clinton's past mistakes of trying to deal with the problems of coverage and cost at the same time. Containing costs is just too threatening to too many health care interests. So the first part of the task has got to be to get the uninsured covered. The second part will have to be in addressing costs to keep the new system of healthcare up and running. If we are to take out the issues of cost then we can understa

President Obama signed the highly anticipated -- and highly controversial -- Affordable Care Act into law on March 23, 2010 with the goal of putting American consumers back in the driver's seat when it comes to controlling their health coverage and care. This was a landmark in U.S. social legislation and something that most Americans felt was long overdue. President Obama said, "…the bill I'm signing will set in motion reforms that generations of Americans have fought for and marched for and hungered to see," enshrining, "the core principle that everybody should have some basic security when it comes to their health care" (Jacobs & Skocpol 2010).

One of the major factors that needs to be contemplated when evaluating the impact of national health care is what will become of the safety-net programs that service around 100 million Americans? Redlener and Roy (2009) state that the whole concept behind safety-net programs is to guarantee that all citizens' -- regardless of their social or economic situations -- access to fundamental services falls below a certain point. Today's health care safety-net is a multifaceted collection of entitlements, specialty services (e.g., care for people with HIV / AIDS), hospital-based programs, and emergency care services that is designed to facilitate access to important health care for the people who are medically underserved, uninsured, or underinsured. The U.S.'s biggest safety-net programs are, of course, Medicare and Medicaid (often referred to as "entitlement" programs) (2009) and they are legally protected form having eligibility thresholds lowered below federally established standards (2009). The State Children's Health Insurance Program (SCHIP), created in 1997, is the newest addition to the safety net; its incorporation into the system means that numerous children in the U.S. have a regular source of health care, which includes preventative services (2009). Laws that require hospitals that receive federal funds provide care for anyone seeking emergency treatment (regardless of citizenship or ability to pay) are also a part of the safety net (2009). Disproportionate Share Hospital programs are also a part of the safety net and they are facilities that will receive some kind of compensation (at least partial) when they provide a disproportionate share of otherwise uncompensated care to the poor and underinsured (2009).

Still, even with multiple safety-net options, including community health centers, public hospitals, and clinic, at least 22,000 people died in the United States in 2006 because they lacked health insurance and had limited access to medical care. And the number of deaths related to lack of coverage has been increasing by about 1000 every year (Redlener & Grant 2009).

There are two major elements that will affect the structure, function, and mission of the safety net in the future -- that is beyond the rise and fall of the democrats and republicans. The first element is, undoubtedly, the recession. In a survey that was conducted in 2009 by the American Hospital Association, 9 out of 10 hospitals reported service reductions because of the current economic conditions, and nearly half of them had to cut staff. One-fifth of those had to reduce community services such as mental health care, patient education, and community clinics, and 8 out of 10 had cut back on facility and technological upgrades, including upgrades in the area of electronic health records. The combination of increased demand and greatly diminished resources has placed enormous stress on the safety net. The second element… [END OF PREVIEW]

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