Healthcare Reform Section 4
The 2010 Patient Protection and Affordable Care Act changed the face of healthcare for its consumers, providers, and insurers. The unique perspectives of different interest groups significantly influenced the final draft of this bill. These same groups continue to lobby their elected representatives to either remain committed to the Act or to fight for its removal. Your group's responsibility for this assignment is to select a side of the debate that your group believes accurately reflects the party you represent in this discussion. Each group should remain engaged in the debate during the entire unit and offer more than "I think..." statements. Facts and data are encouraged and expected. Let the debate begin.
Side Score: 11
Side Score: 13
The Patients are PRO Patient Protection and Affordable Care Act for the following reasons:
1. Decreases the number of uninsured Americans
2. Offers free preventative care
3. Offers expanded healthcare coverage
4. It’s more affordable for those with lower income
5. There is no denial to children being covered under a parent's coverage if the child has a pre-existing condition
6. It offers seniors better prescription benefits and better long term care benefits
7. Offers better drug discounts to everyone
8. There are no co-pay, coinsurance and deductibles for preventative care
9. Children will be covered until the age of 26 under their parent's coverage
10. Offers tax breaks to help moderate income people buy healthcare
11. Insurances can't rescind coverage if a covered member becomes ill
12. People cannot be denied coverage for preexisting conditions
13. Dollar amount caps can't be placed on the policy by the insurer
14. 80 percent of money paid towards healthcare must be directly used on medical care or reimbursed to the patient
The Health Care Law and You: Take health care into your own hands. Retrieved from http://www.healthcare.gov/law/
"Selected Patient Protection and Affordable Care Act (PPACA) implementation dates of interest to RNs as caregivers, RNs as patients, and RNs as employees". Nursingworld.org. Retrieved September 21, 2012.
Holan, Angie D. (March 20th, 2012). "RomneyCare & ObamaCare: Can you tell the difference?" PolitiFact.com. Tampa Bay Times. Retrieved September 21, 2012.
Enrollment Policy Provisions in the Patient Protection and Affordable Care Act. Families USA. Retrieved September 21, 2012.
Side: For Reform
Destroys the doctor-patient relationship
Due to the changes with obamacare doctors have government rules and regulations what will tear apart the doctor-patient relationship. Doctors will have to focus more on government rules and regulations, rather than the specific needs of their patients.
"According to the NPS, doctors fear that the quality of care will deteriorate under the Patient Protection and Affordable Care Act and that their reimbursements will go down as well."(B. Monegain, 2011)
"When asked about the quality of healthcare over the next five years, 65 percent believe it will deteriorate..."(B. Monegain, 2011)
So my question is, how can a piece of paper determine how to treat a patient? If this is the case, why do we need doctors? Why can the patient just look at a piece of paper and determine what he/she needs to do next? It's great that individuals will be able to seek medical care, but how effective is the care if your doctor says"I have your diagnosis, let me look at the "manual" and see how to treat you". Sure setting these rules could save the government tons of money. Legislating care by regulations set forth on a piece of paper, rather than allowing the educated doctor the opportunity to use his/her training to assess, and treat, the patient is probably not the answer to Americans being uninsured.
Monegain, B. 2011. Doctors concerned about effects of healthcare reform. Healthcare finance news. New York, NY
Side: Against Reform
1. More than 87 million Americans could lose access to their current health care plan under the new law
2. Fewer physicians would be available which would result in a less quality of care, longer wait times, and physician fatigue.
3. It would become a socialistic form of healthcare.
4. Patients may face a penalty for not having health insurance. Is my constitutional right violated? Congress would set a precedent for
using the commerce clause in the constitution which states that Congress has the power to regulate commerce...among the several
5. The Center for Medicare and Medicaid Services says that the law will impose billions of dollars in annual fees on drug companies,
health insurance plans, and new taxes on medical device sales. This alone will raise health care costs from 2.1 billion dollars to
18.2 billion dollars in 2018.
6. The biggest item used to pay for the program is more than 500 billion dollars in cuts to the Medicare program. This is not good
timing for the 72 million baby boomers who will need this assistance.
7. Out of pocket will be a burden on the middle class-24 million are without insurance, the max out of pocket limit for a family will be
11,900 on top of premiums; in 2009, 1.5 million Americans declared bankruptcy-of these 62% were medically related-and of these,
1/4 had insurance.
8. As a patient, I may not be treated as a human being in need not only of my medical necesssities, but with care, worth, dignity,and
understanding. This will be due to the fact that I will be viewed as a financial asset or burden according to my diagnosis and health.
Reference Health Care Laws/Obamacare retreived from Pro/Con org.9/26/12
Side: Against Reform
Under point number 2, less quality of care would result from doctors spending even less time per appointment. The usual time is around 15 minutes; any less time than this will barely get past the initial assessment. The longer wait times are those times in between appointments and tests or elective surgeries. Patients in other countries with a public health system have waited months for necessary CT's x-rays.etc. Physician fatigue will result in an increase in medical errors, malpractice suits, decreased patient and doctor satisfaction, and increased mortality rates.
Side: For Reform
While it is said that this act will ensure that everyone will have health insurance, this is not true. Many people will loose their current healthcare coverage. One of the main groups effected by this would be small business owners. They will have to pay higher taxes and this could result in all kinds of problems for them. With requiring that everyone has healthcare many feel like this is unconstitutional. Telling people what they have to do when they are given certain rights as a citizen of the United States under the Constitution doesn't go over well. It is said that this bill will lower healthcare premiums and cost, but it will actually raise them. They will be raised because the cost that prescription manufactures will pay will go up. There will be new taxes on medical devices and both of these things being raised will cause the patient to pay more for their prescriptions and will cause overall higher insurance premiums. This bill is said to solve the problem of medical bankruptcies, but it will actually cause them. The Patient Protection and Affordable Care Act is an overall bad thing for the patients.
Health Care Laws/Obamacare. Retrieved from http://healthcarereform.procon.org/
Side: Against Reform
Group: Taxpayers (against reform)
The Patient Protection and Affordable Care Act (ACA) sounds like a great way for all Americans to have access to healthcare with reduced fragmentation of services and it will have an ability to maintain costs. Sounds great when you say it but in reality it just is not true. The older adult may suffer under this new program and be denied access to care simply due to the fact that our bodies develop multiple conditions of frailty as we age. In October 2013 Medicare is implementing its Hospital Readmission Reduction Program which will penalize hospitals for rehospitilizations within 30 days of discharge. Under the Affordable Care Act within two years they will require quality improvement programs through patient safety organizations, “The researchers warn that because some frail older adults have multiple conditions and therefore have a higher possibility of being readmitted hospitals could respond by limiting access to this population.” (Affordable Care Could Have Unintended Consequences, 2012) Although it does state that the ACA will require that hospitals pay a penalty for rehospitalizations this may not offset the potential earnings from the rehospitalizations themselves, therefore better healthcare practices may not be encouraged.
Bundled payments are being introduced as a way to encourage healthcare service collaboration for preventative care and better patient care outcome. This is to lower costs. However under the National Pilot Program on Payment Bundling the researchers note, “The pilot program excludes long-term services and support as part of the ‘bundle,’ so …providers may simply withhold services to this group past the bundled payment period to realize savings.” (Naylor MD & Grabowski, 2012)
Although all age groups are to be served under the ACA, the older adult may suffer due to loopholes within the Act. The hope within medical insurance programs is that young healthy premiums will help displace the older adult’s increased medical costs.
Affordable Care Could Have Unintended Consequences. (2012). PT in Motion, 4(8), p. 10.
Naylor MD, K. E., & Grabowski, D. e. (2012, September 28). Unintended consequences of steps to cut readmissions and reform payment may threaten care of vulnerable older adults. Health Affairs. doi:10.1377/hlthaff.2012.0110.
Side: Against Reform
It is true that no one can dispute healthcare is in trouble. We all know it but no one wants to think they will shoulder the costs. In reality, as our healthcare system stands today, we are all shouldering the burden.
According the AHRQ web site, 70% of US healthcare dollars are spent on chronic disease care. For those Americans little or no insurance coverage, they must either put off getting help or use the emergency room. Either route means a big bill for something that could have been prevented.
The benefits are two-fold. The bill will provide affordable coverage to all Americans. Those who are delaying care or using the ER’s would be able to establish with a care provider for monitoring of conditions and stopping problems before they become costly.
The bill also increases the payment to non-physician providers. This has several benefits. The increased payment is a financial incentive to become a non-physician provider. More providers means better access to care. The non-physician providers are trained to focus on teaching self-management skills and in chronic disease management.
It is true that the bill will have an impact on some Americans tax bills. Again, as the healthcare system exists today, everyone is paying the bill by increased insurance premiums, increased co-pay and co-insurance, and increased cost of services. It stands to reason that if a small tax increase is swallowed now, then we can prevent being choked by skyrocketing healthcare costs in the future.
Side: For Reform
Small Business Owners
-Patient Protection and Affordable Care Act was formed to help reduce the costs of coverage for small businesses.
-Small Business Tax Credits: Small businesses have long paid a premium price for health insurance- often 18% more than larger employers. The tax credit will benefit an estimated 360,000 small employers who will receive the credit. (A More Secure Future).
-Small businesses that provide health coverage for their employees are eligible for a credit. Employers with 10 or fewer employees and average wages or less than $25,000 will get 100% of the credit; for other eligible employers, the credit will be reduced based on the number of employees over 10 and the excess of the employees' average wages over $25,000. (Nevius, A. 2010).
-SIMPLE cafeteria plans for small businesses. The Patient Protection Act establishes a SIMPLE cafeteria plan for small businesses. Under the provision, an eligible small employer is provided with a safe harbor from the nondiscrimination requirements for cafeteria plans as well as from the nondiscrimination requirements for specified qualified benefits offered under a cafeteria plan, including group term life insurance, benefits under a self-insured medical expense reimbursement plan, and benefits under a dependent care assistance program. Under the safe harbor, a cafeteria plan and the specified qualified benefits are treated as meeting the specified nondiscrimination rules if the cafeteria plan satisfies minimum eligibility and participation requirements and minimum contribution requirements. (Nevius, A. 2010).
-The ACA markedly increases the federal role in small and non-group markets. This is reflected in federal-level insurance regulations designed to make coverage more affordable regardless of purchase location. (Miller, E. 2011).
-Another key provision to increase health insurance affordability for small businesses is the availability of federal tax credits. (Nevius, A. 2010).
-The credit covers up to 35% of the employer's contribution; the full credit increases to 50% by 2014. It is estimated that the federal government will devote $40 billion to the small business tax credit over the next ten years (Congressional Budget Office 2009b). (Nevius, A. 2010).
-Under the health care law, employer-based plans that provide health insurance to retiree ages 55-64 can now get financial help through the Early Retiree reinsurance Program. This program is designed to lower the cost of premiums for all employees and reduce employer health costs. (Newsroom, 2011).
-In 2014, small businesses with generally fewer than 100 employees can shop in an Affordable Insurance Exchange, which gives you power similar to what large businesses have to get better choices and lower prices. An exchange is a new marketplace where individuals and small businesses can buy affordable health benefit plans. (Newsroom, 2011).
-Employers with fewer than 50 employees are exempt from new employer responsibility policies. They don't have to pay an assessment if their employees get tax credits through an Exchange. (Newsroom, 2011).
-Tax credit and subsidies available to help employers provide insurance for their employees.
-Small business owners know employees view health insurance as the most desirable benefits they can offer.
-It is fundamental that everyone should be able to obtain necessary health care. Unnecessary barriers to health insurance need to be removed.
The National Small Business Associated has listed its top priority Health Care Reform
Small businesses state that they face different challenges than those of large firms and are at a disadvantage, one of their hopes for health care reform is to diminish those disadvantages and continue to create jobs and assist the economic growth (Small Business Priorities, 2009, p.10).
-Reform will bring down costs for small businesses by creating a health insurance exchange which pools small business and their employees with millions of other Americans to increase competition in the insurance market. (Report Highlights Need for Health Care Reform, 2010 p.26)
-Reform would provide a small business tax credit for an estimated 3.6 million small businesses nationwide and end the “hidden tax” of more than $1,000 added onto every family policy that covers the cost of care for those without insurance.(Report Highlights Need for Health Care Reform, 2010 p.23)
-Health Care Reform will prevent premium hikes for small businesses.
Reform will also ensure employers and employees have stable, insurance coverage, and limit out-of pocket spending.
A More Secure Future. Retrieved from http://www.whitehouse.gov/healthreform/healthcare-overview.
Du, L. (2012, September 1). Health care law's impact on small businesses. Newsday, (Melville, NY).
Miller, E. (2011). Affordability of Health Insurance to Small Business: Implications of the Patient Protection and Affordable Care Act. Journal Of Health Politics, Policy & Law, 36(3), 539-546. (n.d.). Retrieved from http://www.irs.gov/uac/Small-Business-Health-Care-Tax-Credit-for-Small-Employers
Nevius, A. (2010, May). Health Care Reform Reshapes Tax Code. Journal of Accountancy. Vol 209. Retrieved from http://ehis.ebscohost.com/ehost/
Newsroom. Retrieved from http://www.healthcare.gov/news/
Report Highlights Need for Health Care Reform. (2010). O&P;Business News, 19(1), 24-26. 78-1271225
Schoen, C., Davis, K., & Collins, S. (2008). Building blocks for reform: acheiving universal coverage with private and public group health insurance. Health Affairs, 27(3), 646-657.
Small-Business Priorities. (2009). Financial Executive, 25(3), 10.
Thomas, N. (2010). Compliance Matters. The Small Business Health Care Tax Credit: does your practice qualify? PT In Motion, 2(10), 44-46.
Side: For Reform
Actually, healthcare reform would aid small business by reducing the costs of obtaining healthcare insurance for their employees. This would take place through an “insurance exchange” that would let small businesses choose from a large number of insurance plans that provide better coverage at lower costs. For small businesses that are unable to provide health insurance coverage, this exchange would allow for workers to obtain better and lower-cost options for health care coverage. Low income families would be placed on a sliding scale coverage plan to help them obtain insurance.
According to the Executive Summary, The Economic Effects of Health Care Reformation on Small Businesses and Their Employees (2009), the current health care system “…imposes a heavy “tax” on small businesses and their employees. Due to high broker fees, fixed administrative costs, and adverse selection, small businesses pay up to 18 percent more per worker than large firms for the same health insurance policy” (p. 2). These higher costs prevent many small businesses from supplying employees with health insurance coverage.
Under the health care reform, incentives for medium and large firms to offer health care coverage would be provided through a “pay-or-play” program. Small businesses would be exempt from this program. The reform would also encourage entrepreneurs to launch their own businesses thus increasing jobs that would be available, helping to alleviate unemployment.
By providing health care coverage options to small businesses, employers would see a reduction in call-ins from illnesses. Employees would be able to seek medical care and maintain better health outcomes due to the availability of insurance coverage. Health insurance coverage allows for prevention as well as providing coverage for illness.
According to the Executive Summary (2009),
Successful health care reform that genuinely slows the growth rate of costs will greatly aid the overall economy in general and small businesses in particular. Controlling costs will cause living standards and take-home wages to rise more quickly for American workers. Reform will lead to increases in entrepreneurial activity and to a more efficient allocation of workers throughout the economy. And by reducing future federal budget deficits relative to what they otherwise would have been, health care reform will serve to lower the cost of capital and reduce future tax increases for small businesses, which will lead to more investment and job creation in this key component of the economy (p. 14).
Due to these facts, many small businesses are embracing health care reform.
Side: For Reform
Argument against Small business
1. You will be penalized $750 per full-time employee if you’re a company with 50 or more employees, and you don’t provide health insurance. The government won’t charge you for the first 30 workers you don’t cover.
2. You face additional fines if you don’t cover 60% of overall employee health costs, as well government-defined set of services.
3. If you offer your employees health insurance you must cover no less than 72.5% of the cheapest health plan you offer for individuals, and no less than 65% for families. You must automatically enroll every employee in a health plan with the lowest employee premium, unless they opt out.
4. If you choose not to provide health coverage you must pay the Health Choices Commissioner (the person in charge of the SHOP exchange fund) 8% of the average wages paid during a predefined period of enrollment. They charge you a lower percentage if your annual payroll is less than $400,000.
5. You don’t cover your employees and don’t pay your SHOP fee. You’re fined $100 per violation day.
6. Small businesses will only qualify for a full tax credit when they employee 10 or less employees with annual salaries less than $25,000 annually, and the employer must pay for at least 50% of the employees premiums. The amount of the tax credit will only cover approximately 35% of the employers total premium. This leaves the employer responsible for 65% of the cost for paying one half of the employees premium.
7. The increased expenses that the employer will pay out to cover their employees to participate in the exchanges will probably cost more than what the individual employee could obtain if they purchased their insurance themselves on the exchange.
8. The employers actual cost for the premiums over covering their employees will only be 8 to 11% cheaper than if they had purchased them without receiving a tax credit.
9. Small businesses are only eligible to receive the tax credit between the years of 2010 and 2013 and then for any two additional years after that. After the 6 years of coverage, small businesses will be on their own.
10. While the tax credit is available to businesses that employee up to 25 employees with salaries up to $50,000 per year, the amount of the tax credit is substantially less.
DREA. (2010, March 24). What health care reform means for small business. Retrieved from http://www.businesspundit.com/
Miller, E. (2011). Affordability of Health Insurance to Small Business: Implications of the Patient Protection and Affordable Care Act. Journal Of Health Politics, Policy & Law, 36(3), 539-546. doi:10.1215/03616878-1271225
Side: Against Reform
While you make some good points such as the tax benefiting the 360,00 small employers, the Affordable Care Act (ACA) has negative effects for small businesses. With the cap being at 50 employees to be tax exempt, it is limiting the amount of full time employees small businesses want to hire, therefore according to Jim Amos, CEO and chairman of Tasti D-Lite, “It will keep new owners and new openings on the sideline.” Not only will it postpone or even prevent new businesses from opening, it will be bad for the economy and future employment numbers because of that. Marc Schupan,CE of Schupan & Sons stated, "We will look at hiring more closely and could increase temps as opposed to full-time personnel.”
Orsini, P. (2012, June 28). Small Business on Obamacare: No Reason to Hire or Invest. Retrieved from CNBC: http://www.cnbc.com/id/48000806/
Side: Against Reform
For Healthcare Workers (Non-Physician):
The Patient Protection and Affordable Care act includes many provisions that will positively affect health care workers with grants and initiatives for recruitment, retention, and education. It will also include initiatives for new models of care, and expand healthcare coverage to millions of Americans.
Provisions in the act are designed to increase the recruitment and training of many health care professionals, including primary care, public health, and nursing, and increase the diversity and cultural competence of the healthcare workforce. Incentives in the act will also increase the number of health care workers in medically underserved areas and increase and enhance training of faculty in training institutes. In addition, new models of care delivery and reimbursement to improve the coordination of care for patients will be established (Michigan Center for Health Professions, 2010).
The United States already has a shortage in access to primary care, and with healthcare reform, an additional millions of newly insured people will be seeking healthcare.
To target this issue, the ACA has made a large investment to create and increase the number of federally qualified health centers to deliver lower cost, higher quality primary care services to medically underserved populations. Health care reform has a large focus on improving quality, safety, cost, and access to care. There is also an increased focus on prevention, coordination, chronic disease management, health information technology, and patient-centered medical homes which utilize multidisciplinary teams.
Nurse practitioners can contribute as primary care providers, and provide a unique perspective to the underserved population. Increasing funding to APN’s can lead to improved care and outcomes for patients (Flinter, 2012).
To help prevent a shortage of PA's, programs that have graduates entering into primary care will receive grants. To compensate for a lack in nursing, student loans will be paid off if people go to school to become nursing educators.
Physicians are being overworked, and the new bill will attempt to establish "Team Medicine." This will help provide better health care for patients and make doctors happier and less stressed.
Medicare will also pay hospitals that perform better in regards to their patients and limit the number of their readmissions to the hospital. They will also reduce the Medicare payments that the hospital has to make (Washington Post, 2010).
The ACA has also created grants for public health schools and public health training programs, and will increase the supply of nurses by establishing better student loan funding, expanded eligibility for advanced practice nursing grants and creation of a nurse retention grant program.
In addition to physician’s assistants and nursing, the ACA also provides incentives to increase the quantity of direct care workers, including nursing assistance and aides, home health aides, and personal and home care aides. Incentives have also been created to support training programs for dentistry and mental and behavioral health education and training (Michigan Center for Health Professions, 2010).
The Act has also established the National Health Care Workforce Commission to assess need for healthcare workers and identify national workforce priorities. This will help health care workers work more efficiently and provide patients with more equal and reliable access to care (Ormond & Bovbjerg, 2011).
The Commission was created to serve as a resource for the government to communicate and coordinate with departments on multiple levels, evaluate education and training, identify barriers to improved coordination at federal state and local levels and address them, and create ideas to address population needs, technology growth, and other factors. The Commission will allow better collaboration between physicians, nurses, and other health care professionals, which will benefit both health care workers and their patients (U.S. Government Accountability Office, 2010).
Healthcare reform will continue evolving, and ACA has already begun creating improvements in the health care system. Many issues have been addressed and only time will tell whether the provisions, grants, and incentives established by the Act will maintain in the future.
Flinter, Margaret. (2012). From new nurse practitioner to primary care provider: Bridging the transition through FQHC-based residency training. Online Journal of Issues in Nursing, 17.1. 1091373
Michigan Center for Health Professions. (2010). Assessing the impact of health reform on the health care workforce. Lansing, MI: Public Sector Consultants Inc.
Ormond, B. & Bovbjerg, R. (2011). Assuring access to care under health reform: The key role of workforce policy. Washington, DC: Urban Institute.
U.S. Government Accountability Office. (2010). GAO announces appointments to new national healthcare workforce commission. Washington, DC: U.S. Government Accountability Office.
Washington Post. (2010). Landmark: The inside story of America’s new health-care law and what it means for us all. Washington, DC: The Washington Post.
Side: For Reform
As Insurance Executives we are definitely against reform. One of the keys that many miss in the reform plan is that insurance companies are facing a risk base capital change and are now required to keep more capital in reserve to cover claims; this is significantly larger than it has been in the past. By continuing to raise the risk based capital, insurance companies have less capital to cover operational costs or maintain operations and have to look at alternative sources to either increase revenue or decrease operational cost. Layered with the other requirements of the Affordable Care Act, this could be the beginning of the end for the commercial insurance industry, as we know it. The trickledown effect will be devastating. Insurance carriers will look for alternatives, either raising costs or decreasing operational costs; companies will be faced with unhappy clients, who will either leave or go without coverage regardless of the penalty, and the downward spin will begin.
Congress was challenged at the Supreme Court level on portions of the Health Care Act, but not all areas were addressed. It is fraught with issues. Although the intentions behind the Act were meant to be good, it does not appear that anyone looked at the true financial implications of the Act. Public health care will definitely come to us quickly, with this act destroying the foundations and the competitive edge of the insurance industry in a free enterprise. Regulation is one thing but to be setup for failure is truly unconscionable.
As it stands now, insurance providers are able to select who receives coverage and which ones are turned down (those who need coverage the most, the sick and elderly). Private insurers currently cover a less costly population, those who are employed and tend to be young and healthy. The United States government has passed the Affordable Care Act, a system of insurance mandate. Insurance is to be made available to and be carried by individuals and all businesses. One recommendation to the reform is to create state or regional insurance exchanges to pool risk, so that all Americans could obtain a standard benefits package. Where would the spirit of free enterprise go? Can Congress legally and justifiably mandate insurance? Capitalism would turn to socialism. As an executive of an insurance company, the government should not be passing laws that are going to risk the company's very existence.
Yes, perhaps the thought was, it would control greed within the industry. However, that greed will continue unless business ethics are addressed within the industry and strict standards are put into place. This one act is setting an unprecedented action.
As Insurance Executives, the Affordable Care Act is going to be detrimental to private insurance companies and will significantly reduce the profitability of the sector. Private insurance is being forced to provide coverage for more people, some with significant pre-existing conditions, without being able to significantly increase premium rates or deny coverage based on the specific pre-existing needs. For these reasons, many small companies will go out of business, placing increased burdens on the private companies that are able to remain operational. Those remaining will have to follow guidelines, similar the ones established for Medicare and Medicaid, to ensure that some level of profitability remains.
Some of the specific standards that are most going to effect the private insurance industry are: accounting for expenditures of premiums received, inability to impose annual or lifetime limits on individual benefits, and the requirement of essential benefits plans. Under the Affordable Care Act, private insurance companies are going to be required to show that 80-85% of collected premiums are spent on medical services for the subscribers, leaving only 15-20% of monies collected to cover administrative and other overhead costs of operation. This problem is further compounded by the fact that it is no longer acceptable to impose annual or lifetime limits on the amount of coverage that the private insurance company must pay to cover “essential” healthcare services. For this reason, chronically ill individuals that are non-compliant with dietary, medication, or other wellness plans and that are admitted to the hospital on a frequent basis due to exacerbation of their disease process may cost the insurance company more than what it is receiving in premiums form the individual.
One benefit that the Affordable Care Act may provide private insurance companies lies within the standards that are being placed on facilities receiving payments from Medicare and Medicaid. By adopting similar standards, it may be possible for private insurance companies to recoup some of the profits, which would otherwise be lost due to new laws surrounding revoking coverage on individuals. Included in the Medicare reimbursement plan is reduced payments for hospital readmits that are deemed preventable, and a loss of payment for hospital acquired infections which increase the overall cost of caring for the patient. Utilizing these two methods of reimbursement and bundling payments for each hospital stay should help to contain costs to a moderate degree and hopefully ensure some profitability.
Also, the reform’s push to have everyone utilizing electronic health records is a plus. To date, the standards in the industry for electronic health records and the sharing of data to care adequately for patients and control costs have been poor. There is much work to be done in this area, but this is one small positive of the reform act is meaningful. It will resolve all of the industry needs, but it will push healthcare to adopt computerization and move forward in ways we have never seen before. It is, also, responsible for creating jobs in the economy that previously may not have been necessary.
Arrow, K. & Ven,V. (2009). Toward a 21st Century Health Care System: Recommendations for Health Care Reform. Annals of Internal Medicine, 150(7).
Hall, M.A. (2011). Clearing out the underbrush in constitutional challenges to healthcare reform. New England Journal of Medicine, 364(9), 1-4.
The Staff of the Washington Post. (n.d.). Landmark: The Inside Story of America’s New Health-Care Law and What it Means for Us All (pp. 153-164). Thorndike Press.
The united states insurance financial solvency framework. (2010). Retrieved from http://www.naic.org/documents/
Side: Against Reform
Is it failure if a change in company procedure and/or policy saves thousands of lives? In the case of the insurance company, failure is defined as a dollar limit that won’t be reached; a profit that the Board of Directors and Shareholders are requiring is met. In reality, those who are denied coverage because they are considered too high of a risk factor – they will cost the insurance company too much money – those are the ones who are truly set up for failure. In the case of the patient denied coverage, deemed too high of a risk to cover, failure to that patient is not only about not reaching a dream to have insurance coverage, but failure to that patient can also mean death, due to failure to receive the necessary healthcare.
Preexisting conditions allow insurance companies to deny thousands of people from receiving healthcare and insurance yearly. This denial is based on the insurance company clauses that decide who is sick enough and who is not. Why is the fate of the unhealthy, sick, or even terminally ill left up to the business person and money handlers who are really only focused on the bottom line – profit? More than likely, these business people are not medical professionals in the sense that they cannot fairly decide who is worthy of medical care.
It is understood that insurance companies should be concerned about costs, money outlay and money coming in. However, an insurance company is designed to protect and support their clients, those are the people providing the money in the form of payments for health insurance premiums. Therefore, it seems the companies should worry more about the taxpayer (their client) being able to afford the treatments they need and thus provide the plans they deserve.
There have also been programs that have shown positive results that savings can be realized under the bundled care program that insurance companies would utilize under the Affordable Care Act. In one instance, a 15% to 30% savings was realized in hip and knee replacement surgeries where the bundled-care plan was utilized.
Insurance companies should be encouraging health-care providers to be more efficient, creative and focused on keeping patients healthy. They should help the health care providers be more focused on quality of care rather than quantity of patients, and on value rather than volume. According to Emmanuel, et. al, “only 10% of patients account for nearly two-thirds of costs. Today, there is little financial support for physicians and hospitals to coordinate their care or focus on keeping them healthy. Instead of paying a fee for each service, providers should receive a fixed amount for a bundle of services or for all the care a patient needs. Physicians and hospitals will then be empowered to use their clinical skills to craft the right care for their individual patients. Insurance companies need to embrace this idea.”
Emanuel, E.J., Tanden, N., and Berwick, D. (2012). The Democrats' Market-Friendly Health-Care Alternative. The Wall Street Journal, U.S. edition. A19. Retrieved September 25, 2012.
Side: For Reform
You have made some very valid points regarding the Affordable Care Act from insurance executives point of view. You state that private insurance companies will be forced to provide coverage for more people, some with pre-existing conditions. Though this may be true, there are tens of millions of uninsured Americans and that number continues to grow. These Americans are not getting treatments and are non-compliant with medication regimens simply because they can’t afford it. More than 70% of these Americans lack insurance because they simply cannot afford it. It is very possible many of these pre-existing conditions occurred because these Americans were unable to afford preventative and diagnostic health care to even find out that that had a pre-existing condition. Will the profitability of the sector decrease that much with the addition of millions of Americans gaining health insurance? Not only will the sector receive profit form the addition of all the new insured Americans, the new insured Americans will hopefully be more likely to be more compliant with needed medications and treatment plans in which the insurance companies will get reimbursed for.
Another point made stated that many small companies will go out of business. The health care reform is a huge supporter for small businesses. Small insurance companies may not be able to significantly increase their premium rates, but there is a huge opportunity for these small businesses to flourish, create jobs and assist in economic growth. The Affordable Care Act hopes to get every American insured. There will be the possibility of millions of patients needing insurance. (Small Business Priorities, 2009, p.10)
You state that this act will have a trickledown effect on insurance carriers. Those clients will be unhappy and will leave without coverage. Though some financial changes will be made, Americans will still receive health care and insurance companies make profit from this. Once these uninsured Americans receive insurance they are able to partake in preventative, diagnostic, therapeutic and maintenance health care that they weren’t able to before.
In addition many insurance carriers have already stopped paying for hospital acquired infections and pressure ulcers. The cost that goes along with these illnesses is tremendous. Insurance companies are gaining profit placing for this on hospitals.No downward spiral is foreseen, only better healthcare for those not able to receive it.
The Affordable Care Act isn’t a fool proof way to fix the healthcare problem. It is a step in the right direction. The intentions of the Act are intended to benefit Americans. It is important to remember there will always be change and with that means learning new ways to embrace the opportunities we are given.
Arrow, K., Auerbach, A., Bertko, J., Brownlee, S., Casalino, L. P., Cooper, J., & ... Jost, T. (2009). Toward a 21st-century Health Care System: Recommendations for Health Care Reform. Annals Of Internal Medicine, 150(7), 493-495.
Rethmeier, K. A. (2010). Innovation for healthcare reform: Creating opportunities to explore expand and excel. Journal Of Management & Marketing In Healthcare, 3(2), 150-162. doi:10.1179/175330310X12665775636508
Small-Business Priorities. (2009). Financial Executive, 25(3), 10.
Side: For Reform
As a health care provider, I believe everyone deserves quality health care. There should be health care available for all medical conditions including pre-existing conditions. Statistics indicate employer based health insurance as well as other types of health insurance continues to decline. (Gallup.com/poll/148079/
Over a period of time, the insurance companies have priced the average American out of health care benefits. The insurance companies are more concerned with profit than meeting the needs of the citizens. Competition within the health care insurance companies has allowed the rates of health care insurance to soar. What was once a household benefit has now been limited to those who have money.
Health Care reform is needed to insure all citizens have the available funds to pay for needed care without the hassle of stacks of paperwork to show eligibility. Whether the insurance company is paid by private insurers or by government funding, insurance companies need to be held accountable for the monies the policy holders pay. To offer affordable care, there must be controls in place to monitor each dollar the policy holder pays. The policy holders are paying for a service so the money paid to the insurance companies should be spent on the insured. Six figure salaries and benefits to the insurance executives need to be capped. Reserve amounts to pay future claims are calculated into the premium payments. With proper management from the insurance administration, it should not be necessary to increase these amounts. Health care reform will not affect the insurance companies if intelligent changes are made governing the parameters of claims processing. Changes in stream-lining operations to eliminate excess hiring, accountability in spending at the executive levels, salary reviews and adjustments, and auditing of general, everyday spending are some ways to curb spending.
Drugs should be monitored more closely to determine if patients really need so many. There are some restrictions and information sharing of the drugs patients are prescribed but more should be done to protect the patient and the payments involved. The money saved in these simple changes would off-set any additional spending necessary for offering health care to non-insured citizens.
Government requirement of health insurance would be a positive health care reform to insure all citizens have coverage for health care. The profit margin to insurance companies would not decrease; it would increase. Do the math, an increase in policy holders means an increase in funds. Yes, the claims payments would increase but the percentage allowed per insured for administrative costs would also increase as this amount is automatically calculated in the insured’s premium.
Side: For Reform
(Posted for Taxpayer Group)
Group 1: Impact on Tax Payers
The health care reform law will impose higher taxes on tax payers and violate our ability to make our own decisions to buy or not to buy insurance by requiring the purchase of medical insurance. This law will increase taxes by more than $500 billion, putting much of the burden on middle-class families. The bill imposes job-killing mandates and penalties on businesses, increases taxes, and burdens on small businesses. “It includes a long term hidden tax by deferring the 'Cadillac tax' on certain high cost health plans until 2018. The number of Americans that will ultimately suffer from this hidden tax will mushroom each year because the tax is indexed to inflation—the growth in the Consumer Price Index—rather than the much higher growth rate of healthcare costs.” (ProCon.org, 2010)
In the Federal Tax Course Letter it states,
• “An additional 0.9% Medicare tax (for a total Medicare tax of 3.8%) will be imposed on taxpayers (other than corporations, estates or trusts) receiving wages with respect to employment in excess of $200,000 (250,000 in the case of joint filers and surviving spouses, and $125,000 in the case of married taxpayer filing separately [Code Sec. 3101(b)(2)].
• An additional 0.9% Medicare tax will be imposed on an individual’s net earnings from self-employment in excess of the above threshold amounts [Code Sec. 1401(b)(2)].
• Higher-income taxpayers with investment income will be subject to a new 3.8% unearned income Medicare contributions tax on their net investment income. The unearned income Medicare tax is imposed on the lesser of (1) net investment income, or (2) the excess of modified gross income over the threshold amounts [Code Sec. 1411(a)]. (Beware of Medicare Tax Increase in 2013, 2012, p. 6)
What does this mean for the taxpayer; it means that you may need to talk with a tax advisor to help shield you from the government imposing increased taxes on your earned income. Retirement plan distributions will be exposed to the 3.8% Medicare tax. If you sell your home starting in 2013 you could be subject to capital gains tax at 3.8%. Estates and trusts will be exposed to 3.8% unearned income Medicare contribution tax. Kiplinger’s states, “In 2013, employers must limit your pretax contributions to flexible spending accounts to $2,500 per year (down from $3,000 to $4,000 for many employers) and provide a summary of benefits during open enrollment.” (Lankford K, 2012, p. 13)
The IRS will have to enforce 47 new tax codes mandated by “The Affordable Care Act” and it is stated in Bloomberg BusinessWeek that, “Putting all of this into place is expected to cost $881 million through 2013, according to the Treasury Department, Douglas Shulman, the agency’s commissioner, told Congress that the IRS needs $13.1 billion in fiscal 2013, an 11% increase from 2012, to get the job done on schedule.” (Dwoskin, 2012) A sampling of these mandates include, “Patrons of tanning salons pay a 10% tax to catch fake rays, Medical device makers pay a 2.3% tax on annual sales, and by 2014 Americans who decline health coverage pay a penalty tax of $695 per year or 2.5% of household income. (Dwoskin, 2012)
No one contradicts the fact that changes need to occur in our medical system but we need a better detailed plan. Taxes will increase drastically under the current Patient Protection and Affordable Care Act and will continue to rise as the IRS struggles to implement and enforce the new tax codes. In the end everyone will be left with increased financial burdens due to this Act and possibly little change in medical outcomes.
ProCon.org. (2010, July 28). Will Obamacare lower taxes? HealthCare Reform.ProCon.org Retrieved from http://healthcarereform.procon.org/
Beware of Medicare Tax Increase in 2013. (2012). Federal Tax Course Letter, 26(8), 6-10.
Dwoskin, E. (2012). Collecting America's Newest Tax. Bloomberg Businessweek(4287), 28.
Lankford K, K. S. (2012). Health Care: A Work In Progress. Kiplinger's Personal Finance, 66(9), 13-14.
Side: Against Reform
Tax payers, you have made some interesting points about the new healthcare reform laws. One that I really find interesting is in regards to a "violation of our ability to make our own decisions to buy or not buy insurance. It is the belief of group 5 (Small Business), that all Americans should have health insurance. The millions of people without health insurance are not without because they are exercising their constitutional right to do so, they either can't afford private insurance, insurance is not offered by their employer, or the insurance offered is too expensive.
Excessive growth of health care costs is by far the largest contributor to our fiscal stress and inability of middle class to get ahead or improve their lifestyle. In 2004 the estimated total costs of care for uninsured Americans was almost $125 billion. The new tax reform law will not only insure that all Americans have health insurance, but it will also decrease taxes for mid and lower class Americans. The new reform strategy has been geared to prevention of illness and promoting wellness by population health management, outcome based payment, accountable care organizations, and evidence based practice (EBP), all of which will decrease the amount of ER, doctors office, specialty services needed, and duplication of care that will in turn save millions of dollars in health care per year.
• There is also a tax credit for small businesses.
• It is estimated that the federal government will devote $40 billion to small business tax credit over the next ten years (Congressional Budget Office 2009b).
Miller, E. (2011, Jun). Affordability of Health Insurance to Small Business: Implications of the Patient Protection and Affordable Care Act. Journal of Health Policies, policy & Law, 36(3), 539-546.
Carlson, J. (2012), Clarity at last. (cover story). Modern Healthcare, 42(27), 2-02.
Romer, C. D. (2012, July 22). Only the First Step In Containing Health Costs. New York Times. p6.
Thomas, N. (2010). Compliance Matters, The Small Business Health Care Tax Credit: does your practice qualify? PT in Motion, 2(10), 44-46.
Side: For Reform
The inability of the American middle class to get ahead is only in part due to the excessive growth of healthcare costs. Who paid that $125 billion dollar care cost? Taxpayers. Not only will all taxpayers soak up the costs, but they will also be paying for the premiums on top of that. Is it always fair to heavily tax the wealthy just because they are wealthy? Where is the justification? The wealthy will not remain wealthy or placid if we constantly depend on them to support the rest of us. We all need to contribute with more of an equal percentage.
Side: Against Reform
This new healthcare reform act that will increase the number of individuals who maintain health insurance could potentially drive physicians away. A poll that was conducted by Athenahealth and Sermo (2010) indicated that 66% of primary care physicians will consider opting out of all government-run programs - i.e. Medicaid. The Affordable Care Act, requires individuals to obtain health insurance; this will add millions of new beneficiaries to the current system which will increase the demand for health care services. With this influx of added beneficiaries the health care provider shortage will continue to grow. The projected shortage of physicians in 2025 is estimated to be 130,600 across all specialties (AAMC, 2010). This new healthcare reform bill is supposed to be budget-neutral which means that this bill will not cost or save the government any money; therefore, providing services will require receiving money elsewhere - this could come from the pockets of the physicians, as well as taxpayers, and other healthcare providers. As Palestrant (2010) stated, "we are hoping more physicians become available to treat the influx of 31 million more patients, [but] the government is implementing a massive reduction in physician reimbursement." It is also apparent that this Affordable Care Act requires health plans to cover certain preventative screenings without cost to the consumers which will place the additional burden on health care providers (Public Sector Consultants Inc, 2010).
The healthcare reform may look beneficial on paper; however, in the long run it will cause a decrease in physicians while there is an increase need for patient care. This will cause longer wait times. Physicians will have a set of government rules and regulations to direct the care that patients receive that could cause physician-patient relationships to deteriorate. Huntoon (2010) stated, "What little joy is left in the practice of medicine today is often found in third-party-free practices, in which the physician is accountable solely to the patient, and care is managed by physician and patient working together." As a physician, I would be against healthcare reform because it will negatively affect the careers and salaries, falsely promise unlimited care to individuals, and turn upcoming physicians away.
AAMC. The impact of health care reform on the future supply and demand for physicians updated projections through 2025. (2010, June). Retrieved from https://www.aamc.org/download/158076/
Athenahealth & Sermo (2011). Physical Seniment Index. Retrieved from:
Huntoon, L. (2010). The road ahead in medicine. Journal of American Physicians and Surgeons, 14(4), 98-99.
Monegain, B. 2011. Doctors concerned about effects of healthcare reform. Healthcare finance
news. New York, NY.
Palestrant, D. (2010) Why physicians oppose the health care reform bill. Forbes.
Public Sector Consultants Inc. (November, 2010). Assessing the impact of health reform on the
health care work force. Michigan Health Council. (pp. 6-8, 23-24). Retrieved from: http://www.mhc.org/file_archive/
Side: Against Reform
Dispute Physician Argument
There is a legitimate concern about the ability of current primary care providers to be able to handle the influx of patients that is predicted due to the healthcare reform bill. The bill has provisions to address this concern.
According to the US Department of Health and Human Services the provisions of the Affordable Care Act supports training, development, and placement of new primary care providers. The act also gives money to states to develop unique strategies to expand the primary care workforce.
The bill also increases payment to non-physician providers. Non-physician providers focus on chronic disease and self-management of disease. By taking this burden from primary care physicians, they can focus on the more acute cases.
The bill also increases payment to primary care providers. This financial incentive will hopefully keep primary care physicians working in primary care and entice medical students to choose primary care as a specialty.
The Affordable Care Act isn’t perfect. The plan is complex and extensive. Most of us must rely on others to read and interpret the plan. It appears that the authors of the bill anticipated the negative effects of the bill and made provisions to offset the negatives.
ProCon website : www.procon.org Aug. 23, 2010
US Department of Health and Human Services – www.dhhs.gov
Side: For Reform
The Affordable Care Act is granted hundreds of millions of dollars to address many issues. While the provisions ranges are varied, they aim to address specific needs of the health care workforce and care delivery system. A large portion of the population will soon be requiring more health care services because the older population has increased significantly. While health care services requirements will be increasing, health care professionals will be decreasing because they will be retiring. Without new professionals coming into the workforce, shortages will intensify. While health care professionals are required, many younger generations want to have a balance between their work life and home life (Public Sector, 2010). Without a schedule to accommodate their needs, it is less likely they will accept a job that is too demanding.
Public Sector Consultants Inc. (November, 2010). Assessing the impact of health reform on the health care work force. Michigan Health Council. (p. 5-7). Retrieved from: http://www.mhc.org/file_archive/
Side: Against Reform
The patient-doctor relationship should not be greatly affected by the regulations. Communication, respect and fairness are just a few aspects of what determines a quality patient-doctor relationship. It was stated, “Due to the changes with obamacare doctors have government rules and regulations what will tear apart the doctor-patient relationship. Doctors will have to focus more on government rules and regulations, rather than the specific needs of their patients.” Doctors can focus on the specific needs of their patients, and determine what method of treatment is best for the patient, while staying within the rules and regulations.
Because of the affordable care act, everyone will be covered by some form of health insurance. Rules and regulations have been put into place, however they should not interfere with the doctors knowledge and education. The act is assuring these knowledgeable doctors are doing what’s best for ALL patients, and not just the patients with money and insurance.
Studies show that a reduction in mortality of 5-15% could be expected if the uninsured were to gain continuous health coverage (1). Research has also shown that uninsured patients receive less preventative care, are diagnosed at more advanced disease states, once diagnosed receive less therapeutic care, and have higher mortality rates compared to those insured (1). Not only does the affordable care act provide free preventative care, but by doing so, many diseases can be caught at an earlier stage and dealt with on a lower, less expensive level.
From a patient perspective, it has to be considered if one will be paying more for insurance or for out-of-pocket costs due to not having insurance. When going to an emergency room, who is paying for the uninsured patient who could have received preventive care prior to being admitted had they had insurance? The affordable care act may initially be costly, however in the long term for effective; especially for those who currently do not have insurance.
Side: Against Reform