Question

The areas of provision and reimbursement of health care services have each undergone considerable changes in the past several years, with the following current trends identified as being the most significant contributors to change:

The Patient Protection and Affordable Care Act (also referred to as the ACA or "Obamacare") and the Health Care and Education Reconciliation Act of 2010

Bundled payment structure versus fee-for-service payment structure

Accountable Care Organizations (ACOs)

Technology and Telemedicine

Medicare Advantage Plans

Population health management strategies

Using your employer/organization's resources, appropriate websites, and the GCU Library as your informational foundations, research these trends and others you may find relevant, and write a 1,250-1,500 word essay in which you examine the following:

Which of the currently identified health care trends overall are already impacting your employer/organization, or an organization in your city/region in your health care field?

Which of the currently identified health care trends are specifically impacting your sector of allied health, and why?

What emerging health care trends on the horizon may impact your employer/organization and/or your specific allied health sector?

Which of the current or emerging trends do you see as most likely to positively impact your specific role and sector in allied health? Which trends are most likely to negatively impact it? (Examples: wages, job security, educational requirements, etc.)

How will the trends you identify impact safety, risk management, and/or quality improvement policies in your organization/and or an organization in your city/region in your health care field?

You are required to use and cite a minimum of three qualified resources from the readings or the GCU Library in order to complete this assignment successfully.

Answer 1

The history of the Affordable Care Act – The Patient Protection and Affordable Care Act was signed into law by President Obama on March 23, 2010. It is more commonly known as the Affordable Care Act (or ACA) — and it’s most commonly referred to by its nickname, Obamacare.

The ACA's major provisions came into force in 2014. By 2016, the uninsured share of the population had roughly halved, with estimates ranging from 20–24 million additional people covered during 2016. The increased coverage was due, roughly equally, to an expansion of Medicaid eligibility and to major changes to individual insurance markets. Both involved new spending, funded through a combination of new taxes and cuts to Medicare provider rates and Medicare Advantage. Several Congressional Budget Office reports said that overall these provisions reduced the budget deficit, and that repealing the ACA would increase the deficit. The law also enacted a host of delivery system reforms intended to constrain healthcare costs and improve quality. After the law went into effect, increases in overall healthcare spending slowed, including premiums for employer-based insurance plans.

The act largely retains the existing structure of Medicare, Medicaid, and the employer market, but individual markets were radically overhauled around a three-legged scheme. Insurers in these markets are made to accept all applicants and charge the same rates regardless of pre-existing conditions or sex. To combat resultant adverse selection, the act mandates that individuals buy insurance and insurers cover a list of "essential health benefits". However, a repeal of the tax mandate, passed as part of the Tax Cuts and Jobs Act of 2017, will become effective in 2019. To help households between 100–400% of the Federal Poverty Line afford these compulsory policies, the law provides insurance premium subsidies. Other individual market changes include health marketplaces and risk adjustment programs.

The act has also faced challenges and opposition. In 2009, Senator Ted Kennedy died, and the resultant special election cost the Democrats their 60-seat filibuster-proof Senate majority before the ACA had been fully passed by Congress. The Supreme Court ruled 5 to 4 in 2012 that states could choose not to participate in the ACA's Medicaid expansion, although it upheld the law as a whole. The federal health exchange, HealthCare.gov, initially faced major technical problems during its rollout in 2013. In 2017, a unified Republican government failed to pass several different partial repeals of the ACA. The law spent several years opposed by a slim plurality of Americans polled, although its provisions were generally more popular than the law as a whole, and the law gained majority support by 2017.

Key events leading up to the passage of Obamacare (The Affordable Care Act)
Next, follow the timeline of key events leading up to the passage of the Obamacare law, along with key provisions that went into place after the law was enacted.

July 2009: Speaker of the House Nancy Pelosi and a group of Democrats from the House of Representatives reveal their plan for overhauling the health-care system. It’s called H.R. 3962, the Affordable Health Care for America Act.
August 25, 2009: Massachusetts senator Ted Kennedy, a leading supporter of health-care reform, dies and puts the Senate Democrats’ 60-seat supermajority required to pass a piece of legislation at risk.
September 24, 2009: Democrat Paul Kirk is appointed interim senator from Massachusetts, which temporarily restores the Democrats’ filibuster-proof 60th vote.
November 7, 2009: In the House of Representatives, 219 Democrats and one Republican vote for the Affordable Health Care for America Act, and 39 Democrats and 176 Republicans vote against it.
December 24, 2009: In the Senate, 60 Democrats vote for the Senate’s version of the bill, called America’s Healthy Future Act, whose lead author is senator Max Baucus of California. Thirty-nine Republicans vote against the bill, and one Republican senator, Jim Bunning, does not vote.
January 2010: In the Senate, Scott Brown, a Republican, wins the special election in Massachusetts to finish out the remaining term of US senator Ted Kennedy, a Democrat. Brown campaigned heavily against the health-care law and won an upset victory in a state that consistently votes in favor of the Democratic party.
In January 2010, eHealth published research conducted by Opinion Research highlighting public perceptions of health-care reform.
March 11, 2010: Now lacking the 60th vote needed to pass the bill, Senate Democrats decide to use budget reconciliation in order to get to one bill approved by the House and the Senate. The use of budget reconciliation only requires 51 Senators to vote in favor of the bill in order for it to go to the president’s desk for signature.
March 21, 2010: The Senate’s version of the health-care plan is approved by the House in a 219-212 vote. All Republicans and 34 Democrats vote against the plan.
March 23, 2010: President Obama signs the Affordable Care Act into law.

Actual Events That Occurred As A Result of the Affordable Care Act – 2011 to 2014
January, 2011: Medical Loss Ratio Requirements: In 2011, insurance companies must ensure the value for premium payments. If insurance companies don’t spend at least 80% to 85% of premiums on care (for individual, small group markets and large group) the difference is sent to customers in a refund.
January 2011: A Florida judge rules that elements of the Affordable Care Act are unconstitutional.
November 14, 2011: The US Supreme Court agrees to hear arguments in the Obamacare case brought by 26 states and the National Federation of Independent Business. It argues that elements of the Affordable Care Act are unconstitutional.
June 28, 2012: The US Supreme Court upholds the major provisions of the Affordable Care Act.
August 2012: The White House confirms the ACA’s “contraceptive mandate” for women’s preventive services without cost-sharing: HIV screening, contraception counseling, and domestic violence support services.
November 6, 2012: President Obama is re-elected, effectively ensuring the ACA will survive.
January 2013: The limit on pre-tax contributions to flex spending accounts is capped at $2,500 annually.
July 2, 2013: The White House agrees to a one-year delay for large businesses to provide workers with affordable health care.
October 1, 2013: Healthcare.gov, the federal exchange serving 36 states, experiences technical difficulties and eventually goes offline before reopening on December 2, 2013.
October 1, 2013: Several state-run exchanges experience enrollment hurdles, including the exchanges in California, Oregon, Washington, and Maryland. Ultimately, some perform better than others.
October, 2013: Republicans led by Senator Ted Cruz shut down the US federal government and curtail most routine operations after Congress fails to enact legislation appropriating funds for fiscal year 2014 or to enact a continuing resolution for the interim authorization of appropriations for fiscal year 2014.
October 17, 2013: Regular government operations resume after an interim appropriations bill is signed into law.
November 26, 2013: Eight Senate Democrats tell the Obama administration that they’re “troubled by the ongoing technical difficulties” with healthcare.gov and want an alternative way for insurers and web-based brokers to enroll subsidy-eligible consumers.
December 2, 2013: Healthcare.gov, the federal exchange serving 36 states, reopens after experiencing technical difficulties and eventually going offline for several weeks.
January 1, 2014: The bulk of remaining regulatory changes in the Affordable Care Act go into effect.
January, 2014: Medical Loss Ratio Requirements: Health Affairs published its most recent analysis of Medical Loss Ratio performance by major insurers.
March 6, 2014: The federal government extends the two-year grace period for individuals enrolled in non-grandfathered health insurance plans.
May 1, 2014: The US Department of Health and Human Services announces that more than 8 million people enrolled in a health insurance plan during the first Open Enrollment Period (OEP).
March 4, 2015 – King v. Burwell: The U.S. Supreme Court (SCOTUS) hears oral arguments for King v. Burwell, a lawsuit challenging U.S. Treasury regulation, 26 C.F.R. § 1.36B-2(a)(1), issued under the Patient Protection and Affordable Care Act (ACA). King argues that the ACA only allows subsidies to be distributed through state-run exchanges, and that regulations implemented by the IRS exceed the authority granted to it by Congress. (Read eHealth’s white paper on King vs. Burwell.)
June 25, 2015 – King v. Burwell: The Supreme Court ruled 6-3 that subsidies could be distributed through Healthcare.gov, the Federal Exchange, if a state did not set up its own exchange.
January 1, 2016: The threshold for itemizing medical expenses on taxes increases from 7.5% to 10% for seniors.
May 12, 2016: U.S. District Judge Rosemary Collyer ruled that the ACA’s cost-sharing reduction (CSRs) subsidies, which pay a portion of an enrollee’s deductibles, do not have permanent funding in the legislation. This makes them subject to appropriations, which means they must be approved by the Congress. The ruling was placed on hold, pending an appeal.
Tuesday, November 8, 2016: Donald Trump is elected to be the next president of the United States.
November 20, 2016: Vice President-elect, Mike Pence, says “President-elect Donald Trump will prioritize repealing President Barack Obama’s landmark health care law right “out of the gate” once he takes office.
January 2017: “Grandmothered” health insurance plans become illegal. Grandmothered health insurance plans are individual health insurance plans purchased after the Affordable Care Act was signed into law (March of 2010), but before they became illegal, which was January 1, 2014. In some states, the deadline for these plans to be phased out was extended until 2017.

The following changes are slated for implementation over the coming years, as required by Obamacare.
  
January 2018: All existing health insurance plans must cover preventive care and checkups without copayments.
January 2020: The Medicare Part D coverage gap (“donut hole”) is phased out.