Chapter 11 and 12 give great background to the Affordable Care Act (ACA) and trends in the US healthcare system. Chapter 11 begins by introducing what the ACA is. During the Obama administration, he aimed to fix problems criticized of the current healthcare system and provide access to healthcare to all. However, from day one, the ACA that passed in 2010 was heavily disproved of by the Republican Party. His aim was to expand access, improve affordability, and also cut healthcare costs. Though there were some issues, the ACA was a huge step of progression for healthcare in the US, especially for low income families. Also, the funding of the ACA involved cuts in government spending, largely payments to doctors and hospitals that provide care to Medicare and Medicaid patients, and also an imposed tax on citizens who did not enroll in any health insurance plan. This is interesting, especially because initially it was proposed that it would be a mandate that all citizens have health insurance. This is similar to Australia in that all citizens are covered either by public or private plans, but everyone must have insurance. However, the Supreme Court ruled that rather than mandating health insurance, there is the power to tax instead. Because of the US and its issues with bipartisan opinions, the ACA was never fully supported. There were complaints from the public who had private insurance plans that did not meet the requirements of the ACA, and therefore some plans increased in cost. However, this was addressed by issuing waivers. Being that the ACA was the best attempt at a universal coverage, the controversy was and still is prevalent. ACA expansion would be great to see. The initiative of improving costs and providing equitable, quality care is the direction we should be moving.
In following the Obama administration, the trump administration consisted of primarily Republican support. There was an attempt to overturn the ACA with certain proposed changes. One of these changes involved the defunding of Planned Parenthood. This was alarming because Planned Parenthood offers affordable birth control options, hormone therapy, primary care, STD testing, and emergency contraceptive. There seemed to be a narrative that only focused on the abortions performed, which is still invasive to say the least. Defunding Planned Parenthood is an attack on those who received Medicaid services, which are primarily low income families. However, the Republican majorities were not able to overturn the ACA, rather during the Trump administration is was weakened. There is still hope that the ACA can expand, or Medicare for All, which would remove all private insurance plans, is largely favored by Democrats, and still some opposers.
Chapter 12 gives an overview of the trends in the US healthcare system. It begins describing the zig-zag movement, where there was a notion to move more towards public sector involvement at first, then a zag back towards private sector encouragement. During the many changes, there is be an antigovernment sentiment now more than ever where the public is concerned about personal freedom, economy freedom, and a debt-free future. Some of the trends involved in the healthcare system are promoting focuses that can advance equitable care, as well as quality care. For example, technology plays a big role in access to health information. Having detailed information on patients in an electronic records can help provide linkages to progression of disease or illness, and provide wholistic understanding in regards to environmental and biome factors. I remember working Cape Fear Hospital when EPIC (an EHR system) was being integrated and the improvement of patient records and ease of access to payment as well. This is definitely a great progression in the system. Focus on metal health is also great, especially with costs considering many mental health services can get expensive, even with insurance. I believe this can also decrease some stigma revolving around mental health if access to these services are easier. Also, having machinery that can be used at home, rather than a patient having to be treated in a hospital setting can reduces costs and provide convenience. I found the impact of technology very interesting. Telemedicine is now a thing, and in some cases can be the best option for treatment if it is minor. Also, the mention of automation and removing lower level jobs such as phlebotomists and coders is interesting. It makes me wonder how long it will take for that to take effect, and also think about people who are employed with those types of jobs.
Goldsteen, R. L., Goldsteen, K., & Goldsteen, B. (2021). Jonas’ introduction to the U.S. health care system. Springer Publishing Company, LLC.
Hi Kristen,
Thank you for your summary of Chapters 11 and 12. I think most of us in healthcare have watched the development of the Affordable Care Act over the last decade – it’s hard to believe it’s been in place that long. It definitely did feel like a progression in healthcare when it was enacted, but you are correct that there has been resistance, much of it political, since the beginning. After watching the PBS video this semester, it’s interesting to see how other countries have been able to mandate healthcare, making it universal, when the United States has not been able to come to that sort of understanding. I agree with your statement that we should be moving toward higher quality care, and I think that should be the case regardless of what type of system we have in place. It’s difficult when funding to providers and healthcare systems is cut, because they also have to support the infrastructure to maintain good quality services, but that’s where I see value-based care coming into place. I work in a system that is very focused on population health. Internally we’re trying to meet quality benchmarks to ensure shared savings and quality reimbursement. However, I tell my team all the time that, even though we talk data and metrics, everything we do is with the patient at the center of care and focused on evidence-based practice. Each number is someone’s mother, father, sister, brother or child, and we do not take that lightly.
Thank you for pointing out the additional services provided by Planned Parenthood. That is a topic that is so polarizing, and it’s easy to see why there are such strong feelings in both directions. While every individual will have their own personal and/or professional opinion, I think everyone should be educated on both the services provided, as well as the downstream ramifications when those services are suspended. You mentioned mental health as well – while I see and hear more conversations about mental and behavioral health, there are not yet enough resources to support that area of healthcare. As North Carolina plans to launch the Medicaid Managed Care Behavioral Health and Intellectual/Developmental Disabilities Tailored Plan, the discussions I’m hearing are about the staffing, training and additional resources needed to support that patient population. Telehealth and remote monitoring are providing increased opportunities for care, too, and much of that got its’ true foothold during the pandemic when we had to be a little more creative in providing access to care.
Thanks for sharing your perspective – it will be interesting to see how all these areas develop in the next decade!
Layne
Hi Kristen
I would like to start off by saying that your post was well written, easy to read, and well thought out. Its crazy how politics are such a major part of healthcare. Republicans ideology favors private healthcare while Democrats ideology favors public healthcare. Democrats want the government to have more of a say in healthcare which would allow them to control prices, have widely available healthcare to everyone (including low income families and those with pre existing conditions that could be turned down by private insurance companies), etc. Republicans want the government to be less involved in healthcare which allows people to open private practices, its would give people the option to pick and choose who they go see, etc. The truth is you kind of need both. You need the private sector to take the added pressures of of the public sector and you need the public sector for the people who couldn’t get health coverage or the help they needed otherwise in the private sector.
I also liked how you talked about your personal experiences when working at the hospital in Cape Fear. It is truly amazing how far technology has come and how far it will continue to progress. I believe that technology will continue evolving and become revolutionary. I love that you talked about mental health and the stigma that surround it. I think that our generation has brought a light on mental health issues. People seem more open to talk about mental health or any issues they faced in the past or present. It is important for everyone to feel like they have a voice and that people are listening. It is also important for people to have the access and ability to find and ask for help no matter what situation they might currently be in. I think that we have a lot to look forward to when it comes to the healthcare industry.