Evaluating the PPACA Essay.

Evaluating the PPACA Essay.


Evaluate the Patient Protection and Affordable Care Act. Detail its timeline from inception to implementation. Analyze the effect the PPACA currently has on access and delivery of healthcare and the anticipated effects it will have on healthcare delivery in the future. What opportunities has the PPACA created for nursing? Describe your state’s position on Medicaid expansion. How has this helped/hurt health care in Texas?Evaluating the PPACA Essay.


Evaluating the PPACA

The Patient Protection and Affordable Care Act (PPACA)  is a legislation that considerably transformed health care in the U.S.  ACA was designed to enable more Americans to get health insurance mainly by targeting families and individuals with moderate and low incomes since they constitute the huge majority of those without insurance. The law   addresses   health care costs, access to health insurance as well as delivery of care (Kominsk et al., 2017))   Evaluating the PPACA Essay.

ACA’s timeline from inception to implementation

On March 23, 2010, after a long and contentious legislative and political process, President Obama signed into law the ACA, ushering in the most considerable transformations to the United States since Medicaid and Medicare was passed in 1965. Some elements of ACA became active immediately after the law was passed in 2010 (French et al., 2016).Evaluating the PPACA Essay.

In 2010, employers were offered funding to cover persons between fifty-five and sixty-five years old and the federal government provided tax credits to cover a segment of the contribution of employer for small businesses with not more than twenty-five employees. Also, there was the establishment of a new Patient’s Bill of Rights and insurance firms were barred from denying coverage to minors less than 19 years with preexisting medical conditions. In the same year, new processes were created to monitor increases in premium rates and offer a report on the minimum medical loss ratio. Young adults were allowed to stay on their parent’s coverage until they reached 26. Financial incentives were provided to primary care providers (PCPs), physician assistants, and nurses, and payments were increased for  PCPs in community health centers, underserved regions, and rural communities(French et al., 2016).Evaluating the PPACA Essay.

In 2011 a 10 percent bonus payment from Medicare was provided to PCPs for five years. In 2012, a new annual fess was imposed on the pharmaceutical manufacturing sector  and a  Medicare Value-Based Purchasing(VBP) program was created. In 2013, the enrollment into the individual health insurance marketplace begun and the bundled payments for Care Improvement Initiative started testing reimbursement models.  In the same year, there were modifications in tax treatments of flexible spending and health savings accounts, and a 2.3 percent excise tax was imposed on the sale of all taxable medical devices.  Also, the rates of Medicaid reimbursement for primary care services were increased to 100 percent of the rates of Medicare for 2013 and 2014(French et al., 2016).Evaluating the PPACA Essay.

In 2014, insurance companies were prohibited from refusing coverage on the basis of preexisting conditions and could only vary rates on the basis of tobacco use, family size, rating area, and age( but not on gender, previous claims history, or health status.  Key provisions of the ACA, including the subsidized Marketplace coverage, state Medicaid expansion, and individual mandate were implemented in 2014. Also, risk adjustment, risk corridor, and reinsurance programs were effected to assist stabilize premiums and lessen adverse selection (French et al., 2016).Evaluating the PPACA Essay.

The effect the PPACA currently has on access and delivery of healthcare and the anticipated effects it will have on healthcare delivery in the future

Expanding insurance coverage and eventually increasing access to care is one of the key goals of the ACA.  The law expands access to health insurance and health care, and to date, around twenty million individuals who were previously insured have attained coverage. The law has great potential to increase access to care in the future by enabling more people, particularly low-income groups to have access to health insurance.  According to French et al. (2016), ACA has numerous strategies targeting diverse groups and increasing overall health insurance coverage.Evaluating the PPACA Essay. Currently, under the dependent coverage provision, young adults are able to stay on the insurance plans of their parents as dependants until they reach 26. Under employer mandate, larger employers are needed to provide reasonably priced, comprehensive I health insurance to employees who work on a full-time basis.  Under individual mandate, people without employer-sponsored insurance (ESI) are mandated to buy health insurance individually or be penalized,  and some are offered premium tax credits. These individuals along with small businesses can buy plans via the federal marketplace or state-level exchanges.Evaluating the PPACA Essay.

To  help individuals with low income, the ACA expands eligibility for Medicaid to all nonelderly individuals (those below 65 years) with yearly incomes below or at 133 % federal poverty level(FPL) although not all states are participating in Medicaid expansion).  These provisions are expanding insurance coverage and also improving the affordability of insurance plans.  The ACA has also increased coverage and access to care by imposing novel regulations on insurers and their policies. For instance, insurers can no longer deny coverage or charge higher premiums because one has a preexisting condition, and insurance policies are required to offer a minimum quantity of preventive services with no cost-sharing (French et al., 2016).Evaluating the PPACA Essay.

The ACA has impacted the delivery of health care through its delivery system reforms. Health professionals and health care organizations are required to deliver quality health care and improved patient outcomes.  The Hospital Readmission Reduction Program (HRPP) cuts Medicare payments to hospitals with too much readmission within thirty days of initial hospitalization. Under ACA’s Bundled Payments for Care Improvement (PBCI), the health care provider takes responsibility for the costs and quality of a care episode.  In bundled care, health care consumers are able to make informed care choices.  Medicare Accountable Care Organizations are financially responsible for the overall cost and quality of care provided to Medicare beneficiaries. ACOs focus on communication, preventive care, and stewardship of resources to prevent waste (Cleveland et al., 2019). Evaluating the PPACA Essay.

Opportunities that PPACA has created for nursing

The PPACA compels nurses to carry on care coordination, transformational leadership, and innovation as key stakeholders in the provision of quality, accessible, and reasonably priced care. According to Clevelander al. (2019), regulations following the enactment of the ACA tie quality to reimbursement. These regulations mandate insurance companies to submit a yearly report to Health and Humans Services’ secretary to warrant that benefits under the insurers’ plans improve health outcomes via activities like care coordination, case management,   management of chronic diseases, and quality reporting;  implement activities to lessen medical errors and improve the safety of the patient; implement activities to avert hospital readmission;  and implement health promotion and wellness programs. The monetary effect of these regulations includes financial fines for providers who provide low quality care. Cleveland et al. (2019) indicate that since nurses work in partnership with physicians, they offer exceptional disciplinary expertise to help financial stakeholders in developing patient-centric and programmatic innovation that surpasses value by increasing quality.Evaluating the PPACA Essay.

ACA’s health care delivery reforms require providers to deliver quality and improve patient outcomes which saving on costs.  According to Cleveland et al. (2019),   the combination of cost and patient outcomes continue driving nurse administrators and nurses to improve patient outcomes via evidence-based practice. As such, nurses have been empowered to fully partner with doctors and offer them the support they require to advance the medical practice. Also, the ACA changed the focus of health care, program development, and from a disease-specific, patient center approach to an approach that focuses on the management of health mainly through preventive and primary care. Nurses play a major role in the provision of the constituents of health reform by taking leadership positions in informatics, care coordination, and case management (Cleveland et al., 2019). Evaluating the PPACA Essay.

Texas State’s position on Medicaid expansion and How it has helped/hurt health care in Texas

Texas is among the twelve states that have not expanded Medicaid under the ACA. Texas legislature has been dominated by GOP  lawmakers who have argued that expansion of the Medicaid program would lead to increases in costs of health care for the state,  particularly if the federal governments fail to keep the promise to assist pay for more people who have become eligible for coverage under the Medicaid program.Evaluating the PPACA Essay.

The position of Texas not to expand Medicaid hurts health care and Texas is the state with the largest number without insurance in the country. Failure to expand Medicaid has left more than five million uninsured individuals in the state with no option for affordable health insurance. Sommers (2016) indicates that compared to other states in the Southern region that have expanded Medicaid,  the decision not expand Medicaid to has left millions of low-income residents in Texas less able to pay for their medical bills, and afford prescriptions, with those with chronic conditions unable to get regular care. To make matters matter, the state is opposed to outreach and enrollment for numerous Texans who qualify to be covered under the ACA.Evaluating the PPACA Essay.