Delays in Rollout of the Affordable Care Act
Implementation of the Affordable Care Act has faced a number of challenges, which have delayed its implementation. Technical problems have delayed the rollout of the Affordable Care Act. Technical problems that exist in the development of massive information technology (IT) infrastructure hinder the implementation of the Affordable Care Act. The technical problems emanate from the inability of the website to allow more than 500 users to sign up at the same time and thus making the registration system crash or fail. The Affordable Care Act and Center for Medicare and Medicaid Services are developing exchange websites to allow millions of Americans who are uninsured to sign up. For example, the Affordable Care Act wants to provide for the enrollment of the Small Business Health Options Program (SHOP) and the Hispanic community. Since the implementation of the Affordable Care Act requires massive IT infrastructure, the IT experts need more time to understand technical glitches that the website faces, and thus prevent the occurrence of foreseeable technical issues.
Fraud and Abuse in Health Care
Health care fraud and abuse are corrupt practices that happen in the health care system. The health care fraud and abuse have made the health care system lose billions of dollars to fraudsters. Specifically, health care fraud comprises intentional deceptions such as billing of fake medical services with the objective of defrauding insurance companies or health care system. Comparatively, health care abuse encompasses misrepresentation of facts to receive compensation or obtain payments illegally. To prevent or curb the occurrence of fraud and abuse in the health care, the Affordable Care Act provides effective pieces of legislation. The Affordable Care Act contains tough rules and penalties for criminals recommends the use of advanced information technology and provides a substantial budget for anti-fraud efforts. Since the Center for Medicare and Medicaid Services has numerous strategies for fighting health care fraud and abuse, the Affordable Care Act utilizes them and develops robust strategies of curbing health care fraud and abuse.
Pending shortage of primary care physicians
Given that the Affordable Care Act aims at increasing insurance coverage among Americans, it will cause a significant shortage of primary care physicians. The first way of coping with the pending shortage of primary care physicians is to change the model of primary care so that non-physician practitioners such as assistant physicians and nurse practitioners can provide primary care. Moreover, the change of the primary care model by transforming nurse-managed health centers and patient-centered medical homes into primary health care centers will expand primary care centers and consequently relieve the shortage of primary care physicians. The second way of coping with the shortage of primary care physicians is to increase the number of physicians who train in medical institutions. The Affordable Care Act increases the number of physicians who train through the Primary Care Residency Expansion program. The third way is to allow physicians to delegate routine care practices to non-physician practitioners, and consequently, alleviate work burden on physicians.
Importance of tax repeal
Repeal of device-tax is important because it will have beneficial impacts on the device industry and the health care system. Given that the device industry is experiencing a decline in sales, tax repeal will boost the sale of the medical devices to various healthcare centers in the United States. Increased sales of medical devices will consequently enhance the growth of the device industry, and thus create employment to thousands of Americans. The device industry claims that taxes have been consuming significant part of their revenues, which have prevented them from conducting research and development. Thus, tax repeal will enable the device industry to budget for the research and development, and improve the growth of the device industry. In the health care system, tax repeal will lower the cost of medical services because healthcare centers will not be using expensive medical devices. In this view, insurance companies will experience a significant reduction in reimbursement that they make to hospitals.
Mental health and ACA
It is a good idea for the Affordable Care Act to include insurance coverage for mental health. Since human health entails mental health, failure to include mental health to the insurance coverage is a form of discrimination. Statistics show that 60% of people with mental health and 90% of people who abuse substances do not access essential healthcare services due to discrimination. Overall, 62 million Americans who suffer from mental disorders and substance abuse issues do not have insurance cover because insurers discriminate against them. The rules demand that insurers should no longer discriminate people with mental illnesses or who abuse substances by denying them coverage or increasing their charges. The rules also compel healthcare centers to treat patients irrespective of their mental illnesses or substance abuse issues. In this view, inclusion of mental health coverage in the Affordable Care Act is a good idea because it will end discrimination of people with mental illnesses and substance abuse issues.
Brief summary
The increase in the Medicare spending compelled Congress to formulate laws that would prevent the cost of paying doctors from increasing exponentially. In 1997, Congress enacted legislations, which aimed at limiting the constant increase of doctors’ pay annually. However, since 2003, doctors persuaded Congress to overlook 1997 legislations, and increase their pay according to their demands. The new proposal, therefore, aims at repealing the 1997 legislations permanently and allowing Medicare to follow how private insurers pay doctors. Private insurers consider the quality and cost of healthcare services that doctors provide, but they do not consider the quantity of healthcare services. The traditional fee-for-service system is not an effective system because it offers financial incentives to doctors to provide medical services that are not necessary. To implement the new system of payment, which focuses on the quality and cost of medical services, it requires about 150 billion of dollars within a period of 10 years. However, clinical and physician services cost 130 billion last year, and projections show that it will double by the year 2012. Therefore, changing the way doctors earn is timely in reducing Medicare spending.
Affordable Care Act
The Affordable Care Act is good because it brings massive reforms to the health care system and insurance companies. Healthcare services are very expensive in that Americans with insurance cover are the ones who can afford them, and thus leaving millions of Americans who do not have any cover. Given that a significant number of Americans have been unable to access essential healthcare services because they are expensive, the Affordable Care Act seeks to ensure that all Americans access and afford quality healthcare services that they need. Moreover, since insurance companies have been charging high premiums, the richest Americans only have been able to afford insurance cover that they need. In this view, the Affordable Care Act does not only enable Americans to access healthcare services, but also afford insurance cover for them to acquire medical services at various healthcare centers of their choice.
Independent Payment Advisory Board
The Affordable Care Act needs some adjustments to improve it so that it can serve its purpose of providing quality and affordable healthcare services to Americans. As the Act aims at providing universal healthcare services by offering one insurance package for all forms of illnesses or conditions, it fails to recognize the unique needs of various people. Provision of mandatory mental health, free preventive care, no lifetime limit, and free contraceptives make insurance cover to be very expensive to the young people because they do not utilize these healthcare services. In this view, as a member of the Independent Payment Advisory Board, I would adjust the Act to offer different insurance packages that cater for the unique needs of people. For example, the young people under the ages of 26 years should have a choice on whether or not to subscribe to insurance packages that have birth control and kids’ packages.
Since the Act makes it mandatory for everyone to sign up for the insurance cover, as a member of the Independent Payment Advisory Board, I would increase penalties for individuals who delay to sign up depending on the number of years taken. The Act stipulates that an individual should pay penalties of 1%, 2%, and 2.5% of adjusted gross income by 2014, 2015, and 2016 respectively, which are low when compared to the cost of insurance. In this view, I would increase penalties to enhance sustainability of the Affordable Care Act and encourage many people to sign up in time. Additionally, given that about 3 million of Americans have uninsurable medical conditions, I would create a special package for state risk pool. The creation of the state risk pool is essential because it provides a special insurance support to people with uninsurable health conditions. Such a move would reduce insurance premiums, and thus enhance sustainability of the Affordable Care Act.