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1
Schultz, David. "The Implementation and Evaluation of the United States Affordable Care Act." Medicine, Law & Society 12, no. 1 (2019): 17–38. http://dx.doi.org/10.18690/mls.12.1.17-38.2019.
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In 2010 the United States Congress adopted the Patient Protection and Affordable Care Act (“ACA”), more commonly referred to as Obamacare. The ACA was proposed by President Barack Obama while running for president and it was passed with a near straight party-line vote of Democrats in the US House and Senate in 2010. The ACA was meant to address several problems with the American health care delivery system, including cost, access and outcomes. This article describes the major features of the ACA including the context of the US health care system, evaluates the ACA’s implementation history and assesses its fate and future reforms throughout the presidency of Donald Trump. The overall conclusion based on its implementation is that while the ACA made significant reforms in terms of access to health care, it is not clear that it addressed affordability or began to improve health care outcomes in the US.
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Hoffmann, Jeffrey. "Preemption and the MLR Provision of the Affordable Care Act." American Journal of Law & Medicine 40, no. 2-3 (2014): 280–97. http://dx.doi.org/10.1177/009885881404000207.
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This Note focuses on the medical loss ratio provision (“MLR Provision”) of the Patient Protection and Affordable Care Act (ACA). The MLR Provision states that health insurance companies must spend at least a certain percentage of their premium revenue on “activities that improve healthcare quality” (in other words, meet a minimum threshold medical loss ratio) and comply with reporting requirements determined by the Secretary of the United States Department of Health and Human Services (HHS). Because states have historically had authority over the regulation of health insurance, there is an outstanding question as to whether or not the MLR Provision has legal authority to preempt conflicting state MLR regulations.Part II of this Note outlines the major requirements in the MLR Provision and discusses the history of MLR regulation in the United States. Part III discusses the likelihood that the courts will soon resolve the question of preemption regarding the MLR Provision.
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Gable, Lance. "The Patient Protection and Affordable Care Act, Public Health, and the Elusive Target of Human Rights." Journal of Law, Medicine & Ethics 39, no. 3 (2011): 340–54. http://dx.doi.org/10.1111/j.1748-720x.2011.00604.x.
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The passage of the Patient Protection and Affordable Care Act (ACA) in March 2010 represents a significant turning point in the evolution of health care law and policy in the United States. By establishing a legal infrastructure that seeks to achieve universal health insurance coverage in the United States, the ACA targets some of the major impediments to accessing needed health care for millions of Americans and by extension attempts to strengthen the health system to support key determinants of health. Yet, like many newly passed legislative provisions, the ultimate effects and significance of the ACA remain uncertain. Those charged with implementing the ACA face formidable obstacles — indeed, some of the same obstacles that have been erected to impede other major pieces of social legislation in the past — including entrenched political opposition, constitutional challenges, and what will likely be a prolonged struggle over the content and direction of how the law is implemented. As these debates continue, it is nevertheless important to begin to assess the impact that the ACA has already had on health law in the United States and to consider the likely effects that the law will have on public health going forward.
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Pratt, William Robert, and Jerry D. Belloit. "Hospital costs and profitability related to the Patient Protection and Affordable Care Act." Journal of Hospital Administration 3, no. 3 (2014): 100. http://dx.doi.org/10.5430/jha.v3n3p100.
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On March 23, 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act (PPACA). This law was one of the most controversial and transforming pieces of legislation impacting health care delivery in recent history. The legislation was created in response to rising health care costs and the belief that, in part, cost shifting of indigent uninsured care to paying patients would reduce the overall costs of health care. The recent Supreme Court decision upholding the individual mandate portion of the law is expected to significantly reduce the number of uninsured. Using operational data from 212 hospitals in California, this study examines the anticipated impact on hospital costs, profitability, and some patient outcome benchmarks from the restructuring of health care delivery in the United States by the PPACA.
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K. Quaye, Randolph. "The Patient Protection and Affordable Care Act (ACA) of 2010 and Ohio physicians." Leadership in Health Services 27, no. 2 (2014): 116–25. http://dx.doi.org/10.1108/lhs-10-2012-0037.
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Purpose – This paper aims to explore the perspectives of Ohio physicians on the Patient Protection and Affordable Care Act (ACA) of 2010. While much has been debated about ACA, relatively few studies have focused on how ACA will impact on physicians' practice behavior. Design/methodology/approach – The research data came from a mailed survey of ninety physicians randomly selected from the Cigna Directory of Physicians practicing in Ohio. Study examined how informed were physicians about ACA, and explored how much the effect of ACA has been discussed in their practice, how they think ACA will impact their practice, and whether or not they are in favor of the provisions under the Act. Findings – Overwhelmingly, while the physicians surveyed were familiar with the specific provisions of ACA, almost half of them opposed it. Primary care physicians reported generally favorable opinions about ACA. All but one of the physicians concluded that ACA, much like managed care provisions, has undermined and will continue to reduce the autonomy and professional independence of physicians. Research limitations/implications – This study is limited by its small sample and reliance on a small set of physicians. Practical implications – This study has practical implications for examining how Ohio physicians are responding to the new health care reform in the United States. It has broader implications for addressing the problem of the uninsured and the role of the federal government in health care provision. Social implications – If physicians are opposed to this reform as the study seems to suggest, it might have broader implications for future career aspirations for physicians. Originality/value – So far as we can tell, there has not been any exploratory study in Ohio examining the perspectives of physicians on ACA.
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Rovin, Kimberly, Rebecca Stone, Linda Gordon, Emilia Boffi, and Linda Hunt. "Better Than Nothing: Participant Experiences in Using a County Health Plan." Practicing Anthropology 34, no. 4 (2012): 13–18. http://dx.doi.org/10.17730/praa.34.4.754915t6lkh712q1.
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The United States health care system has reached a crisis point, with 49.9 million Americans now living without health insurance (DeNavas-Walt, Proctor, and Smith 2011). The United States government has responded to this crisis in a variety of ways, perhaps the most visible being the enactment of the Patient Protection and Affordable Care Act (ACA) in March 2010. With a goal of expanding access to health insurance to 32 million Americans by 2019, the ACA marks an important moment in the history of United States health care reform with the potential to drastically change the United States health insurance landscape (Connors and Gostin 2010). The law delineates only general categories of required benefits and leaves it to each state to decide the specific benefits that will be provided by the insurers in their state (Pear 2011).
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Thoene, Michael. "Unintended Consequences : the Financial Assumptions and Economic Theory of Obamacare : the Patient Protection and Affordable Care Act." Olsztyn Economic Journal 9, no. 3 (2014): 251–63. http://dx.doi.org/10.31648/oej.3180.
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This article examines the Patient Protection and Affordable Care Act (ACA,) often referred to colloquially as Obamacare, from a financial and economic perspective in order to analyze the potential efficacy of the system. Research was gathered pertaining to the stated objectives of the program, and economic theory was applied in order to reveal if the aims of the program are congruent with economic theory. It was found that the authors of the ACA did not anticipate or under-anticipated several economic effects of the legislation, which will hamper the implementation and effectiveness of the program. Furthermore, the economic theories employed by the Obama administration relied heavily upon classical economic theory, with little or no attention given to Transaction Cost Economics (TCE). Moreover, the law itself is overly complex and controversial due to a myriad of provisions added through the intercession of lobbyists from the healthcare, insurance and special interest sectors. The end result is that Americans may obtain a slightly improved healthcare system, but the United States will most likely still lag behind the rest of the industrialized world in many key health statistics.
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Moffit, Robert E. "Expanding Choice through Defined Contributions: Overcoming a Non-Participatory Health Care Economy." Journal of Law, Medicine & Ethics 40, no. 3 (2012): 558–73. http://dx.doi.org/10.1111/j.1748-720x.2012.00689.x.
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The Patient Protection and Affordable Care Act of 2010 (the Affordable Care Act) is the law of the land. But it faces an uncertain future.During congressional deliberations on the 2,700-page legislation leading up to its enactment, from February to March 2010, not one major survey recorded majority support for the legislation. Since its enactment, popular opposition to the Affordable Care Act has hardened, and was a significant factor in the 2010 congressional election, in which Democrats lost 63 seats and Republicans regained the majority in the House of Representatives. Ballot initiatives in Missouri and Ohio, showcasing popular opposition to the individual mandate, passed in 2010 with overwhelming majorities. While the United States Supreme Court in National Federation of Independent Business et al. v. Sebelius, 132 S. Ct. 2566 ( 2012), declared the mandate on the states to expand Medicaid unconstitutionally coercive, the majority of the Justices also upheld the individual mandate as a permissible tax. The new law thus emerged as a central topic in the 2012 election.
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Orentlicher, David. "Rights to Healthcare in the United States: Inherently Unstable." American Journal of Law & Medicine 38, no. 2-3 (2012): 326–47. http://dx.doi.org/10.1177/009885881203800204.
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Although international covenants have long recognized a fundamental right to healthcare, and other countries provide healthcare coverage for all of their citizens, rights to healthcare in the United States have been adopted only grudgingly, and in a manner that is inherently unstable. While a solid right to healthcare would provide much benefit to individuals and society, the political and judicial branches of the U.S. government have granted rights that are incomplete and vulnerable to erosion over time.Unfortunately, enactment of the Patient Protection and Affordable Care Act (ACA) does not change these fundamental weaknesses in the regime of U.S. healthcare rights. Millions of Americans will remain uninsured after ACA takes full effect, and rather than creating a more stable right to healthcare, ACA gives unstable rights to more people. As a result, even if ACA survives its constitutional challenges, access to healthcare still will be threatened by the potential for attrition of the rights that ACA provides.
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Kominski, Gerald F., Narissa J. Nonzee, and Andrea Sorensen. "The Affordable Care Act's Impacts on Access to Insurance and Health Care for Low-Income Populations." Annual Review of Public Health 38, no. 1 (2017): 489–505. http://dx.doi.org/10.1146/annurev-publhealth-031816-044555.
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The Patient Protection and Affordable Care Act (ACA) expands access to health insurance in the United States, and, to date, an estimated 20 million previously uninsured individuals have gained coverage. Understanding the law's impact on coverage, access, utilization, and health outcomes, especially among low-income populations, is critical to informing ongoing debates about its effectiveness and implementation. Early findings indicate that there have been significant reductions in the rate of uninsurance among the poor and among those who live in Medicaid expansion states. In addition, the law has been associated with increased health care access, affordability, and use of preventive and outpatient services among low-income populations, though impacts on inpatient utilization and health outcomes have been less conclusive. Although these early findings are generally consistent with past coverage expansions, continued monitoring of these domains is essential to understand the long-term impact of the law for underserved populations.
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Mondal, Wali I. "The Health Insurance Exchange: An Oligopolistic Market In Need Of Reform." Journal of Business & Economics Research (JBER) 11, no. 12 (2013): 569. http://dx.doi.org/10.19030/jber.v11i12.8264.
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<p>Until the Patient Protection and Affordable Care Act commonly known as the Affordable Care Act (ACA) was signed into law in March 2010, United States was the only industrialized rich country in the world without a universal healthcare insurance coverage. While pioneering works by Burns (1956, 1966) focused on the Social Security Act of 1935 in addressing the health insurance needs of U.S. retired population through Medicare, and later Medicaid was created by the Social Security Amendments of 1965, U.S. health insurance has remained a private, for-profit venture. The passage of ACA was one of the most contentious legislations of modern times. Soon after it was signed into law, various groups of private citizens and a number of States challenged some provisions of the ACA; however, the Supreme Court of the United States upheld its key provisions. A segment of the Congress remains opposed to the ACA on ideological ground and continues to challenge it with a variety of legal maneuvers. Notwithstanding the political or ideological arguments for or against the ACA, the objective of this paper is to analyze the competitiveness of the health insurance marketplace which opened on October 1, 2013. In doing so, the paper will address the structure of the health insurance exchange and suggest ways and means to make it more competitive.</p>
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Manchikanti, Laxmaiah. "The Impact of Comparative Effectiveness Research on Interventional Pain Management: Evolution from Medicare Modernization Act to Patient Protection and Affordable Care Act and the Patient-Centered Outcomes Research Institute." Pain Physician 3;14, no. 3;5 (2011): E249—E282. http://dx.doi.org/10.36076/ppj.2011/14/e249.
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The Patient-Centered Outcomes Research Institute (PCORI) was established by the Affordable Care Act of 2010 to promote comparative effectiveness research (CER) to assist patients, clinicians, purchasers, and policy-makers in making informed health decisions by advancing the quality and relevance of evidence concerning the manner in which diseases, disorders, and other health conditions can effectively and appropriately be prevented, diagnosed, treated, monitored, and managed through research and evidence synthesis. The development of PCORI is vested in the Medicare Modernization Act (MMA) and the American Recovery and Reinvestment Act (ARRA). The framework of CER and PCORI describes multiple elements which are vested in all 3 regulations including stakeholder involvement, public participation, and open transparent decision-making process. Overall, PCORI is much more elaborate with significant involvement of stakeholders, transparency, public participation, and open decision-making. However, there are multiple issues concerning the operation of such agencies in the United States including the predecessor of Agency for Healthcare Research and Quality (AHRQ), the Agency for Healthcare Policy and Research (AHCPR), AHRQ Effectiveness Health Care programs, and others. The CER in the United States may be described at cross-roads or at the beginnings of a scientific era of CER and evidence-based medicine (EBM). However the United States suffers as other countries, including the United Kingdom with its National Health Services (NHS) and National Institute for Health and Clinical Excellence (NICE), with major misunderstandings of methodology, an inordinate focus on methodological assessment, lack of understanding of the study design (placebo versus active control), lack of involvement of clinicians, and misinterpretation of the evidence which continues to be disseminated. Consequently, PCORI and CER have been described as government-driven solutions without following the principles of EBM with an extensive focus on costs rather than quality. It also has been stated that the central planning which has been described for PCORI and CER, a term devised to be acceptable, will be used by third party payors to override the physician’s best medical judgement and patient’s best interest. Further, stakeholders in PCORI are not scientists, are not balanced, and will set an agenda with an ultimate problem of comparative effectiveness and PCORI that it is not based on medical science, but rather on political science and not even under congressional authority, leading to unprecedented negative changes to health care. Thus, PCORI is operating in an ad hoc manner that is incompatible with the principles of evidence-based practice. This manuscript describes the framework of PCORI, and the role of CER and its impact on interventional pain management. Key words: Patient-Centered Outcomes Research Institute (PCORI), comparative effectiveness research (CER), National Institute for Health and Clinical Excellence (NICE), Patient Protection and Affordable Care Act (ACA), Medicare Modernization Act (MMA), American Recovery and Reinvestment Act (ARRA), interventional pain management, interventional techniques, evidencebased medicine, systematic reviews.
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Leonard, Elizabeth Weeks. "Rhetorical Federalism: The Role of State Resistance in Health Care Decision-Making." Journal of Law, Medicine & Ethics 39, S1 (2011): 73–76. http://dx.doi.org/10.1111/j.1748-720x.2011.00571.x.
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The Patient Protection and Affordable Care Act (ACA) represents the most significant reform of the United States health care system in decades. ACA also substantially amplifies the federal role in health care regulation. Among other provisions, ACA expands government health care programs, imposes detailed federal standards for commercial health insurance policies, creates national requirements on employers and individuals, and enlists state administrative capacity to implement various federal reforms. In response, a persistent voice in the protracted, contentious debate surrounding ACA was, and continues to be, resistance from states. The rhetoric of federalism — states’ rights, reserved powers, state sovereignty, limited government, and local diversity — resonates deeply even around provisions of ACA that do not specifically implicate state interests. For example, the loudest and most persistent state objections target the new mandate that individuals maintain health insurance, a requirement imposed by ACA and enforced through federal tax penalties.
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Kapp, Marshall B. "Conscripted Physician Services and the Public's Health." Journal of Law, Medicine & Ethics 39, no. 3 (2011): 414–24. http://dx.doi.org/10.1111/j.1748-720x.2011.00611.x.
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The Patient Protection and Affordable Care Act of 2010 (PPACA) purportedly assures almost all Americans of the right to health insurance coverage. The long-term success of this legislation in improving the public’s health in the United States will likely hinge in no small part on the degree to which statutorily establishing a right to health insurance coverage translates into actual timely, meaningful access to health services, particularly physician services, for specific individuals.
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Manchikanti, Laxmaiah. "Obamacare 2012: Prognosis Unclear for Interventional Pain Management." Pain Physician 5;15, no. 5;9 (2012): E629—E640. http://dx.doi.org/10.36076/ppj.2012/15/e629.
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The Patient Protection and Affordable Care Act (ACA), informally referred to as ObamaCare, is a United States federal statute signed into law by President Barack Obama on March 23, 2010. ACA has substantially changed the landscape of medical practice in the United States and continues to influence all sectors, in particular evolving specialties such as interventional pain management. ObamaCare has been signed into law amidst major political fallouts, has sustained a Supreme Court challenge and emerged bruised, but still very much alive. While proponents argue that ObamaCare will provide insurance for almost everyone, with an improvement in the quality of and reduction in the cost of health care, opponents criticize it as being a massive bureaucracy laden with penalties and taxes, that will ultimately eliminate personal medicine and individual practices. Based on the 2 years since the passage of ACA in 2010, the prognosis for interventional pain management is unclear. The damage sustained to interventional pain management and the majority of medicine practices is irreparable. ObamaCare may provide insurance for all, but with cuts in Medicare to fund ObamaCare, a limited expansion of Medicaid, the inadequate funding of exchanges, declining employer health insurance coverage and skyrocketing disability claims, the coverage will be practically nonexistent. ObamaCare is composed of numerous organizations and bureaucracies charged with controlling the practice of medicine through the extension of regulations. Apart from cutting reimbursements and reducing access to interventional pain management, administration officials are determined to increase the role of midlevel practitioners and reduce the role of individual physicians by liberalizing the scope of practice regulations and introducing proposals to reduce medical education and training. Key words: Patient Protection and Affordable Care Act, ObamaCare, interventional pain management, Patient-Centered Outcomes Research Institute, Independent Payment Advisory Board, Centers for Medicare and Medicaid Services, Accountable Care Organizations, Medicare, Medicaid
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Huntoon, Kristin M., Colin J. McCluney, Christopher A. Scannell, et al. "Healthcare Reform and the Next Generation: United States Medical Student Attitudes toward the Patient Protection and Affordable Care Act." PLoS ONE 6, no. 9 (2011): e23557. http://dx.doi.org/10.1371/journal.pone.0023557.
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Wei, Zhang, and Marian Jarlenski. "The Politics of Opposition to the Enactment of the Patient Protection and Affordable Care Act in the United States." International Critical Thought 4, no. 2 (2014): 208–20. http://dx.doi.org/10.1080/21598282.2014.906798.
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Kinney, Eleanor D. "Comparative Effectiveness Research under the Patient Protection and Affordable Care Act: Can New Bottles Accommodate Old Wine?" American Journal of Law & Medicine 37, no. 4 (2011): 522–66. http://dx.doi.org/10.1177/009885881103700402.
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The Patient Protection and Affordable Care Act (PPACA), as amended by the Health Care and Education Reconciliation Act of 2010, initiated comprehensive health reform for the healthcare sector of the United States. PPACA includes strategies to make the American healthcare sector more efficient and effective. PPACA's comparative effectiveness research initiative and the establishment of the Patient-Centered Outcomes Research Institute are major strategies in this regard. PPACA's comparative effectiveness research initiative is one in a long line of federal initiatives to address the rising costs of healthcare as well as to obtain better value for healthcare expenditures. The key question is whether the governance and design features of the institute that will oversee the initiative will enable it to succeed where other federal efforts have faltered. This Article analyzes the federal government's quest to ensure value for money expended in publically funded healthcare programs and the health sector generally. This Article will also analyze what factors contribute to the possible success or failure of the comparative effectiveness research initiative. Success can be defined as the use of the findings of comparative effectiveness to make medical practice less costly, more efficient and effective, and ultimately, to bend the cost curve.
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Sismondo, Sergio. "Key Opinion Leaders and the Corruption of Medical Knowledge: What the Sunshine Act Will and Won’t Cast Light on." Journal of Law, Medicine & Ethics 41, no. 3 (2013): 635–43. http://dx.doi.org/10.1111/jlme.12073.
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In 2010, in connection with the Patient Protection and Affordable Care Act (Obamacare), the United States Congress passed the Physician Payment Sunshine Act. This legislation requires pharmaceutical companies, medical device companies, and other manufacturers of medical supplies to collect information on their payments to physicians, beginning on August 1, 2013, and to annually report this information to the Centers for Medicare and Medicaid Services (CMS), beginning on March 31, 2014. All payments of over $10 are to be reported and aggregate payments of more than $100 to a single physician in a single year must also be reported.
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Young, Aaron, Humayun J. Chaudhry, Jon V. Thomas, and Michael Dugan. "A Census of Actively Licensed Physicians in the United States, 2012." Journal of Medical Regulation 99, no. 2 (2013): 11–24. http://dx.doi.org/10.30770/2572-1852-99.2.11.
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ABSTRACTThe Patient Protection and Affordable Care Act, signed into law in 2010 and upheld by the U.S. Supreme Court last year, is expected to provide health care coverage to as many as 32 million Americans by 2019. As demand for health care expands, the need for accurate data about the current and future physician workforce will remain paramount. This census of actively licensed physicians in the United States and the District of Columbia represents data received from state medical boards in 2012 by the Federation of State Medical Boards. It demonstrates that the total population of licensed physicians (878,194) has expanded by 3% since 2010, is slightly older, has more women, and includes a substantive increase in physicians who graduated from a medical school in the Caribbean. As state medical boards begin to collect a Minimum Data Set about practicing physicians and their practice patterns in the years ahead, this information will inform decisions by policymakers, regulators and health care market participants to better align health care demand with supply.
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Sawyer, Ashlee N., Melissa A. Kwitowski, and Eric G. Benotsch. "Are You Covered? Associations Between Patient Protection and Affordable Care Act Knowledge and Preventive Reproductive Service Use." American Journal of Health Promotion 32, no. 4 (2017): 906–15. http://dx.doi.org/10.1177/0890117117736091.
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Purpose: Sexual and reproductive health conditions (eg, infections, cancers) represent public health concerns for American women. The present study examined how knowledge of the Patient Protection and Affordable Care Act (PPACA) relates to receipt of preventive reproductive health services among women. Design: Cross-sectional online survey. Setting: Online questionnaires were completed via Amazon Mechanical Turk, a crowdsourcing website where individuals complete web-based tasks for compensation. Participants: Cisgendered women aged 18 to 44 years (N = 1083) from across the United States. Measures: Participants completed online questionnaires assessing demographics, insurance status, preventive service use, and knowledge of PPACA provisions. Analysis: Chi-squares showed that receipt of well-woman, pelvic, and breast examinations, as well as pap smears, was related to insurance coverage, with those not having coverage at all during the previous year having significantly lower rates of use. Hierarchical logistic regressions determined the independent relationship between PPACA knowledge and use of health services after controlling for demographic factors and insurance status. Results: Knowledge of PPACA provisions was associated with receiving well-woman, pelvic, and breast examinations, human papillomavirus vaccination, and sexually transmitted infections testing, after controlling for these factors. Results indicate that expanding knowledge about health-care legislation may be beneficial in increasing preventive reproductive health service use among women. Conclusion: Current findings provide support for increasing resources for outreach and education of the general population about the provisions and benefits of health-care legislation, as well as personal health coverage plans.
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Mauldin, Rebecca L., Kathy Lee, and Antwan Williams. "FEDERAL POLICY SUPPORTS AND GAPS IN ADDRESSING RACIAL-ETHNIC HEALTH DISPARITIES IN U.S. LONG-TERM CARE FACILITIES." Innovation in Aging 3, Supplement_1 (2019): S161. http://dx.doi.org/10.1093/geroni/igz038.576.
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Abstract Older adults from racial and ethnic minority groups face health inequities in long-term care facilities such as nursing homes and assisted living facilities just as they do in the United States as a whole. In spite of federal policy to support minority health and ensure the well-being of long-term care facility residents, disparities persist in residents’ quality of care and quality of life. This poster presents current federal policy in the United States to reduce racial and ethnic health disparities and to support long-term care facility residents’ health and well-being. It includes legislation enacted by the Patient Protection and Affordable Care Act of 2010 (ACA), regulations of the U.S. Department of Health and Human Services (DHHS) for health care facilities receiving Medicare or Medicare funds, and policies of the Long-term Care Ombudsman Program. Recommendations to address threats to or gaps in these policies include monitoring congressional efforts to revise portions of the ACA, revising DHHS requirements for long-term care facilities staff training and oversight, and amending requirements for the Long-term Care Ombudsman Program to mandate collection, analysis, and reporting of resident complaint data by race and ethnicity.
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Rambur, Betty A. "What’s at Stake in U.S. Health Reform: A Guide to the Affordable Care Act and Value-Based Care." Policy, Politics, & Nursing Practice 18, no. 2 (2017): 61–71. http://dx.doi.org/10.1177/1527154417720935.
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The U.S. presidential election of 2016 accentuated the divided perspectives on the Patient Protection and Affordable Care Act of 2010, commonly known as Obamacare. The perspectives included a pledge from then candidate Donald J. Trump to “repeal and replace on day one”; Republican congressional leaders’ more temperate suggestions in the first weeks of the Trump administration to “repair” the Affordable Care Act (ACA); and President Trump’s February 5, 2017 statement—16 days after inauguration—that a Republican replacement for the ACA may not be ready until late 2017 or 2018. The swirling rhetoric, media attention, and the dizzying rate of U.S. health and payment reforms both within and outside of the ACA makes it difficult for nurses, both United States and globally, to discern which health policy issues are grounded in the ACA and which aspects reflect payer-driven “volume to value” reimbursement changes. Moreover, popular and controversial elements of the ACA—for example, the clause that prohibits insurance carriers to deny coverage to those with preexisting health conditions and the more controversial individual mandate that bears Supreme Court support as a constitutional provision—are paired in ways that might be unclear to those unfamiliar with nuances of insurance rate determination. To support nurses’ capacity to maximize their impact on health policy, this overview distills the 906-page ACA into major themes and describes payment reform legislation and initiatives that are external to the ACA. Understanding the political and societal forces that affect health care policy and delivery is necessary for nurses to effectively lead and advocate for the best interests of their patients.
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Garthwaite, Craig L. "The Doctor Might See You Now: The Supply Side Effects of Public Health Insurance Expansions." American Economic Journal: Economic Policy 4, no. 3 (2012): 190–215. http://dx.doi.org/10.1257/pol.4.3.190.
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In the United States, public health insurance programs cover over 90 million individuals. Expansions of these programs, such as the recently passed Patient Protection and Affordable Care Act (PPACA), may have large effects on physician behavior. This study finds that following the implementation of the State Children's Health Insurance Program (SCHIP), physicians decreased the number of hours spent with patients, but increased their program participation. Suggestive evidence shows that this decrease resulted from shorter office visits. These findings are consistent with the predictions from a mixed-economy model of physician behavior and provide evidence of crowd out resulting from the creation of SCHIP. (JEL H75, I11, I13, I18)
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Hswen, Yulin, Jared B. Hawkins, Kara Sewalk, et al. "Racial and Ethnic Disparities in Patient Experiences in the United States: 4-Year Content Analysis of Twitter." Journal of Medical Internet Research 22, no. 8 (2020): e17048. http://dx.doi.org/10.2196/17048.
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Background Racial and ethnic minority groups often face worse patient experiences compared with the general population, which is directly related to poorer health outcomes within these minority populations. Evaluation of patient experience among racial and ethnic minority groups has been difficult due to lack of representation in traditional health care surveys. Objective This study aims to assess the feasibility of Twitter for identifying racial and ethnic disparities in patient experience across the United States from 2013 to 2016. Methods In total, 851,973 patient experience tweets with geographic location information from the United States were collected from 2013 to 2016. Patient experience tweets included discussions related to care received in a hospital, urgent care, or any other health institution. Ordinary least squares multiple regression was used to model patient experience sentiment and racial and ethnic groups over the 2013 to 2016 period and in relation to the implementation of the Patient Protection and Affordable Care Act (ACA) in 2014. Results Racial and ethnic distribution of users on Twitter was highly correlated with population estimates from the United States Census Bureau’s 5-year survey from 2016 (r2=0.99; P<.001). From 2013 to 2016, the average patient experience sentiment was highest for White patients, followed by Asian/Pacific Islander, Hispanic/Latino, and American Indian/Alaska Native patients. A reduction in negative patient experience sentiment on Twitter for all racial and ethnic groups was seen from 2013 to 2016. Twitter users who identified as Hispanic/Latino showed the greatest improvement in patient experience, with a 1.5 times greater increase (P<.001) than Twitter users who identified as White. Twitter users who identified as Black had the highest increase in patient experience postimplementation of the ACA (2014-2016) compared with preimplementation of the ACA (2013), and this change was 2.2 times (P<.001) greater than Twitter users who identified as White. Conclusions The ACA mandated the implementation of the measurement of patient experience of care delivery. Considering that quality assessment of care is required, Twitter may offer the ability to monitor patient experiences across diverse racial and ethnic groups and inform the evaluation of health policies like the ACA.
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Berlinger, Nancy, Michael K. Gusmano, and Eva Turbiner. "Revisiting ‘The Clinic’: ethical and policy challenges in US community health centers." Health Economics, Policy and Law 9, no. 4 (2014): 425–34. http://dx.doi.org/10.1017/s1744133114000140.
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AbstractWhere do poor people in the United States (US) go when they get sick? Often, they go to Federally Qualified Health Centers (FQHCs) and hospital emergency departments. Even after the implementation of the Patient Protection and Affordable Care Act (ACA), these safety-net health care organizations will continue to play a crucial role in the US health care system. FQHCs have long grappled with some of the biggest questions facing the US health care system and their leaders and clinicians face ethical challenges in everyday practice. Ethical and policy challenges in the US health care safety-net are not usually ‘tragic choices’ involving the allocation of transplantable organs, or ventilators during a pandemic. They are everyday choices with a tragic dimension because, even with the adoption of the ACA, the US has not yet decided whether poor people deserve a ‘home’ or a ‘net’ when they are sick, and whether even a net should be in good repair.
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Paradise, Jordan. "The Legal and Regulatory Status of Biosimilars." American Journal of Law & Medicine 41, no. 1 (2015): 49–84. http://dx.doi.org/10.1177/0098858815591509.
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Alongside the constitutional controversy ultimately addressed by the Supreme Court, the colossal Patient Protection and Affordable Care Act (ACA) ushered in a new paradigm for regulation of biologics by the Food and Drug Administration (FDA). Nestled within the expansive ACA, the Biologics Price Competition and Innovation Act (BPCIA) set forth an abbreviated pathway to market for “biosimilar” and “interchangeable” biological products. While the current BPCIA implementation debate focuses chiefly on the scope of scientific and technical assessments by the FDA and the effect on the emergent biosimilar industry, two issues will prove essential for determinations of access to and costs of the resulting products: how the biosimilar and interchangeable biosimilar biologics are to be named, and whether pharmacist substitution is appropriate for products the FDA deems interchangeable. This article examines the current debate surrounding the use of nonproprietary names for biosimilar biologics, as well as state efforts to reconcile automatic substitution laws for the eventual products. In particular, the article addresses the implications for patients and the United States health care system, highlighting the potential negative effect on anticipated cost-savings, hindrances for effective tracking and reporting of adverse events, and a general lack of consistency in state laws.
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Hodge, James G., Erin C. Fuse Brown, Daniel G. Orenstein, and Sarah O'Keefe. "Congress, Courts, and Commerce: Upholding the Individual Mandate to Protect the Public's Health." Journal of Law, Medicine & Ethics 39, no. 3 (2011): 394–400. http://dx.doi.org/10.1111/j.1748-720x.2011.00609.x.
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Despite historic efforts to enact the Patient Protection and Affordable Care Act (PPACA) in 2010, national health reform is threatened by multiple legal challenges grounded in constitutional law. Premier among these claims is the premise that PPACA’s “individual mandate” (requiring all individuals to obtain health insurance by 2014 or face civil penalties) is constitutionally infirm. Attorneys General in Virginia and Florida (joined by 25 other states) allege that Congress’ interstate commerce powers do not authorize federal imposition of the individual mandate because Congress lacks the power to regulate commercial “inactivity.” Stated simply, Congress cannot regulate individuals who choose not to obtain health insurance because they are not engaged in a commercial venture. Several courts initially considering this argument have rejected it, but two federal district courts in Virginia and Florida have concurred, leading to numerous appeals and the near promise of United States Supreme Court review.
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Cabeceiras, Peter. "Providers, Prescriptions and Patients: Methodology for U.S. Health Care Reform." Journal of Student Research 4, no. 1 (2015): 63–68. http://dx.doi.org/10.47611/jsr.v4i1.180.
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Abstract Health care reform should be considered equal parts moral and economic issues. The United States spends more on health care than any other nation in the world ($2.6 trillion annually), yet the U.S. has some of the worst health outcomes of developed nations.1,2 Although health care spending comprises over one-sixth of the economy (17.9% of GDP), over fifty million U.S. citizens live without health insurance. The U.S. needs to use finances more efficaciously not only to enhance quality of care and patient outcomes, but to avoid a looming economic crisis.3 Recently, the Congressional Budget Office reported that if Medicare cost inflation exceeds overall economic growth by 2.5%, the top marginal tax rates in 2050 will approach 92%.3,4 The Patient Protection and Affordable Care Act (ACA) addresses problems associated with cost, coverage and quality by introducing: the Individual Mandate, Accountable Care Organizations (ACOs), Bundled Payments for Care Improvement (BPCI) Initiative, Patient-Centered Outcomes Research Institute (PCORI), and many more pilot programs that act as vehicles of site-specific reform. However, underlying health care problems still remain that must be resolved to facilitate the ACA reforms. These daunting issues include, but are certainly not limited to: the shortage of physicians, ACO practitioner liability, weaknesses of the Individual Mandate, the remaining uninsured and the outmoded practices of the U.S. Food and Drug Administration (FDA). The goal of this paper is to address these problems and propose strategic reforms that will either augment or exist concomitantly with the ACA.
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Marmor, Theodore, and Michael K. Gusmano. "The state of American health care: November 2016 to November 2020, a look forward." Health Economics, Policy and Law 13, no. 1 (2017): 1–9. http://dx.doi.org/10.1017/s1744133116000359.
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AbstractThe election of Donald Trump, coupled with the retention of Republican majorities in the US House of Representatives and Senate, raises questions about future of the Patient Protection and Affordable Care Act, the structure and funding of the country’s public health insurance programs – Medicare, Medicaid and the Child Health Insurance Program – and the direction of health policy in the United States, more generally. Political scientists are not renowned for their capacity to predict the future and many of those who forecast election results have received criticism in recent weeks for failing to predict the Trump victory. While the future is uncertain, it is possible for social scientists to offer a ‘conditional causal analysis’ about the future. This essay is an effort to think about the likely shape of American health care between now and the next US presidential election.
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Owens, Heather. "Sleep—an Essential Component of Obesity Screening and Counseling: A Policy Analysis of the Affordable Care Act." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 56 (January 2019): 004695801984200. http://dx.doi.org/10.1177/0046958019842001.
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The Patient Protection and Affordable Care Act (PPACA) has provided access to health care for millions of people in the United States. One of the most beneficial aspects of the PPACA is the obesity screening and counseling provision. Currently, it is estimated that over 39% of US adults are obese. Research has linked sleep disturbances to obesity and obesity-related behaviors. The purpose of this article is to advocate for evidence-based care through the inclusion of sleep disturbance screening and management under the PPACA obesity screening and counseling provision. An in-depth policy analysis of the PPACA was conducted to examine the feasibility of adding sleep screenings to the obesity screening and counseling provision available under current law. Findings suggest that the adoption of this policy would require stakeholder advocacy and educational reform. Implementation of the policy would require additional economic investments, but the long-term savings could be significant. A campaign to raise awareness regarding the association between sleep disturbance and obesity among the public and health care professionals would be essential. Policy implementation would require interprofessional collaboration when performing sleep disordered screening and management. Preventative health care for individuals who have not previously accessed the health care system has the potential to socially and economically benefit society if policies provide for evidence-based care. Sleep screening and counseling is essential under the PPACA to adequately address the US obesity crisis.
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Cheng, Glen. "The National Residency Exchange: A Proposal to Restore Primary Care in an Age of Microspecialization." American Journal of Law & Medicine 38, no. 1 (2012): 158–95. http://dx.doi.org/10.1177/009885881203800103.
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Healthcare deficiencies in the United States have long been perpetuated by a shortage of primary care providers. A core purpose of the Patient Protection and Affordable Care Act (PPACA) is to provide health insurance for America's approximately fifty million uninsured. Implementation of universal health insurance, however, does not mean sufficient healthcare access for all, since the supply of physicians does not and will not meet demand. For reasons reviewed in this Article, the current physician shortage mainly impacts primary care providers. This shortage is particularly troubling because increased provision of primary care relative to specialty care has been associated with improvement in health outcomes, disease prevention, cost effectiveness, and coordination of care. This Article highlights provisions in the PPACA that impact primary care physicians. Finally, this Article proposes the creation of a universal primary care loan repayment program and a national residency exchange designed to alleviate the U.S. primary care crisis by facilitating optimal distribution of resident physicians in each medical specialty based on community need.
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Mariner, Wendy K. "Health Reform: What's Insurance Got to Do with It? Recognizing Health Insurance as a Separate Species of Insurance." American Journal of Law & Medicine 36, no. 2-3 (2010): 436–51. http://dx.doi.org/10.1177/009885881003600208.
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Health reform debates in the United States are typically conducted using the language of insurance. President Barack Obama described his hopes for expanding access to care as “health insurance reform.” Both proponents and opponents of reform debated the merits of reform proposals leading to the Patient Protection and Affordable Care Act of 2010 in insurance terms. Yet, disagreements over the structure of reform reveal deep differences in what proponents and opponents of reform mean by insurance and the role it should play in mediating access to health care. Scholars of insurance law are likely to describe insurance somewhat narrowly as a risk spreading device. Industry representatives, among others, often view conventional indemnity insurance as the norm. From this perspective, reforms that move too far beyond underwriting risks can be seen as undermining actuarial fairness, threatening the very idea of insurance and possibly the industry itself.
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Kapp, Marshall B. "If We Can Force People to Purchase Health Insurance, Then Let's Force Them to Be Treated Too." American Journal of Law & Medicine 38, no. 2-3 (2012): 397–409. http://dx.doi.org/10.1177/009885881203800206.
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Proponents of the 2010 Patient Protection and Affordable Care Act (PPACA) justify the Act's mandate that uninsured individuals either purchase a minimally defined health insurance policy (“Maintain Minimum Essential Coverage”) or pay a fine, as a necessary and proper exercise of Congress's express constitutional power to regulate interstate and foreign commerce. The United States Supreme Court will decide the correctness of that highly debatable position during its spring 2012 session.Assuming, without by any means predicting, that the validity of all parts of the PPACA—including the individual insurance mandate—is upheld, the Court's (likely multiple) opinions will constitute a major development in the evolution of American constitutional jurisprudence, even if Congress subsequently repeals specific sections of the legislation. Several commentators have expressed concern about the ramifications of a judicially validated PPACA for attempts by the government, especially through the mechanism of Comparative Effectiveness Research (CER), to limit or ration particular forms of potentially beneficial medical care for some or all patients.
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Nichols, Len M. "Government Intervention in Health Care Markets is Practical, Necessary, and Morally Sound." Journal of Law, Medicine & Ethics 40, no. 3 (2012): 547–57. http://dx.doi.org/10.1111/j.1748-720x.2012.00688.x.
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The intensity of the opposition to health reform in the United States continues to shock and perplex proponents of the Patient Protection and Affordable Care Act (PPACA). The emotion (“Abort Obama”) and the apocalyptic rhetoric (“Save our Country, Protect our Liberty, Repeal Obamacare”), render civil and evidence-based debate over the implications and alternatives to specific provisions in the law difficult if not problematic. The public debate has largely barreled down two non-parallel yet non-intersecting paths: opponents focus on their fear of government expansion in the future if PPACA is implemented now, while proponents focus on the urgency and specifics of our health care market problems and the limited number of tools we have to address them. Frustration on both sides has led opponents to deny the seriousness of our health system’s problems and proponents to ignore the risk of governmental overreach. These non-intersecting lines of argument are not moving us closer to a desired and necessary resolution.
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Majette, Gwendolyn Roberts. "PPACA and Public Health: Creating a Framework to Focus on Prevention and Wellness and Improve the Public's Health." Journal of Law, Medicine & Ethics 39, no. 3 (2011): 366–79. http://dx.doi.org/10.1111/j.1748-720x.2011.00606.x.
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On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (PPACA), a major piece of health care reform legislation. This comprehensive legislation includes provisions that focus on prevention, wellness, and public health. Some, including authors in this symposium, question whether Congress considered public health, prevention, and wellness issues as mere afterthoughts in the creation of PPACA. As this article amply demonstrates, they did not.This article documents the extent of congressional consideration on public health issues based on personal experience working on the framework for health care reform — specifically, my experience as a Fellow for a member of the Health Subcommittee of the Senate Finance Committee from 2008-2009. I also include a review of congressional activity in the United States House of Representatives. Analysis of the congressional meetings and hearings reveals that Congress had a deep understanding about the critical need to reform the U.S. public health and prevention system.
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Zhang, Donglan, Matthew R. Ritchey, Chanhyun Park, Jason Li, John Chapel, and Guijing Wang. "Association Between Medicaid Coverage and Income Status on Health Care Use and Costs Among Hypertensive Adults After Enactment of the Affordable Care Act." American Journal of Hypertension 32, no. 10 (2019): 1030–38. http://dx.doi.org/10.1093/ajh/hpz101.
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Abstract Background Hypertension is highly prevalent among the low-income population in the United States. This study assessed the association between Medicaid coverage and health care service use and costs among hypertensive adults following the enactment of the Patient Protection and Affordable Care Act (ACA), by income status level. Methods A nationally representative sample of 2,866 nonpregnant hypertensive individuals aged 18–64 years with income up to 138% of the federal poverty level (FPL) were selected from the 2014 and 2015 Medical Expenditure Panel Survey. Regression analyses were performed to examine the association of Medicaid coverage with outpatient (outpatient visits and prescription medication fills), emergency, and acute health care service use and costs among those potentially eligible for Medicaid by income status—the very low-income (FPL ≤ 100%) and the moderately low-income (100% > FPL ≤ 138%). Results Among the study population, 70.1% were very low-income and 29.9% were moderately low-income. Full-year Medicaid coverage was higher among the very low-income group (41.0%) compared with those moderately low-income (29.1%). For both income groups, having full-year Medicaid coverage was associated with increased health care service use and higher overall annual medical costs ($13,085 compared with $7,582 without Medicaid); costs were highest among moderately low-income patients ($17,639). Conclusion Low-income individuals with hypertension, who were potentially newly eligible for Medicaid under the ACA may benefit from expanded Medicaid coverage by improving their access to outpatient services that can support chronic disease management. However, to realize decreases in medical expenditures, efforts to decrease their use of emergency and acute care services are likely needed.
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BASSOK, OR. "Interpretative theories as roadmaps to constitutional identity: The case of the United States." Global Constitutionalism 4, no. 3 (2015): 289–327. http://dx.doi.org/10.1017/s2045381715000167.
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AbstractAs long as the American Constitution serves as the focal point of American identity, many constitutional interpretative theories also serve as roadmaps to various visions of American constitutional identity. Using the debate over the constitutionality of the Patient Protection and Affordable Care Act, I expose the identity dimension of various interpretative theories and analyse the differences between the roadmaps offered by them. I argue that according to each of these roadmaps, courts’ authority to review legislation is required in order to protect a certain vision of American constitutional identity even at the price of thwarting Americans’ freedom to pursue their current desires. The conventional framing of interpretative theories as merely techniques to decipher the constitutional text or justifications for the Supreme Court’s countermajoritarian authority to review legislation and the disregard of their identity function is perplexing in view of the centrality of the Constitution to American national identity. I argue that this conventional framing is a result of the current understanding of American constitutional identity in terms of neutrality toward the question of the good. This reading of the Constitution as lacking any form of ideology at its core makes majority preferences the best take of current American identity, leaving constitutional theorists with the mission to justify the Court’s authority to diverge from majority preferences.
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West-Oram, Peter. "Freedom of Conscience and Health Care in the United States of America: The Conflict Between Public Health and Religious Liberty in the Patient Protection and Affordable Care Act." Health Care Analysis 21, no. 3 (2013): 237–47. http://dx.doi.org/10.1007/s10728-013-0251-6.
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Corrigan, Kelsey L., Leticia Nogueira, K. Robin Yabroff, et al. "The impact of the Patient Protection and Affordable Care Act on insurance coverage and cancer‐directed treatment in HIV‐infected patients with cancer in the United States." Cancer 126, no. 3 (2019): 559–66. http://dx.doi.org/10.1002/cncr.32563.
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Garcia-Arce, Andres, and Jose L. Zayas-Castro. "Interventions as an alternative to penalties in preventable readmissions." Journal of Hospital Administration 4, no. 3 (2015): 70. http://dx.doi.org/10.5430/jha.v4n3p70.
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While expenditures in healthcare in the United States are the highest in the world, it is widely known that those resources are not being used efficiently. The government addressed this situation in the Patient Protection and Affordable Care Act, in an attempt to improve quality and affordability of healthcare. In the fiscal year 2013, the Centers for Medicare and Medicaid Services began imposing financial penalties through the Inpatient Prospective Payment System to hospitals that have higher than expected readmission rates for specific diseases. The nature and effects of this new policy have raised several concerns. This article discusses Medicare’s hospital readmissions reduction program and presents an alternate policy based on diseasespecific interventions to reduce preventable readmissions. Our results show that a policy based on implementing disease-specific interventions, instead of penalties, may save 33.43% of hospitals from being under the penalization level in the first year, while at the same time improving the delivery of care.
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Talamantes, Efrain, and Sergio Aguilar-Gaxiola. "Perspective: POTUS Trump’s Executive Orders - Implications for Immigrants and Health Care." Ethnicity & Disease 27, no. 2 (2017): 121. http://dx.doi.org/10.18865/ed.27.2.121.
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<p class="Default">The United States, under new executive orders proposed by its 45th president, may quickly lose its greatness in serving Emma Lazarus’ untimely portrait of immigrants and refugees as <strong>“</strong><em>the tired, poor and huddled masses yearning to breathe free</em><strong>.” </strong>After years of progress in improving health care access to underserved populations, new executive orders threaten our nation’s advancements in health equity. Within this perspective, we offer examples on how these actions may result in damaging impacts on patients, families, communities and the health care workforce. We add our voices to a myriad of national leaders who are advocating for the preservation of the Affordable Care Act (ACA) and the protection of immigrants, including Deferred Action for Childhood Arrivals (DACA).</p><p class="Default"><em>Ethn Dis. </em>2017;27(2):121-124; doi:10.18865/ed.27.2.121</p>
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Ossei-Owusu, Shaun. "Code Red." American Journal of Law & Medicine 43, no. 4 (2017): 344–87. http://dx.doi.org/10.1177/0098858817753404.
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The United States' health care system is mired in uncertainty. Public opinion on the Patient Protection and Affordable Care Act (“ACA”) is undeniably mixed and politicized. The individual mandate, tax subsidies, and Medicaid expansion dominate the discussion. This Article argues that the ACA and reform discourse have given short shrift to a more static problem: the law of emergency care. The Emergency Medical Treatment and Active Labor Act of 1986 (“EMTALA”) requires most hospitals to screen patients for emergency medical conditions and provide stabilizing treatment regardless of patients' insurance status or ability to pay. Remarkably, this law strengthened the health safety net in a country that has no universal health care. But it is an unfunded mandate that responded to the problem of emergency care in a flawed fashion and contributed to the supposed “free rider” problem that the ACA attempted to cure.But the ACA has also not been effective at addressing the issue of emergency care. The ACA's architects reduced funding for hospitals that serve a disproportionate percentage of the medically indigent but did not anticipate the Supreme Court's ruling in NFIB v. Sebelius, which made Medicaid expansion optional. Public and non-profit hospitals now face a scenario of less funding and potentially higher emergency room utilization due to continued uninsurance or underinsurance. Alternatives to the ACA have been insufficiently attentive to the importance of emergency care in our health system. This Article contends that any proposal that does not seriously consider EMTALA is incomplete and bound to produce some of the same problems that have dogged the American health care system for the past few decades. Moreover, the Article shows how notions of race, citizenship, and deservingness have filtered into this health care trajectory, and in the context of reform, have the potential to exacerbate existing health inequality. The paper concludes with normative suggestions on how to the mitigate EMTALA's problems in ways that might improve population health.
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Rao, Paul R. "Outcomes and Quality: Key Characteristics of a Successful SLP Value Journey." Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders 25, no. 3 (2015): 94–106. http://dx.doi.org/10.1044/nnsld25.3.94.
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We are living in a challenging era of healthcare reform marked by dramatic change and unprecedented political and legal turmoil surrounding this reform. Healthcare reform in the name of the Patient Protection and Affordable Care Act (PPACA, 2010) is becoming “hardwired” over the five years since its inception, yet as recently as March of 2015, the Supreme Court of the United States heard arguments to roll back subsidies for the Federal Health Exchanges which if approved could increase insurance rates by nearly 75% on over 8 million subscribers. The national healthcare landscape including reforms, changes, wins, and losses to date will be described. The “secret sauce” for meeting these challenges is to embrace value in healthcare which can be defined as outcomes over cost. In the context of our current levels of care, an inexorable movement away from volume to value will be described focusing on outcomes. The challenges we face especially in reporting outcomes and shifting from volume to value are described. Finally, arguments and illustrations are provided for how speech-language pathologists (SLPs) can continue to espouse value in becoming critical players in the value-based healthcare economy.
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Goldwater, Jason C. "Human Factors and Usability in Mobile Health Design – Factors for Sustained Patient Engagement in Diabetes Care." Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care 3, no. 1 (2014): 63–70. http://dx.doi.org/10.1177/2327857914031009.
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The degree of health care resource consumption within the United States is significant, even with the passage of the Patient Protection and Affordable Care Act (PPACA), with annual expenditures expected to reach 14% of the US gross domestic product by 2016. This suggests the need for population-level solutions that cover the spectrum of both clinical and non-clinical care for the primary prevention of chronic disease, in particular diabetes, which affects over eight percent of the population and costs over $100 billion annually. Over the past decade, there have been an abundance of technological solutions that provide the potential of mitigating the risk issues associated with diabetes and improving self-management practices. One such technology in particular is emerging that may become very important to the delivery of health care: mobile phones. In 2012, a study undertook a comprehensive assessment of the use of mobile health (mHealth) in the management and treatment of diabetes. This study encompassed the review of over 514 articles, as well as series of key informant interviews and site visits, to determine the effectiveness and utility of mHealth in managing and treating diabetes. The research suggested that the usability of mHealth applications could be understood and assessed according to four major factors: user-friendliness, user design, user satisfaction and user confidence. The first two primarily deal with the type of technology and the design of the interface. The last two concern user perception and are crucial in appropriately evaluating how well the application meets a patient’s expectations, which is a critical component of both quality of care and patient outcomes.
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Aizer, Ayal A., Benjamin Falit, Mallika L. Mendu, et al. "Cancer-Specific Outcomes Among Young Adults Without Health Insurance." Journal of Clinical Oncology 32, no. 19 (2014): 2025–30. http://dx.doi.org/10.1200/jco.2013.54.2555.
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Purpose The Patient Protection and Affordable Care Act (ACA) will likely improve insurance coverage for most young adults, but subsets of young adults in the United States will face significant premium increases in the individual market. We examined the association between insurance status and cancer-specific outcomes among young adults. Methods We used the SEER program to identify 39,447 patients age 20 to 40 years diagnosed with a malignant neoplasm between 2007 and 2009. The association between insurance status and stage at presentation, employment of definitive therapy, and all-cause mortality was assessed using multivariable logistic or Cox regression, as appropriate. Results Patients who were uninsured were more likely to be younger, male, nonwhite, and unmarried than patients who were insured and were also more likely to be from regions of lower income, education, and population density (P < .001 in all cases). After adjustment for pertinent confounding variables, an association between insurance coverage and decreased likelihood of presentation with metastatic disease (odds ratio [OR], 0.84; 95% CI, 0.75 to 0.94; P = .003), increased receipt of definitive treatment (OR, 1.95; 95% CI, 1.52 to 2.50; P < .001), and decreased death resulting from any cause (hazard ratio, 0.77; 95% CI, 0.65 to 0.91; P = .002) was noted. Conclusion The improved coverage fostered by the ACA may translate into better outcomes among most young adults with cancer. Extra consideration will need to be given to ensure that patients who will face premium increases in the individual market can obtain insurance coverage under the ACA.
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Shi, Weilong, Albert Anastasio, Ndeye F. Guisse, et al. "Impact of Insurance and Practice Type on Access to Orthopaedic Sports Medicine." Orthopaedic Journal of Sports Medicine 8, no. 7 (2020): 232596712093369. http://dx.doi.org/10.1177/2325967120933696.
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Background: The Patient Protection Affordable Care Act has expanded Medicaid eligibility in recent years. However, the provisions of the act have not translated to improved Medicaid payments for specialists such as orthopaedic surgeons. The number of health care practitioners who accept Medicaid is already decreasing, with low reimbursement rates being cited as the primary reason for the trend. Hypothesis: Private practice orthopaedic groups will see patients with Medicaid or Medicare at lower rates than academic orthopaedic practices, and business days until appointment availability will be higher for patients with Medicaid and Medicare than those with private insurance. Study Design: Cross-sectional study. Methods: Researchers made calls to 2 regular-sized orthopaedic practices, 1 small orthopaedic practice, and 1 academic orthopaedic practice in each of the 50 states in the United States. Callers described a scenario of a recent injury resulting in a bucket-handle meniscal tear and an anterior cruciate ligament tear seen on magnetic resonance imaging at an outside emergency department. For a total of 194 practices, 3 separate telephone calls were made, each with a different insurance type. Data regarding insurance acceptance and business days until appointment were tabulated. Student t tests or analysis of variance for continuous data and χ2 or Fisher exact tests for categorical data were utilized. Results: After completing 582 telephone calls, it was determined that 31.4% (n = 59) did not accept Medicaid, compared with 2.2% (n = 4) not accepting Medicare and 1% (n = 1) not accepting private insurance ( P < .001). There was no significant association between type of practice and Medicaid refusal ( P = 0.12). Mean business days until appointment for Medicaid, Medicare, and private insurance were 5.3, 4.1, and 2.9, respectively ( P < .001). Conclusions: Access to care remains a significant burden for the Medicaid population, given a rate of Medicaid refusal of 32.2% across regular-sized orthopaedic practices. If Medicaid is accepted, time until appointment was significantly longer when compared with private insurance.
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Heled, Yaniv. "The Biologics Price Competition and Innovation Act 10--A Stocktaking." Texas A&M Journal of Property Law 7, no. 1 (2021): 81–109. http://dx.doi.org/10.37419/jpl.v7.i1.3.
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On March 23, 2010, President Obama signed into law the Biologics Price Competition and Innovation Act (BPCIA) as part of the Patient Protection and Affordable Care Act (“Obamacare”). The purpose of BPCIA was to create for biologics a regime similar to that of the Drug Price Competition and Patent Term Restoration Act (Hatch–Waxman Act) and, in so doing, to open biologics markets to competition and, subsequently, lower the price of these expensive and increasingly important pharmaceuticals. Using original data, this Essay takes stock of the decade that has passed since the enactment of BPCIA. This Essay surveys the state of competition in United States biologics markets, entry of follow-on biologics into these markets, and the effects such entry has had on biologics prices. This Essay’s main findings are that, as of March 23, 2020—exactly ten years since the signing of BPCIA into law—the FDA has approved a total of 26 follow-on biologics deemed biosimilar to 9 original products (ratio: 2.63 follow-on/original products), with only 16 of these deemed biosimilar to 7 original products (ratio: 1.78 follow- on/original products) actually available on the market. None of these follow-on products have been approved as interchangeable with their reference products, which means that substitution of the 7 original products with one of their 16 approved biosimilars cannot be done automatically. The price of these products was 10%–37% lower than the price of the original biologic, with the average price savings being 24% or 27%. All 35 approved follow-on and reference products are owned by a total of 11 pharmaceutical companies. The number of years of market exclusivity of the 9 original biologics before the approval of the first biosimilar ranged between 13.5–28.92 with an average of 18.27 years or 15.33–29.42 with an average of 19.87 years before the launch of the first competing biosimilar. This Essay further puts forward a new method of measuring comparative levels of competition in drug markets by comparing the ratio of total approved follow-on products per total approved original products at certain critical benchmarks. Using this measurement tool, this Essay compares BPCIA’s track record with the levels of competition in small-molecule drugs before and after the Hatch– Waxman Act, showing that that BPCIA significantly underperforms in comparison and fails to instigate levels of competition that would lead to significant price drops and increase access to biologics in the United States. A short survey of the most likely reasons for BPCIA’s underperformance follows. This Essay concludes by presenting the following question: if BPCIA’s current track record is (still) not enough to convince that it is failing to meet its goals, what more would it take to reach such a conclusion, and how much longer should policymakers wait before it is possible to surmise that BPCIA in its current form has failed to significantly increase access to biologics in the United States?
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Manchikanti, Laxmaiah. "Medicare Physician Payment Systems: Impact of 2011 Schedule on Interventional Pain Management." Pain Physician 1;14, no. 1;1 (2011): E5—E33. http://dx.doi.org/10.36076/ppj.2011/14/e5.
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Physicians in the United States have been affected by significant changes in the patterns of medical practice evolving over the last several decades. The recently passed affordable health care law, termed the Patient Protection and Affordable Care Act of 2010 (the ACA, for short) affects physicians more than any other law. Physician services are an integral part of health care. Physicians are paid in the United States for their personal services. This payment also includes the overhead expenses for maintaining an office and providing services. The payment system is highly variable in the private insurance market; however, governmental systems have a formula-based payment, mostly based on the Medicare payment system. Physician services are billed under Part B. Since the inception of the Medicare program in 1965, several methods have been used to determine the amounts paid to physicians for each covered service. Initially, the payment systems compensated physicians on the basis of their charges. In 1975, just over 10 years after the inception of the Medicare program, payments changed so as not to exceed the increase in the Medical Economic Index (MEI). Nevertheless, the policy failed to curb increases in costs, leading to the determination of a yearly change in fees by legislation from 1984 to 1991. In 1992, the fee schedule essentially replaced the prior payment system that was based on the physician’s charges, which also failed to live up to expectations for operational success. Then, in 1998, the sustainable growth rate (SGR) system was introduced. In 2009, multiple attempts were made by Congress to repeal the formula – rather unsuccessfully. Consequently, the SGR formula continues to hamper physician payments. The mechanism of the SGR includes 3 components that are incorporated into a statutory formula: expenditure targets, growth rate period, and annual adjustments of payment rates for physician services. Further, the relative value of a physician fee schedule is based on 3 components: physician work, practice expense (PE), and malpractice expense that are used to determine a value ranking for each service to which it is applied. On average, the work component represents 53.5% of a service’s relative value, the fee component represents 43.6%, and the malpractice component represents 3.9%. The final schedule for physician payment was issued on November 24, 2010. This was based on a total cut of 30.8% with 24.9% of the cut attributed to SGR. However, as usual, with patchwork efficiency, Congress passed a one-year extension of the 0% update, effective through December 2011. Consequently, CMS issued an emergency update of the 2011 Medicare fee schedule, with multiple revisions, resulting in a reduction of the conversion factor of $36.8729 from December 2010 to $33.9764 for 2011. Key words: Health policy, physician payment policy, physician fee schedule, Medicare, sustained growth rate formula, interventional pain management, regulatory reform
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King, Michael W. "Health Care Efficiencies." American Journal of Law & Medicine 43, no. 4 (2017): 426–67. http://dx.doi.org/10.1177/0098858817753407.
Full textAbstract:
Despite the U.S. substantially outspending peer high income nations with almost 18% of GDP dedicated to health care, on any number of statistical measurements from life expectancy to birth rates to chronic disease,1 the U.S. achieves inferior health outcomes. In short, Americans receive a very disappointing return on investment on their health care dollars, causing economic and social strain.2 Accordingly, the debates rage on: what is the top driver of health care spending? Among the culprits: poor communication and coordination among disparate providers, paperwork required by payors and regulations, well-intentioned physicians overprescribing treatments, drugs and devices, outright fraud and abuse, and medical malpractice litigation.Fundamentally, what is the best way to reduce U.S. health care spending, while improving the patient experience of care in terms of quality and satisfaction, and driving better patient health outcomes? Mergers, partnerships, and consolidation in the health care industry, new care delivery models like Accountable Care Organizations and integrated care systems, bundled payments, information technology, innovation through new drugs and new medical devices, or some combination of the foregoing? More importantly, recent ambitious reform efforts fall short of a cohesive approach, leaving fundamental internal inconsistencies across divergent arms of the federal government, raising the issue of whether the U.S. health care system can drive sufficient efficiencies within the current health care and antitrust regulatory environments.While debate rages on Capitol Hill over “repeal and replace,” only limited attention has been directed toward reforming the current “fee-for-service” model pursuant to which providers are paid for volume of care rather than quality or outcomes. Indeed, both the Patient Protection and Affordable Care Act (“ACA”)3 and proposals for its replacement focus primarily on the reach and cost of providing coverage for health care, rather than specifics for the delivery of health care.4 With the U.S. expenditures on health care producing inferior results, experts see consolidation and alternatives to fee-for-service as fundamental to reducing costs.5 Integrating care coordination and delivery and increasing scale to drive efficiencies allows organizations to benefit from shared savings and relationships with payors and vendors.6 Deloitte forecasts that, by 2024, the current health system landscape—which includes roughly 80 national health systems, 275 regional systems, 130 academic medical centers, and 1,300 small community systems—will morph into just over 900 multi-hospital systems.7Even though health care market and payment reforms encourage organizations to consolidate and integrate, innovators must proceed with extreme caution. Health care organizations attempting to drive efficiencies and bring down costs through mergers may run afoul of numerous federal and state laws and regulations.8 Calls for updates or leniency in these laws are growing, including the possible recognition of an “Obamacare defense” to antitrust restrictions9 and speculation that laws restricting physicians from having financial relationships will be repealed, ostensibly to allow sharing of the rewards reaped from coordinated care.10 In the meantime, however, absent specific waivers or exemptions, all the usual rules and regulations apply, including antitrust constraints,11 physician self-referral12 and anti-kickback laws and regulations,13 state fraud and abuse restrictions,14 and more. In short, a maelstrom of conflicting political prescriptions, health care regulations, and antitrust restrictions undermine the ability of innovators to achieve efficiencies through joint ventures, transactions, innovative models, and other structures.This article first considers the conflicting positions taken by the United States government with respect to achieving efficiencies in health care under the ACA and alternative delivery models, on the one hand, and health care regulatory enforcement and antitrust enforcement, on the other. At almost a fifth of the U.S. economy,15 health care arguably has grown ungovernable, exceeding the ability of any one law or branch of government to create or implement coherent reform. Indeed, the article posits that although the ACA reformed and expanded access to health care, it failed to transform the way health care is delivered beyond limited “demonstration projects”, leaving fee-for-service intact. Nonetheless, even with limited rather than revolutionary goals, the ACA still lacks sufficient authority across disparate branches of government to achieve its stated goals. The article then examines the conflicting positions of the various United States regulatory schemes and enforcement agencies governing health care, and whether they can be reconciled with the stated goal of the government, often referred to as the “Triple Aim”:16 improving quality of care, improving population health, and lowering health care costs. It examines fundamental, systemic challenges to achieving the “Triple Aim”: longstanding health care regulatory laws that impede adoption of innovative delivery systems beyond their current “demonstration project” status, and antitrust enforcement that promotes waste and duplication in densely populated areas, while preventing necessary consolidation to more efficiently reach rural areas. The article concludes with recommendations for promoting efficiency through modest reconciliation of the conflicting goals and regulations in health care.