BHA FPX 4003 Assessment 1 The Affordable Care Act and Beyond

• BHA FPX 4003 Assessment 1

Introduction

The Affordable Care Act (ACA) and the Medicare Access and CHIP Reauthorization Act (MACRA) represent two pivotal moments in the evolution of the American healthcare system. Although distinct in their objectives, these laws have collectively transformed healthcare delivery in the United States. This analysis explores the goals of these legislations, their interconnectedness, and their implications for current and future healthcare policy, as discussed in BHA FPX 4003 Assessment 1.

Sources Addressing the Affordable Care Act

ACA’s Impact on Racial and Ethnic Disparities

Buchmueller and Levy (2020) highlight how the ACA has helped reduce disparities in health insurance coverage among racial and ethnic groups. Non-Hispanic Black and Hispanic populations have seen significant improvements in insurance access compared to whites. However, challenges remain, as Black and Hispanic individuals are still more vulnerable to lacking health insurance.

Expanding Healthcare Access

Gruber and Sommers (2019) reflect on the ACA’s achievements, including the expansion of Medicaid and the creation of health insurance exchanges. These measures have increased insurance coverage and improved health outcomes, though concerns about workforce adequacy and state governments’ financial burdens persist.

Enhancing Health Equity

According to Lantz and Rosenbaum (2020), the ACA has improved affordability and quality of care while reducing race-based disparities. Section 1557 of the ACA enhanced human rights in healthcare by addressing fairness and accessibility. Additionally, Medicaid expansion under the ACA has reduced mortality rates and improved health equity.

Sources Addressing the Medicare Access and CHIP Reauthorization Act (MACRA)

Transformation of Accountable Care Organizations (ACOs)

Abodunde, Slater, and Coustasse (2020) discuss how MACRA has driven the success of ACOs, improving healthcare quality and accountability. This transformation is pivotal in enhancing patient outcomes while managing costs effectively.

Payment Model Innovations

Cheng et al. (2020) explain how MACRA’s Advanced APM and Merit-based Incentive Payment System (MIPS) incentivize providers to deliver cost-effective, high-quality care. Payment models reward efficiency, affordability, and quality, aligning with broader goals of healthcare reform.

Small and Medium-Sized Practices

Soylu et al. (2020) focus on MACRA’s impact on smaller primary care practices. While MACRA has improved care standards, implementation challenges remain. Policymakers must address unintended consequences to smooth transitions to the new payment models.

Affordable Care Act Overview

Transforming Healthcare Delivery

Signed into law in 2010, the ACA addressed high uninsured rates, rising healthcare costs, and inequalities in care quality. Key strategies included:

• Establishing health insurance marketplaces for individuals and small businesses.
• Expanding Medicaid to cover more low-income individuals.
• Protecting consumers by banning exclusions based on pre-existing conditions (Zhao et al., 2020).

Increasing Access and Quality

The ACA’s expansion of Medicaid and creation of insurance marketplaces significantly reduced uninsured rates, providing essential health benefits, including preventive services. These measures improved healthcare access and outcomes across diverse populations (Zhao et al., 2020).

Impact of ACA and MACRA on Healthcare Delivery

ACA’s Contributions

The ACA has improved access to quality healthcare by expanding insurance coverage and reducing financial barriers. Medicaid expansion and insurance marketplaces have increased the insured population, leading to better health outcomes and reduced disparities (Lantz & Rosenbaum, 2020).

MACRA’s Innovations

MACRA replaced the Sustainable Growth Rate formula with a value-based payment system, focusing on efficiency and quality. Through MIPS and Advanced APMs, providers are incentivized to deliver high-quality, cost-effective care. These models support population health management and sustainable healthcare delivery (Jones et al., 2019).

Effects on the U.S. Healthcare Environment

Quality Improvements

Both the ACA and MACRA emphasize quality improvements. The ACA introduced patient-centered care models, while MACRA’s focus on value-based payments aligns incentives with outcomes (Chernew et al., 2020).

Enhanced Health IT and Data Sharing

MACRA builds on the ACA’s health information technology (HIT) advancements. By promoting interoperability and electronic health record (EHR) utilization, MACRA supports coordinated and patient-centered care delivery (Chernew et al., 2020).

Expanding Preventive Care

Preventive care initiatives under the ACA have encouraged early intervention and health equity, addressing social determinants of health and reducing disparities (Chernew et al., 2020).

Impact on Healthcare Quality and Access

Expanding Insurance Coverage

The ACA expanded insurance coverage and improved access to preventive care, significantly reducing uninsured rates. These measures have laid the groundwork for achieving equitable healthcare (Chernew et al., 2020).

Value-Based Care

MACRA’s focus on value-based payment models encourages efficiency and quality in care delivery. By aligning payment incentives with outcomes, MACRA fosters sustainable and patient-centered care systems (Jones et al., 2019).

Future Directions

Both ACA and MACRA highlight the importance of continuous innovation in healthcare delivery. The emphasis on health IT, interoperability, and data sharing ensures that the healthcare system remains adaptable to evolving needs (Chernew et al., 2020).

Conclusion

The Affordable Care Act and MACRA have profoundly transformed the U.S. healthcare landscape. The ACA expanded access, reduced disparities, and improved care quality, while MACRA introduced value-based payment models that prioritize efficiency and patient outcomes. These laws have set the stage for a more equitable and sustainable healthcare system. As outlined in BHA FPX 4003 Assessment 1, ongoing efforts to integrate technology, enhance quality, and address disparities will continue shaping American healthcare’s future.

References

Abodunde, B., Slater, C., & Coustasse, A. (2020). MACRA and accountable care organizations. Journal of Ambulatory Care Management, Publish Ahead of Print (9). 

https://doi.org/10.1097/jac.0000000000000350

Buchmueller, T. C., & Levy, H. G. (2020). The ACA’s impact on racial and ethnic disparities in health insurance coverage and access to care. Health Affairs, 39(3), 395–402. 

https://doi.org/10.1377/hlthaff.2019.01394

Cheng, J., Kim, J., Bieber, S. D., & Lin, E. (2020). Four years into MACRA: What has changed? Seminars in Dialysis, 33(1), 26–34. 

https://doi.org/10.1111/sdi.12852

Chernew, M. E., Conway, P. H., & Frakt, A. B. (2020). Transforming Medicare’s payment systems: Progress shaped by the ACA. Health Affairs, 39(3), 413–420. 

https://doi.org/10.1377/hlthaff.2019.01410

Gruber, J., & Sommers, B. D. (2019). The Affordable Care Act’s effects on patients, providers, and the economy: What we have learned so far. Journal of Policy Analysis and Management, 38(4), 1028–1052. 

https://doi.org/10.1002/pam.22158

Jones, R. T., Helm, B., Parris, D., Grubbs, S. S., Choy, H., & Kapetanovic, K. (2019). The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) made it simple for medical and radiation oncologists. JAMA Oncology, 5(5), 723. 

https://doi.org/10.1001/jamaoncol.2018.5631

Lantz, P. M., & Rosenbaum, S. (2020). The potential and realized impact of the Affordable Care Act on health equity. Journal of Health Politics, Policy, and Law, 45(5), 831–845. 

https://doi.org/10.1215/03616878-8543298

Soylu, T. G., Goldberg, D. G., Cuellar, A. E., & Kuzel, A. J. (2020). Medicare Access and CHIP Reauthorization Act in small to medium-sized primary care practices. The Journal of the American Board of Family Medicine, 33(6), 942–952. 

https://doi.org/10.3122/jabfm.2020.06.200142

Zhao, J., Mao, Z., Fedewa, S. A., Nogueira, L., Yabroff, K. R., Jemal, A., & Han, X. (2020). The Affordable Care Act and access to care across the cancer control continuum: A review at 10 years. CA: A Cancer Journal for Clinicians, 70(3). 

https://doi.org/10.3322/caac.21604