Local, State, or Federal Health Policy Analysis Paper
This assignment is an analysis of local, state, or federal health policy.
1.Select a state health policy reform innovation
2.Discuss the rationale for the policy, how it was adopted (e.g., federal waivers, passage by state legislature), the funding structure, and (to the extent statistical data are available) its impact. ethical outcome based on evidence.
3.Examples of state innovations include Maryland’s hospital rate setting, Vermont’s single payer system, and Massachusetts’ health reforms
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Submission Requirements:
The paper is to be formatted per current APA style, 5 pages in length, excluding the title, abstract and references page. Local, State, or Federal Health Policy Analysis Paper.
Incorporate a minimum of 5 current (published within last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work.
Journal articles and books should be referenced according to current APA style.
Policy analysis
Policy continues to play a key role in how the government responds to the health agenda. However, like any other political objective, health policy in the USA continued to remain in continuous flux such that policies that initially received much political support facing considerable opposition later on in time, with the reverse being equally true. This state of flux is exemplified by Affordable Care Act (ACA) that was enacted in 2010 and still remains operation. But from its inception, ACA has had considerable support and has faced strong opposition. Currently, Congress must decide on how to proceed with the debate. They have the option of eliminating ACA and replacing it with a different health policy or revising ACA with a focus on the contentious aspects of the legislation to make it more acceptable to a wider political audience (Tripati, 2018). The present paper analyzes ACA as a health policy and the polarizing debates surrounding the legislation. Local, State, or Federal Health Policy Analysis Paper.
ACA was conceptualized as a policy that enabled the government to increase the number of Americans with health insurance (uninsured Americans were 47 million at the time the bill was passed) through making health insurance more affordable and expanding access to care. The legislation achieved these objectives through expanding Medicaid eligibility and creating new market places where Americans who previous did not have health insurance could acquire coverage directly from insurers. In fact, it expanded insurance coverage in three ways. Firstly, it expanded Medicaid through broader Medicaid eligibility to include Americans who earned up to 138% of the federal poverty level. Secondly, present opportunities for small insurers to take up the slack from large insurers through targeting employers with less than 51 personnel. Thirdly, offering premium subsidies to buy health insurance coverage for persons who earned less than 401% above the federal poverty level. In addition, ACA mandated new approaches that sought to improve health care quality and reduce costs; including reducing costs for some experimental delivery models and Medicare services (Tripati, 2018).
Since its enactment and operationalization, ACA has improved health care in the USA. First, it has reduced the number of uninsured Americans. Despite rollout problems, ACA has enabled a sizeable number of previously uninsured Americans to obtain coverage. Statistics indicated that 22.8 million Americans registered for new insurance between 2013 and 2015 while 5.9 million lost health insurance coverage. The total number of uninsured Americans was reported at 25.8 million, down from 42.7 million. Secondly, it offers an effective incentive for enrollment through mandating that most adults must be covered, with failures subjected to fines interpreted as lawfully imposed taxes. Local, State, or Federal Health Policy Analysis Paper. Thirdly, it helped in stabilizing the insurance marketplace through offering tax credits that helped low-incomes earners to buy insurance coverage. Fourthly, it reduces the payments made to providers through cost containment strategies that cuts the money that medical providers receive from Medicare to reduce spend over growth reported for Medicare. Fifthly, it has facilitated health care cost containment, although not taking into accounted the reduced coverage by insurers, higher drug prices, higher out of pocket costs, and recession. Sixthly, it has improved health care quality through creating new government entities, commissions, boards and agencies that are responsible for managing health care practice, although this has attracted regulatory compliance costs. Finally, it has shifted health care away from care based on volume of services towards care based on value. Overall, ACA has three objectives. The first objective is to reduce health care costs, improve care quality, and reduce the number of uninsured Americans (Glassman, Giedion & Smith, 2017). Local, State, or Federal Health Policy Analysis Paper.
Despite being the most monumental change in health care policy in the USA since the passage of Medicare and Medicaid in 1965, ACA implementation has been marked by unexpected twists and turns, and controversies that include delays in key provisions and court challenges. In fact, since its enactment, ACA has been associated with numerous claims concerning its success and failures from those who support and oppose it. The views expressed in these debates have been sensational and colored the political persuasion. A point that these debates often overlook is that there is a distinction between health care access and affordability. Health care insurance is a financial mechanism that facilitates health care affordability while access refers to the actual process of getting the required care. ACA has been instrumental in narrowing the gap between health care access and affordability, an overall trend that overlooks some cases to the contrary. To be more precise, it has made insurance available for an additional 20 million Americans who previously did not have insurance. This information often overlooks the fact that as more people receive insurance, there are 6 million Americans who previously had insurance but lost coverage in the ACA regime. Besides that, the increase in insurance coverage has largely been reported in Medicaid expansion at 13 million to imply that middle and working class Americans (constituting 40% of the American population) have not received much support, especially those who earn more than 400% above the federal poverty level. The result is that health care access has been uneven with the Americans enrolled in Medicaid hindered by narrow networks while those not enrolled in Medicaid facing high out of pocket costs (Belland, Rocco & Waddan, 2016).
It is clear that ACA has results in a net rise in the number of insured Americans, mainly through expanding Medicaid. The cost reductions associated with ACA remain arguable achievements while care quality appears not to have improved. Also, diminished health care access has been reported. With a new American president, ACA is facing critical analysis that takes a renewed look at its actual gains and losses. Some of the legislators in Congress are pushing for ACA to be revised to address its shortcomings while others are calling for the legislation to be repealed and replaced. This has resulted in many proposals being presented to improve, repair, replace or repeal ACA (Geyman, 2018). Local, State, or Federal Health Policy Analysis Paper
Regardless of how the political debate proceeds and the decisions made by Congress, the results are likely to have far reaching consequences. Replacing ACA implies that the 251.6 million Americans with health insurance (as well as the 26 million Americans without insurance) face an uncertain future. The number of insured Americans would drop to 231.9 million if ACA is repealed but not replaced. Average out of pocket costs would also increase by $4,200. This decision would also eliminate the revenue programs under ACA and increase the federal deficit by $33.1 billion every year. Replacing ACA with a single payer plan would increase federal spending by $1 trillion and national spending by $435 while ensuring that all American have insurance coverage, although undocumented immigrants would not enjoy this privilege. Replacing ACA with the American Health Care Act (AHCA) would reduce enrollment for insurance by 14 million and increase federal deficit by $38 billion. Repealing ACA with no replacement would result in 12 million lacking insurance coverage with enrollment declining by 25% most of whom would be healthy and young Americans (Geyman, 2018). Local, State, or Federal Health Policy Analysis Paper
As the political debate continues over how to handle ACA and policy makers weight their options ahead, it is evident that political tensions exist that extend to their objectives. For instance; should they reduce costs and federal deficit, or expand coverage to ensure that all Americans can access high quality care; should they preserve choices among most patients who may not require comprehensive coverage, or protect the sickest Americans who require the most expensive health care; and minimize cost by shifting it to the states and consumers or limit the cost liability for the federal government. Making decisions about these options or striking a balance across the options will involve value and political calculation about what they intend the American health care system to look like in terms of key objectives.
References
Belland, D., Rocco, P. & Waddan, A. (2016).
Obamacare Wars: Federalism, State Politics, and the Affordable Care Act
. Lawrence, KS: University Press of Kansas. Local, State, or Federal Health Policy Analysis Paper
Geyman, J. (2018).
Crisis In U.S. Health Care: Corporate Power Vs. The Common Good
. New York, NY: Copernicus Healthcare
Glassman, A., Giedion, U. & Smith, P. (eds.) (2017).
What’s In, What’s Out: Designing Benefits for Universal Health Coverage
. Washington, DC: Center for Global Development.
Tripati, A. K. (2018).
Obamacare Trumpcare Explained: Obamacare-Trumpcare Pro’s and Con’s
. New York, NY: SureShot Books Publishing LLC. Local, State, or Federal Health Policy Analysis Paper