The Patient Protection and Affordable Care Act (ACA) was implemented with the goal of being able to achieve nearly universal health insurance coverage in the United States (Courtemanche, Marton, Ukert, Yelowitz, & Zapata, 2018). With the implementation of the ACA, there was a series of reforms that were developed in order to help provide better health care access, as well as make health insurance more affordable (Courtemanche et al., 2018). Some of the mandates that were associated with the ACA was that individuals who chose not to have health insurance were penalized for not having insurance, as well as employers with over 100 employees were obligated to provide affordable healthcare insurance options (Courtemanche et al., 2018). The whole purpose of these mandates and reforms was to help give the U.S a better healthcare system, and gain some control healthcare crisis situation. Studies of the results of the reform have shown that the ACA “substantially improved access to health care among non-elderly adults” (Courtemanche et al,. 2018, p.663). Adjustments continue to be made to the ACA, with the goal still being to provide better healthcare access to Americans.
One federal initiative that was implemented to improve the health of individuals was the National Quality Strategy (NQS). The NQS was developed in March of 2011 in behalf of the U.S Department of Health and Human Services (Agency for Healthcare Research and Quality, 2017). The primary goal of this initiative is to improve quality in the healthcare provided, thus providing better, safer, and more efficient care to every individual in the population. The NQS strives to achieve these goals by following three aims, which are: better care, healthy people, and affordable care (Agency for Healthcare and Research Quality, 2017). In addition to these aims, the NQS focuses on six priorities to providing better quality care; the number one aim being “making care safer by reducing harm cause in the delivery of care” (Agency for Healthcare Research and Quality, 2017, para.9). Through the utilization of these techniques, the goal to improving healthcare quality can be better achieved.
In representing thousands of hospitals and healthcare organizations all over the United States, it is no wonder the American Hospital Association has great interest in the Affordable Care Act (Shinkman, 2015). The AHA has made it their “business” to know what is going on with the Affordable Care Act because the reforms implemented with it could greatly affect the healthcare facilities that it represents. he American Hospital Association issued its support of the Affordable Care Act (ACA) with exception to a few provisions. The provisions the AHA specifically opposed were: 1. Independent Payment Advisory Board (IPAB) 2. Financial penalties for hospital readmissions 3. No provision for a permanent fix for the Medicare Physician Payment Formula, also now as the Sustainable Growth Rate (SGR)
The AHA took exception to the IPAB because it believed the body was given too much authority. The board composed of 15 members appointed by the president and confirmed by the Senate is tasked with making recommendations to generate savings to the Medicare program and fast-track congressional approval (Shinkman, 2015). Recommendations made to Congress must be acted upon within the required timeline or they automatically become binding (Shinkman, 2015). The AHA believed that they had already offered to give up $155 billion of future payments and, therefore, should not be subject to future cuts at the advice of the unelected members of the IPAB.
Reducing hospital readmissions has been shown to be a very effective way to reduce overall medical expenses and the ACA introduced financial penalties to hospitals with “excessive” readmissions. The penalty is assessed as a reduction in reimbursement rates for hospitals with readmissions rates higher than CMS’ requirements. The AHA opposed this component of the ACA and asserted that hospitals have already implemented exhaustive programs to mitigate readmissions. Some of these programs include the provision of services at no-cost after discharge, which has been scrutinized by legal groups as an inducement to provide unnecessary services; another reason the AHA opposes this provision of the ACA.