The Affordable Care Act (ACA) was passed in 2010. It promises to cut medical costs. The ACA includes more than a dozen provisions aimed at bringing down expenditures in government programs and private insurance. One method aimed at bringing down medical costs is the accountable care organization (ACO) provision. Moreover, 360 health care systems signed on as “accountable care organizations” that utilize a treatment model deigned by the ACA.
In this model, hospitals, or groups of doctors agree to provide care for a particular group of Medicare patients and to be paid based on how well they do at keeping them healthy and lowering cost of care. Doctors who reduce the amount of money spent on Medicare by a certain amount or more get to keep a portion of the savings. Meanwhile, hospitals get reimbursements from government based on several quality measures such as, readmission and patient satisfaction.
The ACA also established the Center for Medicare and Medicaid Innovation and the Patient Centered Outcomes Researched Institute to organize and fund research in to health care improvements. These organizations are designed to help cut medical costs and improve health care received. Thus, providing them with a better quality of life.
Employers are also factored into the ACA’s ability to lower medical costs. Starting in 2018, employers that offer high-cost health care plans will have to pay a 40 percent tax on the amount they spend on plans that go over the limits.
The ACA started the Independent Advisory Board that is supposed to recommend spending cuts if Medicare’s cost growth exceeds its target. There are currently no board members, but the “federal officials say growth is within the prescribed limits so there’s no need for the board to be doing anything yet.”
Another provision to lower medical costs is a revolutionary movement know as “price transparency.” This provision aims to lift the veil of secrecy and empower patients and other payers to make smarter health care decisions. “Federal and state agencies are gathering reams of price information from doctors and hospitals and posting them for public viewing. Health plans are offering online tools that let members calculate their out-of-pocket costs and start-up companies are searching for and publishing the long-secret rates that providers negotiate with insurers.
How would posting rates negotiated between providers and insurers help reduce medical costs? Patients turned consumers can now compare prices for doctor visits, hospitals stays and other services to create market competition that will help keep cost down.
Cutting down on high-tech emergency room testing is another way ACA helps cut medical costs. Furthermore, the “American College of Emergency Physicians joined the American Board of Internal Medicine’s Choosing Wisely campaign, a physician-led initiative designed to encourage conversation between doctors and patients about the risks and benefits of performing certain tests and procedures.”
“One of the American College’s first recommendations was that ER doctors should avoid doing CT scans on patients with minor head injuries who are at low risk for skull fracture and bleeding in the brain. By performing a thorough history and physical examination, doctors can safely determine who is at low risk, the group said.”
Another problem hospitals face that drive up medical cost is disappearing drugs. “Although there are no precise figures for drug diversion from hospitals, industry experts say drug-inventory losses cost hospitals millions of dollars each year. The most commonly diverted drugs are narcotic painkillers such as hydrocodone, morphine and the sedative fentanyl.”
In a 2011 study, the American Journal of Health Systems Pharmacy noted that widespread adoption of automated dispensing machines has improved security of controlled substances. It has made it possible to electronically document the dispensing of doses and the disposal of unused medications and expired medication.
The amount of income per person shows a reduction in medical costs. Per capita cost of healthcare has been broken down by the percentage increase. It shows that growth in the per capita, also known as average annual income per person, has dramatically slowed in recent years.
The ACA efforts to make health care affordable to individuals and reduce cost depends on personal choice whether you decide to get insurance or not, and there are a lot of people choosing not to do so. PMC’s Chief Financial Officer John Abreu said, “We’ve done a lot internally to provide options for people: explaining the exchange, setting up relationships with brokers so they can get on to the state exchange and get insurance, etc., but at the end of the day it’s a personal choice.”
The ACA provided Medicaid expansion for people who fall below the 130 percent poverty level. This provision reduces the indigent funds tax payers pay for the poor and needy medical costs. But those living above the 130 percent poverty level who choose not to buy insurance on the exchanges will have to bite the bullet and pay the penalty. “The fee for not having insurance in 2014 is $95 per adult and $47.50 per child (up to $285 for a family) or 1% of your taxable income, whichever is greater”
Those who can afford to buy insurance, but choose instead to pay penalty still contribute to reducing medical costs for everybody including themselves because the penalty fees helps lower hospital, doctor and other fees they may otherwise pay out of pocket.
“We have a choice: do we follow the Affordable Care Act rules, or do we just pay the bills anyway and not let the system work?” Manwaring told the group. “If you’re over 130 percent above the poverty level and you choose to not buy insurance, you’re taking a gamble with your health because you can’t come to the county and ask us to pay (your) bills just because you choose not to do what the law says.”
Five million poor uninsured adults have fallen into a hole called the “coverage gap”. This gap is the result of state decisions not to expand Medicaid. There income is above current Medicaid eligibility, but below lower limits for marketplace premium tax credits. Individuals that would have been newly eligible for Medicaid would still be dependent on state indigent funds.
Following rules of the ACA law would lower medical costs for doctors and hospitals if they expand Medicaid for those that fell into this coverage gap.
But what about the uninsured with no income that are homeless, living with parents or from house to house that can’t find work or mentally limited in ability to hold a job? There are individuals in this situation. One being a child of mine. It’s a hardship on uninsured adults with no means to buy on the state’s insurance exchanges. Many go to jail who then are exempted from buying insurance.
The Health Insurance Marketplace, also known as the Affordable Insurance Exchange certifies individuals that suffer a hardship that makes them unable to obtain coverage are then exempted from buying insurance.
In conclusion, everyone needs to get covered. If you wait until you get sick to obtain coverage, then health insurance companies can’t afford to provide insurance and everyone’s premium rates would become unaffordable. If everyone used emergency services, then tax payers would be on the hook for the bill.
Anyone can have an accident and most people will use health related services in their life. It’s the same as car insurance, you must have it “just in case”. Insurance also helps promote wellness and prevention. “In theory, a healthier population now will help to curb treatment costs of older Americans.”
Refusing to let the ACA’s system work is like” cutting your nose off to spite your face” as my mother likes to say.