Health Care Utilization: The Patient Protection and Affordable Care Act

Subject: Law
Pages: 5
Words: 1108
Reading time:
4 min
Study level: College

Recent advances in health care in the United States are presented by the Patient Protection and Affordable Care Act (PPACA) in 2010. In particular, the Act provides coverage for people regardless of medical position, gender, age, and pre-existing conditions. The reform also guarantees individual mandate health insurance for individuals (American College of Physicians, 2011). However, provided individuals are not insured by Medicaid, Medicare, or employer-sponsored health plan, they should adhere to an approved private insurance policy to pay a penalty. The government also provides private insurance, as well as health care subsidies for people whose income is below the poverty line. On the one hand, the PPACA has important policies to face the challenges of increased costs, inadequate coverage, and paying capacity. On the other hand, the current situation in health care has witnessed a great recession in terms of fast-growing health care costs, and an ongoing shortage in primary care treatment for adults.

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According to the American College of Physicians (2011), the United States faces challenges “in providing affordable health insurance coverage for all, ensuring that the system can meet the growing demand for health care, and controlling costs ” (p. 2). As a result, the health care reform measures have inhibited access to health care because of raised costs and decreased health care capacity. What is more problematic, in case changes are not provided to the PPACA, the U.S. government can no longer introduce private health insurance coverage. Certainly, the Affordable Care Act has enough potential for expanding access of the population to health care. However, further directions are unlikely to support employer-based insurance because premiums grow much faster than salaries and, as a result, the ratio of uninsured people will rapidly increase.

Changes introduced to health care will affect the utilization of services and payments. Some of these impacts will stem from shifts in healthcare coverage. Because the reform implies a greater access to insured people, the demands will continue growing. At the same time, some alterations in payments and coverage can reduce service demands. To explain the issue, it is necessary to define the spending demands, as well as how these estimates influence pricing strategies and utilization. There must be an optimal balance between supply and demand for health care providers to be able to meet the needs of the population (Dunn et al., 2010). Limited supply can decrease the utilization rates, particularly for preventive and elective procedures. While considering total expenditures, including deductibles and health premiums, enrollee costs can be either higher or lower irrespective of insurance coverage (Dunn et al., 2010). Fluctuations in insurance coverage can lead to a temporary rise in utilization because the insured population can ask for health care services that were previously denied because of high costs.

Greater access to the healthcare system leads to discovering new health conditions and a wider range of follow-up procedures. Some of the uninsured prefer saving their premiums by choice, but an increase of insurance of pool of this category of the population can contribute to the overall health of those (Dunn et al., 2010). Additional regulations and procedures can influence the complexity of health care delivery either negatively or positively. Currently, 200.000 individuals belong to the high-risk pool category (Dunn et al., 2010). Overall, hospital utilization is largely affected by the fluctuations that occurred to the ratio of insured people due to the growing demands and insufficient capacity of health care providers.

The PPACA refers to a compulsory health insurance plan because it requires U.S. residents to buy insurance. In the United States, therefore, the health care reforms are premised on a single public funding. Unlike national health insurance, universal health insurance offers a specific healthcare scheme to all residents with no reference to their age and social position. Although the country does not have a universal model of health insurance, the introduced act seeks to expand coverage to the official citizens by 2014 (Menzel, 2012). About the emerged discrepancies in health care systems, it is also possible to consider the morale and ethics of U.S. healthcare because insurance capacities are identified by people’s income rates, but not by their human and civil rights. In this respect, Menzel (2012) argues, “…the basic view of justice referred to above as Equal Opportunity for Welfare, is not only defensible philosophically but represents a very wide central range of U.S. moral and political values” (p. 585). Therefore, people should not be limited in terms of their access to health care coverage or because of their health status. Such a perspective contradicts the concept of universal health care coverage.

The history of health care reforms in the United States reveals evidence of changes that are closely related to the concept of universal health care insurance. This is of particular concern to the Emergency Medical Treatment and Active Labor Act (EMTALA), which allowed individuals with the low-paying capability to receive health care services for free in case of emergency. However, this alternative generated discontent among the population who purchased health insurance. The current PPACA is the closest to the universal concept, except for some disadvantages, which could be removed as soon as the insurance is provided equally to all members of society. The shift from mandate health insurance to a universal version of health care coverage could resolve all issues related to unfair treatment of U.S. citizens about their paying capabilities. When a healthcare system introduces mandatory universal insurance to provide premium care, monitoring costs should seek to accomplish moral duties, but not only improve the economic welfare in the country. Currently, the United States underestimates the moral constraints of health care changes.

My experience testifies to negative outcomes of health care reform for my family and my future care. Being a single mother and having two children creates significant problems because of mandatory health care coverage. I cannot afford to pay even premiums because of my part-time job position. Paying for tuition and spending money on my children does not allow me to receive health care coverage. Even the proposed subsidies cannot cover all my expenditures because my monthly payment is about $ 300-400, which does not only dental coverage. About this situation, I belong to the category of citizens that cannot receive coverage because of insufficient paying capacity. I also agree that the PPACA could have better perspectives in several years. However, currently, the reforms contribute to the increased marginalization of society into those who purchase insurance and those who do not have enough financial potential to afford it. I believe that health care providers should become morally aware of their obligations to introduce change to the current reform and reduce the poverty line.

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References

American College of Physicians. (2011). Health Care Coverage, Capacity and Cost: What Does the Future Hold?: A Report from America’s Internists on the State of America’s Health Care. Web.

Dunn, D., Lewandowski, D., and Pickens, G. (2010). The Influence of Reform on Local Coverage and Utilization. Web.

Menzel, P. T. (2012). Justice and Fairness: A Critical Element in U.S. Health System Reform. Journal Of Law, Medicine & Ethics, 40(3), 582-597.