5.2 Impact on Healthcare Delivery and Access
2 min read•july 24, 2024
The (ACA) reshaped healthcare in the US. It expanded insurance coverage through Medicaid, marketplaces, and mandates, while also changing how care is delivered and paid for.
The ACA's impact was far-reaching. It boosted preventive care, tackled costs through subsidies and reforms, and aimed to improve quality through new care models like ACOs. These changes affected access, delivery, and affordability of healthcare nationwide.
Impact of the Affordable Care Act on Healthcare Delivery and Access
Effects on uninsured population
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- increased eligibility for adults under 65 with income up to 138% of federal poverty level, adopted state-by-state
- required most Americans to have health insurance or pay penalty, encouraged younger, healthier individuals to join insurance pool
- provided platform to compare and purchase plans, offered subsidies for low and middle-income individuals
- allowed young adults to stay on parents' plans until age 26
- prohibited insurers from denying coverage based on health history
- Uninsured rate decreased significantly, varied across demographic groups (racial minorities, low-income individuals)
Changes in healthcare delivery models
- (ACOs) formed networks sharing financial and medical responsibility, focused on coordinated care and improved outcomes
- (PCMHs) emphasized primary care coordination with team-based approach
- shifted from fee-for-service to pay-for-performance, incentivized quality and efficiency
- combined different levels within one organization, improved communication and continuity
- and digital health increased remote monitoring and consultations, improved access in rural areas
Impact on preventive care
- Mandatory coverage of without cost-sharing (vaccinations, screenings, counseling)
- emphasized through workplace programs and community initiatives
- focused on prevention and management (diabetes, heart disease)
- funded initiatives addressing priorities (obesity, smoking cessation)
- expanded coverage (contraception, breast cancer screening)
- addressed through efforts to reduce access gaps among populations
Influence on healthcare costs
- provided tax credits for lower-income individuals, impacted affordability of marketplace plans
- lowered out-of-pocket costs for eligible individuals
- implemented medical loss ratio requirements and rate review processes
- Healthcare spending growth rate changed, affecting national expenditures
- Employer-sponsored insurance saw shifts in offerings and employee costs
- Medicaid expansion impacted state budgets through federal funding and long-term implications
- Prescription drug cost control efforts increased generic approvals and negotiations in some programs
- Long-term strategies focused on innovative payment models and reducing unnecessary care
Key Terms to Review (20)
Accountable Care Organizations: Accountable Care Organizations (ACOs) are groups of healthcare providers and organizations that voluntarily come together to provide coordinated high-quality care to their patients. The goal of ACOs is to improve patient outcomes and reduce healthcare costs by emphasizing preventive care, efficient resource use, and collaboration among healthcare professionals.
Affordable Care Act: The Affordable Care Act (ACA) is a comprehensive healthcare reform law enacted in March 2010 aimed at expanding access to health insurance, improving the quality of care, and reducing healthcare costs. The ACA introduced several key provisions that transformed the healthcare landscape and directly impacted delivery systems, legal frameworks, and future healthcare policies.
Chronic Disease Management: Chronic disease management refers to a comprehensive, proactive approach designed to improve the health outcomes of individuals with chronic conditions, such as diabetes, hypertension, and asthma. This strategy focuses on ongoing care, education, and support to help patients better manage their diseases, ultimately enhancing their quality of life and reducing healthcare costs. Effective chronic disease management aims to provide coordinated care that addresses both the medical and lifestyle needs of patients.
Cost-sharing reductions: Cost-sharing reductions (CSRs) are discounts that lower the amount a person has to pay out-of-pocket for healthcare expenses, such as deductibles, copayments, and coinsurance. These reductions are specifically designed to make health insurance more affordable for individuals and families who qualify based on their income levels, thus enhancing access to healthcare services. By lowering the financial burden on insured individuals, CSRs play a critical role in improving healthcare delivery and ensuring that essential services remain accessible to those in need.
Dependent Coverage Extension: Dependent coverage extension refers to the provision that allows young adults to remain on their parent's health insurance plan until they reach a certain age, typically 26. This policy aims to improve healthcare access for younger individuals, ensuring they have coverage during critical transitional phases such as education and early career development, thus positively impacting their overall health outcomes.
Health Disparities: Health disparities refer to the preventable differences in health outcomes and access to healthcare that exist among different population groups. These disparities can be linked to various factors including socioeconomic status, race, ethnicity, geographic location, and access to health services, leading to inequitable health outcomes and experiences. Understanding these disparities is essential for improving healthcare delivery and ensuring culturally competent care that addresses the unique needs of diverse communities.
Health insurance marketplaces: Health insurance marketplaces are platforms established to facilitate the buying and selling of health insurance plans, created under the Affordable Care Act (ACA) to increase access to affordable coverage. These marketplaces provide consumers with a centralized location to compare various insurance options, often with subsidies available for low- to moderate-income individuals, ultimately aiming to improve healthcare delivery and access by expanding the insured population.
Individual Mandate: The individual mandate is a provision of the Affordable Care Act (ACA) that requires most Americans to have health insurance or pay a penalty. This requirement aimed to increase the number of insured individuals, helping to stabilize the health insurance market and ensure that healthcare delivery and access improved for the population.
Insurance Market Reforms: Insurance market reforms are changes made to the structure and regulations of health insurance markets aimed at improving access to care, reducing costs, and ensuring equitable treatment for all individuals. These reforms often include provisions such as prohibiting discrimination based on pre-existing conditions, establishing essential health benefits, and promoting competition among insurers to enhance consumer choice and affordability.
Integrated Care Delivery Systems: Integrated care delivery systems are coordinated networks of healthcare providers that work together to offer comprehensive and continuous care to patients across various settings. These systems aim to improve healthcare delivery by emphasizing seamless communication, collaboration, and shared responsibility among providers, ultimately enhancing patient access and outcomes while reducing costs.
Medicaid Expansion: Medicaid expansion refers to the provision under the Affordable Care Act that allows states to expand Medicaid eligibility to cover more low-income individuals and families. This initiative aims to increase access to healthcare by providing insurance coverage for those who earn too much to qualify for traditional Medicaid but not enough to afford private insurance. The expansion is significant for improving healthcare delivery, increasing access to services, and generating legal discussions surrounding state versus federal authority.
Patient-Centered Medical Homes: Patient-Centered Medical Homes (PCMH) are a model of care delivery that emphasizes a holistic, patient-focused approach to healthcare. This model fosters a strong relationship between patients and their primary care providers, ensuring comprehensive, coordinated care that addresses the physical, emotional, and social needs of patients. The PCMH model aims to improve healthcare delivery and access by promoting proactive management of patient health and enhancing the patient experience.
Pre-existing condition protections: Pre-existing condition protections are regulations that prevent health insurance companies from denying coverage or charging higher premiums to individuals with health conditions that existed before applying for health insurance. These protections are crucial in ensuring equitable access to healthcare services, allowing those with chronic illnesses or prior medical history to obtain necessary insurance without facing financial barriers or discrimination.
Premium Subsidies: Premium subsidies are financial assistance provided to individuals and families to help lower the cost of health insurance premiums, making healthcare coverage more accessible and affordable. These subsidies play a crucial role in expanding access to healthcare by reducing the financial burden of insurance premiums, thus enabling more people to enroll in health plans and receive necessary medical services.
Preventive services: Preventive services refer to healthcare services aimed at preventing illnesses, detecting diseases early, and promoting overall health, rather than treating conditions after they occur. These services include screenings, vaccinations, and counseling to help individuals maintain their well-being and avoid serious health issues. By focusing on prevention, these services can significantly impact healthcare delivery and access by reducing the need for more extensive treatments later on and improving health outcomes for the population.
Public health programs: Public health programs are organized efforts by governments and organizations aimed at improving health outcomes for communities and populations through education, prevention, and health promotion. These programs are designed to address health disparities, enhance access to healthcare services, and promote overall well-being among various populations, ultimately impacting healthcare delivery and access.
Telemedicine: Telemedicine refers to the use of telecommunications technology to provide clinical health care from a distance. It enhances healthcare delivery by improving access to medical services, allowing patients to consult with healthcare providers remotely, which is particularly beneficial for those in underserved or rural areas. The rise of telemedicine has influenced how healthcare is delivered, its accessibility, and the integration of advanced technologies into patient care.
Value-Based Care: Value-based care is a healthcare delivery model that emphasizes the quality of care provided to patients rather than the quantity of services rendered. This approach aims to improve patient outcomes while controlling costs by incentivizing healthcare providers to focus on delivering better care through preventive measures, coordinated treatment, and efficient resource use. It aligns payment structures with patient health results, influencing how care is delivered, accessed, and improved in the future.
Wellness and Health Promotion: Wellness and health promotion refer to proactive strategies aimed at improving overall health and well-being, emphasizing preventive measures rather than just treating illnesses. This concept encompasses various activities and initiatives that encourage healthy lifestyles, enhance quality of life, and empower individuals to take control of their health. These approaches impact how healthcare services are delivered and accessed, focusing on creating healthier communities and reducing healthcare costs in the long run.
Women's preventive health services: Women's preventive health services are a set of healthcare practices and screenings designed specifically to prevent illness and promote health among women. These services play a crucial role in ensuring that women have access to essential healthcare resources, including reproductive health screenings, vaccinations, and counseling, which collectively contribute to better health outcomes and quality of life.