Although the health care reform in the United States can be traced back to the 1900s, the events of the past few years have been critical in shaping the future of the American healthcare system (Martin, 2015). These events relate to the passage of the Patient Protection and Affordable Care Act (ACA) in 2010 and the ongoing implementation of important provisions of the legislation in the American healthcare landscape (Alvidiez, 2015). The ACA-led health care reform has affected a multiplicity of health sectors in the country (e.g., government programs, insurance companies, provider groups, and plan sponsors), with available literature demonstrating that the planned reform will expand access to health insurance coverage, contain healthcare costs, establish and promote exchanges, widen uptake of health information technology, and enhance collaboration (Bliss, 2013). This paper undertakes a literature review and synthesis to understand how the ACA-led health care reform is impacting these components. The paper also identifies some potential consequences of the health care reform and suggests some actionable points to fast-track the reform.
Literature Review and Synthesis
Research is consistent that the health care reform in the United States should focus on expanding access to health insurance coverage with the view to improving the health of Americans and enhancing the global competitiveness of the country (Bliss, 2013). The ACA-led health care reform seeks to move individuals out of the vulnerable ranks of the uninsured by expanding Medicaid to everyone below 138 percent of the federal poverty level and requiring the establishment of an insurance exchange where private insurance can be sold to individuals without Medicaid, Medicare, or employer-based insurance (Gaffney, 2014). Although it is evident that the ACA-led health care reform has gained some ground in expanding access to health insurance coverage, Fried, Pintor, Graven, & Blewett (2014) argue that the reform has failed to eliminate uninsurance and underinsurance due to high levels of cost-sharing, deductibles, and coinsurance. This view is reinforced by Kingsley (2014), who argues that costs involved in covering the uninsured and underinsured will become unsustainable shortly.
The reforms introduced by the ACA are already paying dividends in containing health care costs by reducing administrative and peripheral costs, laying much focus on disease prevention rather than treatment, advocating for a payment mechanism that is based on the quality of care or outcome determinants rather than fee-for-service, as well as managing costs for all stakeholders (Bliss, 2013). Wexler, Hefner, Welker, and McAlearney (2014) argue that the ongoing health care reform has reinforced the concept of Accountable Care Organizations (ACOs), which has been instrumental in containing costs “by responding to changes in reimbursement, reducing fragmented care, and focusing on improving the quality of care for defined patient populations” (p. 298).
Bliss (2013) argues that the health care reform being witnessed in the US is achieving the intended outcomes in terms of establishing and promoting insurance exchanges. These exchanges not only assist people who cannot afford group insurance plans to have access to affordable insurance but also protect Americans from the devastating effects of illness-related financial burden while promoting prevention (Kingsley, 2014). However, some critics of the ACA-led health care reform argue that the reality of achieving insurance exchanges may be hard to achieve due to entrenched business interests and concerns (Lape, 2013). Such conflicting interests make it difficult for relevant stakeholders to collaborate more effectively in the provision of optimal health care (Fried et al., 2014).
In health information technology (HIT), available literature demonstrates that the ongoing health reform in America is underscoring the importance of investing in technology (e.g., electronic medical records, electronic prescribing, and messaging) with the view to minimizing administrative costs, enhancing data exchange, promoting adherence to best practices, promoting prevention and treatment, as well as increasing quality of care (Bliss, 2013). Other scholars argue that the incorporation of strong health IT system is critical in supporting integration and coordination of care, reducing costs, and ensuring optimal treatment outcomes (Wexler et al., 2014). Although the ACA-led health care reform emphasizes the importance of HIT in achieving these outcomes, Gaffney (2014) is categorical that some healthcare facilities and ACOs lack the needed health IT infrastructure and are hence unable to minimize administrative costs or ensure quality patient outcomes.
Lastly, research is consistent that the ongoing reform is at its infancy stages in terms of promoting collaboration across fields and sectors. Close collaboration could strengthen and improve the US health care delivery system, save considerable amounts of money, and ensure seamless delivery of care across the health care continuum (Bliss, 2013; Martin, 2015). However, although concerted efforts have been made to enhance collaboration among various stakeholders, optimal outcomes are yet to be achieved in this area (Lape, 2013). As acknowledged by Alvidiez (2015), people “must not lose sight of the fact that while ACA has set in motion many important and purposeful programs, the outcome will be shaped by the actions and reactions of the various stakeholders and the successes and failures of the many initiatives underfoot” (p. 29). On their part, Wicks and Keevil (2014) argue that most stakeholders in the health care industry are unable to collaborate as demanded by the ACA-led health care reform due to a lack of a deep understanding of the various provisions of the Act and fear of change. From the review, it is evident that more needs to be done to remove the perceived fear and spur understanding of the various provisions if stakeholders are to achieve the intended collaboration.
Potential Consequences and Suggested Actions
A major grey area in the ongoing health care reform revolves around the failure of stakeholders in the healthcare industry to collaborate to achieve optimal outcomes. Another consequence concerns the lack of understanding of the various provisions contained in the act, which in turn leads to ineffective collaboration among various stakeholders in the health care industry. A third consequence relates to the incapacity of some healthcare organizations and ACOs to have the required health IT infrastructure. Lastly, it has been argued that the ACA-led health care reform has failed to eliminate uninsurance and underinsurance as originally purposed due to high levels of cost-sharing, deductibles, and underinsurance.
Among the suggested actions, the government needs to help the relevant stakeholders in designing mutually beneficial relationships to enhance collaboration. Additionally, the government needs to invest heavily in helping stakeholders in the health care industry to change according to the expectations of the health reform and also to deepen their understanding of how the health market is changing. The government also needs to facilitate health care organizations and ACOs to secure modern health IT infrastructure to benefit from the many incentives under the reformed health system. Lastly, the government needs to lower the costs of insurance sharing and invest more financial resources in the reform agenda to create universal health care.
Drawing from this exploration, it is evident that the barriers that exist include lack of adequate financial resources, lack of adequate collaboration between stakeholders, absence of comprehensive understanding of the needs and demands of the health reform program, and low uptake of health IT infrastructure. These barriers need to be addressed using the suggested actions to ensure the success of contemporary health care reform in the United States.
Alvidiez, J.A. (2015). Where are we with health care reform? Benefits Magazine, 52(7), 28-33.
Bliss, K. (2013). Role of advocacy in health care reform: Literature review and call to action. American Journal of Health Studies, 28(2), 41-49.
Fried, B., Pintor, J.K., Graven, P., & Blewett, L.A. (2014). Implementing federal health reform in the States: Who is included and excluded and what are the characteristics? Health Services Research, 49(1), 2062-2085.
Gaffney, A.W. (2014). Beyond Obamacare: Universalism and healthcare in the twenty-first century. New Politics, 15(1), 19-25.
Kingsley, T. (2014). Diagnosing the current problems of the United States health care system requires examining the history of health reform. Kennedy School Review, 14(1), 63-69.
Lape, M. (2013). Preparing for healthcare reform: Pathways to integration. Policy & Practice, 71(5), 19-23.
Martin, E.J. (2015). Health care policy: Legislation and administration, patient protection, and affordable care act of 2010. Journal of Health & Human Services Administration, 37(4), 407-411.
Wexler, R., Hefner, J., Welker, M.J., & McAlearney, A.S. (2014). Health care reform: Possibilities & opportunities for primary care. Journal of Family Practice, 63(6), 298-304.
Wicks, A.C., & Keevil, A.A.C. (2014). When worlds collide: Medicine, business, the affordable care act, and the future of health care in the U.S. Journal of Law, Medicine, & Ethics, 42(4), 420-430.