Running head: AFFORDABLE CARE ACT REVIEW OF 2020

Affordable Care Act Review of 2020

Edwin Ocasio, Aaron Winters, Mopolo Garcia,
Jonathan Yochum, Robynne Esquibel
National University, HCA-600
Professor Lewis Baker

AFFORDABLE CARE ACT REVIEW OF 2020

Affordable Care Act Review of 2020

On March 23, 2010, President Obama signed the Affordable Care Act, introducing a
comprehensive health care plan which shall be rolled out over four years. The Act is
subsequently broken down into three major categories:

Improving Quality and Lowering Health Care Costs

New Consumer Protections

Access to Health Care.

Improving Quality & Lowering Health Care Costs
The Affordable Care Act (ACA) seeks to improve the quality of care and the manners in

which that care is delivered, while at the same time reducing costs. When it comes to quality
health care, the ACA is designed to improve quality and efficiency of health care through the
following overarching goals:

Attain high-quality, longer lives free of preventable disease, disability, injury, and
premature death.

Achieve health equity, eliminate disparities, and improve the health of all groups.

Create social and physical environments that promote good health for all.

Promote quality of life, healthy development, and healthy behaviors across all life stages.

Title III of the Patient Protection and Affordable Care Act (ACA) is the most important section
for health care providers and details changes in Medicare. Improving Quality and Efficiency of
Health Care dedicates 501 pages of the ACA focusing on how health care will be delivered. It
moves us from a fee-for-service system toward payments based on quality of delivery. This starts
with Medicare and what Medicare does is usually followed by private insurance. This will go a
long way eventually toward controlling costs.

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Key features of the ACA that pertains to Improving Quality and Efficiency of Health
Care are being rolled out in yearly increments starting in 2010 and projected to be completely
implemented by 2015. These key features of quality health care are outlined below by the
implementing years:
Preventing Disease and Illness. A new $15 billion Prevention and Public Health Fund
will invest in proven prevention and public health programs that can help keep Americans
healthy from smoking cessation to combating obesity. Funding began in 2010.
Providing Free Preventive Care for seniors. The law provides certain free preventive
services, such as annual wellness visits and personalized prevention plans for seniors on
Medicare. Began January 1, 2011.
Improving Health Care Quality and Efficiency. The law establishes a new Center for
Medicare & Medicaid (CMS) Innovation that will begin testing new ways of delivering care to
patients. These methods are expected to improve the quality of care, and reduce the rate of
growth in health care costs for Medicare, Medicaid, and the Childrens Health Insurance
Program (CHIP). Additionally, as of January 1, 2011, Health and Human Services (HHS)
submitted a national strategy for quality improvement in health care. Effective no later than
January 1, 2011.
Improving Care for Seniors After They Leave the Hospital. The Community Care
Transitions Program was implemented to help high risk Medicare beneficiaries who are
hospitalized avoid unnecessary readmissions by coordinating care and connecting patients to
services in their communities. Began January 1, 2011
Linking Payment to Quality Outcomes. The law establishes a hospital Value-Based
Purchasing program (VBP) in Traditional Medicare. This program offers financial incentives to

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hospitals to improve the quality of care. Hospital performance is required to be publicly reported,
beginning with measures relating to heart attacks, heart failure, pneumonia, surgical care,
healthcare associated infections, and patients perception of care. Effective for payments for
discharges occurring on or after October 1, 2012.
Encouraging Integrated Health Systems. The new law provides incentives for physicians
to join together to form Accountable Care Organizations. These groups allow doctors to better
coordinate patient care and improve the quality, help prevent disease and illness and reduce
unnecessary hospital admissions. If Accountable Care Organizations provide high quality care
and reduce costs to the health care system, they can keep some of the money that they have
helped save.
Improving Preventive Health Coverage. To expand the number of Americans receiving
preventive care, the law provides new funding to state Medicaid programs that choose to cover
preventive services for patients at little or no cost. Effective January 1, 2013
Paying Physicians Based on Value Not Volume. The Act rewards the highest quality of
care for Americas seniors. It provides incentives for doctors, and hospitals that improve quality
while providing for better coordination that helps to reduce harmful medical errors and
healthcare-acquired infections. This new provision will tie physician payments to the quality of
care they provide. Physicians will see their payments modified so that those who provide higher
value care will receive higher payments than those who provide lower quality care. Effective
January 1, 2015.
An example that our health care system is heading in the right direction toward
improving health care quality and efficiency is through the immediate steps CMS has taken to
address quality of care issues. Some of those steps are policies and programs such as unnecessary

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hospital readmissions, penalties for hospitals with substantial rates of hospital acquired
conditions, rewarding better care and team-based health care through Accountable Care
Organizations (ACOs). Doctors, nurses and hospitals throughout the country will be able to
learn from these innovative practices to improve the quality of care for patients throughout the
Nation.
Consumer Protection
According to "The Affordable Care Act: Protecting Consumers and Putting Patients Back
In Charge Of Their Care." (2010), "The Affordable Care Act will help support and protect
consumers and end some of the worst insurance company abuses. The health care law offers
new rights and protections that make coverage fairer and easier to understand. It implements
these benefits with an aggressive pre-established timeline that extends out to 2020.The revised
Patients Bill of Rights puts consumers back in charge of their health care and gives them the
stability and flexibility to make informed choices about their health ("About The Law", 2014).
By the year 2020, we predict that the coverage, cost, and care will align with these benefits and
protections outlined in the law.
Coverage
By 2020, children under the age of 19 will not be excluded due to a pre-existing
condition. As young adults, they will also be eligible to be covered under your parents health
plan until are under the age of 26. By assuring this coverage, more young Americans will be
more prone to continue their individual or employer provided policies. This will increase the
number of young, healthy consumers sharing the cost of all other participants. Those with preexisting conditions will continue to actively participate in a health care plan even after their
condition stabilizes, goes into remission, or it is resolved or cured.

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Additionally, insurers will not be able to arbitrarily cancel coverage and the consumer
will be guaranteed the right to appeal and ask that the insurer to reconsider its denial of payment.
The consumer will be more informed about and involved with their care to assure their rights to
health care. They will demand the coverage they desire, deserve, and can afford.
Costs
The law will need to proceed with banning the lifetime limits on most benefits and
protecting consumers from excessive rate hikes to further reduce the burden of health care cost.
More benefits will be realized as the premium dollars are spent primarily on health care not
administrative costs. The consumer will have a greater sense of getting coverage with the peace
of mind that their rates wont drastically increase or go bankrupt maintaining wellness.
Care
Through 2020, free preventive care will be the main recommendation for maintaining a
healthy posture and reducing health care cost. Preventive and routine care helps to find or
prevent health problems before they become serious. Wellness will reduce the abuses of
emergency medical services and provide cost savings for the insurer. Most of these services will
be provided with no co-payment to encourage participation.
The law will protect the patients choice of a primary care doctor within their plans
network. It removes barriers imposed by insurance companies to emergency services, even when
the care is provided in a hospital outside of the health plans network.
Health Insurance Marketplace
Finally, it created the Health Insurance Marketplace. This new system helps consumers,
whether individuals, families, or small businesses understand and get the coverage they want.
For the first time in history consumers from all around the United States will be able to check out

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coverage options online and easily understood. All medical plans will be required to cover a set
of benefits to include physician visits, preventive care, hospital stays and prescriptions.
(http://marketplace.cms.gov/getofficialresources/other-partner-resources). Preexisting conditions
have always been or is more readily becoming a household term, particularly in healthcare
facilities and discussion boards nationwide. Principally what the future will hold for this multidisciplinary seed. The focus of this segment will look to look at pre-existing conditions with
respect to what it holds in 2020.
Currently, there are about 129 million individuals who have a pre-existing condition of
these 17 million are children (Sorian, 2011). A study concluded that about 30% of current
healthy Americans will develop a pre-existing condition within 8 years (Sorian, 2011).
Concerns lie with what the Obama Care Act or Affordable Care has done for these people
and more importantly will continue to provide in the future. First, what should be mentioned are
the positives the program is looking to standardize. Of these, the main ones are related to preexisting conditions, eliminating caps or time restrictions on lifetimes illness, as well as not being
charged higher premiums for such illnesses, but chiefly the prior barrier which denied anyone
coverage who had a pre-existing condition to begin with (Federal Register, 2010).
I expect the future of this legislation to continue and that all states will assimilate to the
new plan by 2020. States, such as Texas, have not fully cooperated with the plan where its
availability is not accessible due to non-support or politics therein. Though all states will
assimilate to the new plan this will come at a cost simply meaning higher cost as a whole to pay
for everyone. However, President Obama expressed in an interview with web MD that it should
lower premiums with the thought that everyone paying into the pot will reduce the premiums.

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The higher cost for everyone in 2020 does not come without warrant particularly when
considering the Preexisting Condition Insurance Plan (PCIP). The PCIP started in late 2010 with
the focus being on assisting those who were denied coverage through their employer or other
individual health care plans because of their preexisting condition. It was to serve as a gap until
the ACA came into full swing. The plan was funded up to $5 Billion dollars with prospects of
serving approximately 350,000 individuals, however, of that projection only 107,000 applied
(Singer, 2013). Which begs the question? Did a surplus incur due to the miss projection? PCIP
closed its doors in 2013 where funding was an issue, essentially not having enough revenue to
fully cover any more recipients.
The ACA again has a plan in place to subsidize the onset of uninsured ill patients who
will soon be joining the pool. Its a $63-per-head fee used to offset cost. This too has a plan
amount and duration which by 2020 will be obsolete or in debt. This piece of legislation looks to
create a $63 per head fee to cushion the cost incurred by individuals with pre-existing conditions
(Alonso-Zaldivar, 2012). Medical plans nationwide look to be effected as workers will also
more than likely be affected. The figures from the regulation shows approximately 190 million
Americans who are already insured through their employers will be expected to pay the $63 per
head fee. Its a 3 year plan totaling $25 billion dollars in support of levying the cost, an initial
plan to predict the costs of covering uninsured people with medical necessities (Alonso-Zaldivar,
2012). Yikes! What will come of this? Predication by 2020 this plan will more than likely not
have enough revenue to offset the influx of uninsured sickly patients. By 2020, the $63 will rise
to $80 or even $90 dollars per head. The 3 year plan will be extended or amended to support the
influx. Eventual causation will force workers to foot the bill either through paying a higher share
of cost so the employers can make up the difference they must pay to the fee fund or through

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increased premiums. Generally speaking, higher cost for all in support of insurance for
everyone! 2020 could possibly be enough time to finally settle premiums to an easily affordable
self-sustaining amount, however such predictions seem difficult to state, particularly when
looking at the previous track record and life expectancy of the population in general.
Nonetheless, a health plan for all is nonetheless a positive step for the future.
Access in Health Care
Access in health care deals with two sub-topics: availability of services and utilization
of services. On one hand, having access to health care requires that an adequate supply of health
services exists. These can be in the form of the number of health care professionals, equipment,
hospital beds and so forth. Additionally, the utilization of services is key as some individuals
may have access while simultaneously experiencing difficulty in utilizing said services. The
relevance of health care access is the premise that the right services are being provided at the
right time to the right patients. Therefore, it is imperative that health care resources meet the
needs of different population groups. Inequities in the health care system not only preclude the
procurement of services for some individuals, but also illustrate how access and quality are
interrelated and affected by legislation, demographics, health care professionals and the like.
Affordable Care Act (OBAMACARE)
One of the original aims of the Affordable Care Act (ACA) was to substantially expand
access to the uninsured as well as the underinsured. Although the ACA was intended to alleviate
hardship for those who couldnt afford quality health care, the results have definitely been mixed
as a portion of the nations insured are being forced to change providers due to increases in
premiums. Furthermore, portions of the population who are uninsured do not qualify for health
care coverage under the ACA, primarily because of income requirements.

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Improving Access
Improving access is of paramount importance in our nation. The inequities that are
observed on an everyday basis are a cruel reminder of the differences in social standing,
education, demographics and so forth. Health care is an individual fundamental right and, as
such, should be afforded the necessary insight, collaboration, and creativity from health care
practitioners, legislators, Congress, and the Executive Branch to ensure that every citizens
health needs are being met.
Employer Mandate
The employer mandate has significantly affected the ability of citizens to access health
care as well as stymied the direction and progress of small and mid-size businesses. Elimination
of the mandate would allow for more of the working public who are currently below the poverty
line to receive more assistance from the government.
Age-related pricing
The age-related pricing issues should be fixed in the short-term by amending the ACA to
subsidize a portion of the insurance for the younger workforce. Subsidizing health premiums
would not only decrease the burden on the workforce, but ensure more equity as it pertains to
access for all parties involved.
More Health Care Options
According to Argosh, recent survey results revealed that Millenials and Baby Boomers
both want to see more healthcare options, complete with an improved shopping experience and
full pricing transparency for all health plans, doctors, and hospitals (2014). This has more to do
with the idea that a more informed individual will seek the best care possible within his or her

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means. That notwithstanding, more options, more hospitals, and more doctors represents the
increased access and health coverage that all of us seek as a nation to serve the public.
Conclusion
The Affordable Care Act will benefit all Americans in the long run. As with acts and or
bills that are passed by Congress, there are going to be Americans that will essentially find a
reason to dislike the law. This law has revealed the inefficiencies that currently exist in our
health care system and the lack of care that it provided to those that are less fortunate. The law
has taken steps forward to correct deficiencies and though the intentions of the law are good,
there is likely to be rough times ahead. Policymakers and stakeholders must take meaningful
steps to reduce the rate of growth in medical costs. The United States health care system will
transform into a system that promotes greater value, by improving the quality of care and
increasing efficiency through the above outlined implementations.

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References
About the law. (2014). Retrieved from http://www.hhs.gov/healthcare/rights/index.html
Alonso-Zaldivar, R., (2012) Obamacare pre-existing condition fee to cost companies $63 per
person. Retrieved from: http://www.huffingtonpost.com/2012/12/10/obamacarepreexisting-condition-fee_n_2273005.html.
Argosh, M. (2014). Obamacare in its current form wont expand access or improve
quality of healthcare and make it more affordable. Retrieved from
http://www.nydailynews.com/new-york/ways-to-fix-obamacare-article-1.1620512
Federal Register. (2010) Patient protection and affordable care act: Preexisting condition
exclusions, lifetime and annual limits, rescissions, and patient protections. Federal
Register, Vol. 75, No. 123 / June, 2010 / rules and regulations
Singer, A. (2013) Obamacare pre-existing conditions coverage: Low enrollment,
high costs. Retrieved from http://blog.heritage.org/2013/03/20/obamacare-pre-existingconditions-coverage-low-enrollment-high-costs/
Sorian, R., (2011) HHS.Gov. Protecting americans with pre-existing conditions
Retrieved from: http://www.hhs.gov/healthcare/facts/blog/2011/01/preexisting.html
The Affordable Care Act: protecting consumers and putting patients back in charge of their care..
(2010). Retrieved from http://www.dol.gov/ebsa/pdf/fsaffordablecareact.pdf