Share this post!
The Patient Protection and Affordable Care Act (ACA), passed by Congress in 2010, achieves comprehensive health care reform through a focus on increasing the number of Americans covered by health insurance and improving the quality of health care, while lowering the cost of care, in part through a focus on prevention and population health.
The ACA makes significant changes in access to and financing of health insurance. The ACA now requires most U.S citizens and legal residents to have health insurance. Rather than relying as heavily on employer-based insurance, the ACA created state Health Benefit Exchanges (or Marketplaces) for individuals and small businesses to purchase coverage. For individuals and families between 100 percent and 400 percent of the federal poverty level, the ACA expands eligibility for Medicaid and provides tax credits for purchasing health insurance. The expansion of both public and private coverage through the ACA insured approximately 17 million more Americans in 2015 and is expected to insure up to 25 million Americans by 2022. Major changes already occurred with the addition of health insurance Marketplaces and the expansion of Medicaid in the thirty-one states and the District of Columbia that chose to expand Medicaid as of July 2016.
In an effort to improve the quality of care delivered and cut unnecessary spending, the federal government is funding pilots aimed at improving the delivery of health care services. These pilot programs include new ways for paying for care that are focused on the quality of care delivered. Instead of paying for each line item separately, payments are being “bundled” to include a single payment for all of the services typically associated with caring for a particular condition. Additional efforts are aimed at improving the quality and efficiency of care resulting from better care coordination. This includes testing new models for delivering care, like accountable care organizations, and investments in health information technology, like electronic medical records. As part of care coordination efforts, the ACA provides new opportunities for health systems to partner with social service providers in order to address social determinants of health that are known to impact health outcomes and hospital readmissions.
In addition to reducing costs by limiting unnecessary health care services, cost containment efforts also focus on reducing billing fraud, increasing pricing competition and transparency, and adding oversight of health insurers. Over the long term, the ACA aims to save health care costs by improving the health and wellness of the overall population. To accomplish this, the ACA increases coverage of health screenings and other preventive services and provides incentives for the creation of employer-based wellness programs. To ensure access to these preventive services, the ACA expands funding for community health centers, school-based health centers, and health care workforce development.
This Jargon Buster was contributed by the Georgia Health Policy Center.
