Instructions: This assignment must be done in APA format. A minimum word count of 1600 for the overall assignment (without references included) is required. A minimum of four (4) scholarly references along with in-text citations is also required for this assignment. However, each question ask for different things so please pay attention. Also, although this assignment is in APA format; please keep the question and answer line up (see example below) For Example: Question: XYZ Answer: XYZ Reference: XYZ Note: Please FOLLOW instructions and keep the above format. Each question is separate. DO NOT COMBINE. 1. Knowledge: What are the two most important things to “know” about the evolution of health policy? About the importance of quality in healthcare? Why are they important? 2. Comprehension: What is your understanding of the state of affairs in the development of health policy in the United States? What is the most important thing to “understand” about quality in healthcare? Why is it important to comprehend the complexity? 3. Application: Give an example of either (but not both) a healthcare policy and its consequences or an example of a quality issue / practice in healthcare. 4. Analysis: In your example analyze the root causes of the issues and the pros and cons of the example. 5. Synthesis: From your example offer a new and unique idea of yours or from the research that addresses a better solution to the issue cited. 6. Evaluation: How is the new idea better / same / worse than the experience you described in your example? Why is it better? What improved consequences might come from your new idea? Instructors Note: Each of these needn’t be long or expansive. Brevity is the soul of wit (Shakespeare). Practice efficiency and directness in your answers. Get to the point quickly. Avoid unnecessary “backfill”. Every word needs to make a contribution to the end points that you intend to make. Part Two Write a 150 word response to each discussion post. A minimum of two references per post is required. In-text citations must be included and cited properly. Note: Write the response as if you are talking to a person in person. Post One I am against the ACA because it caused many companies to drop their employment based healthcare plans because it was too expensive. The income tax was increased to help pay for individuals under the poverty line. I do agree with people who chose not to have health insurance being taxed, but the list of exemptions is growing so the tax is less threatening. Knowledge Healthcare in America cost almost two times per person as it does in any other country and the quality is rather mediocre and millions of Americans did not have the necessary coverage. Older citizens were having a growing difficulty with paying their medical bills. People who had individually purchased their plans were able to be grandfathered into the plan and those who purchased their plans after a certain time had to enroll in a new plan that meets all standards. Comprehension There have been many arguments brought forward by states regarding the ACA. The case has even made it to the Supreme Court. The affordable care act was designed to help out low income families who could not afford to pay the high insurance costs through a traditional plan. The plan also benefitted people who were not on a company plan or military health insurance. A lot of these issues may be politically based arguments that do not have much research behind them. Some may think the act is to help illegal immigrants but in reality you must be an American citizen to get the coverage. Application People who pass the age of 26 are no longer on their parent’s insurance. If they are not at a company that provides health insurance, the individual will have to get on a health plan with the Affordable Care Act. Depending on what the individual is making, they will likely have a very small monthly payment for the plan. With the plan being developed for lower income individuals, people still in college or searching for a job are still able to have healthcare coverage. The plan also benefits people who have pre-existing conditions who before may not have been able to get coverage before the ACA went into effect. Analysis While the affordable care act was designed to make health care affordable to everyone, the lack of physicians is still there. In rural communities, there is still a shortage of doctors to see a large amount of patients. The ACA has made the access to health insurance for minorities higher than ever before ( VanGarde, Yoon, Luck, Mendez-Luck, 2018). With this high rate of patients coming in, the doctor’s offices are more crowded than ever and this has also led many doctors to only accept certain insurances. Synthesis I understand that the amount you pay for the health insurance is based on the income of the individual but I think the low monthly rates should be for people who are not employed due to disability reasons. People who simply don’t want to work should have higher monthly rates. This will lower the need for the tax increase for the middle and upper class. For people with disability, there will be a portion of their money taken out each month to go towards their health insurance. This will also incentivize people to go out and join the workforce in order to pay for their mandatory health insurance and improve their lives. The exemption list will no longer include citizens living abroad, Indian Tribes, Members of religious sections, and people incarcerated. These exemptions will no longer be able to claim these exemptions on their tax returns. This will funnel more money into the healthcare pool to provide coverage for them. Evaluation This plan will meet much pushback from people who are used to not having to have health insurance. The benefit will be the fact that these people will have the required healthcare coverage. The downside is there will be an even bigger increase in the amount of patients coming through a doctors office. Studies have shown that the ACA has not has a large effect of how many people are staying in school longer compared to getting out and finding a job in order to get health insurance benefits (Heim, Lurie, & Simon, 2018). The push back will come from people who feel it unnecessary to have health insurance. Post Two Having never thought about the stance I take on the Affordable Care Act, I initially stood neutral on this topic. With some more research and thinking, I am favoring the Affordable Care Act for a few reasons. One of the reasons was that I initially believed that it should be a choice to be medically insured because unlike car insurance that is required to drive, someone could not get injured from me and I could take on sole responsibility if I injure myself. This was thought about more and realized I can in fact injure others if I am not insured and neglecting taking care of my health and spreading disease and illnesses to others. Because of that, health care should be a requirement to prevent injury/illness to myself and others, just like car insurance is for. Therefore, I do believe the Affordable Care Act is beneficial in protecting public health and the health of all individuals. Knowledge A more formalized health care plan was officially enacted in 2014 by the Obama Administration, called the Affordable Care Act, has taken the burden off millions of Americans in a once-broken healthcare system (Theime Sanford, 2014). This was passed for many reasons, but the main reasons are pre-existing conditions were being denied coverage after a certain time period, many uninsured Americans faced financial struggles when injuries and illnesses struck and was little control and government intervention of offering fair and affordable insurance policies. The ACA has been challenged 70 times by mid-2017 because of the rise in premiums every year and also the availability of coverage with only 44% of counties having only one insurer left in their area (Wilensky, 2018). Comprehension The Affordable Care Act has been changed and updated many times because changing a national healthcare plan does not happen over night and is aimed to improve the overall health of the public. This goal to improve a wider national healthcare coverage at a lower price. Health insurance is needed on a nation-wide basis in order to promote self-health and so diseases and illnesses do not spread as prevalently. This whole concept can be compared to car insurance. In order to drive a car, one must have car insurance, or they can risk paying a fine; same is true with health insurance. In both scenarios, it does not matter the coverage amount, if the individual has the minimum of coverage it would be acceptable. Insurance in both cases is to protect the owner of the insurance as well as everyone else. One who has no insurance may not be properly vaccinated because they cannot afford it and they spread the disease to someone in a public place, although this person would be hard to be directly blamed for such spread illnesses unlike a car wreck. The Affordable Care Act provides many options for individuals with healthcare needs without being turned away for pre-existing conditions, cheaper medications and better preventative care that may have once been ignored for the uninsured due to high cost. With any system, there are pros and cons, which will never be perfect or accepted by everyone, but offers a better solution to the once-flawed system. Application The idea of the Affordable Healthcare Act is to provide affordable healthcare to all Americans. The idea is usually better than the actual outcome. Premiums have increased by 49% for families and 39% since 2014, which takes away the “affordable” part of this plan (Thieme Sanford, 2014). If a family of 4 was paying $500/month in 2014, they are now paying $2,940 more a year based on this these increases. That is a significant amount of money for the average household to be paying extra. Analysis The biggest root cause that drove the Affordable Care Act to be established was to make healthcare affordable to all individuals. This should not be confused with accessibility because although there is overall cheaper healthcare for a wider range of people, however it does not guarantee that the insurance these individuals can afford will be accepted. Before the Affordable Care Act, the system was flawed and uninsured people ended up receiving 2.88 times what they sent out of pocket on healthcare services through charity care, according to the Medical Expenditure Panel Survey (Nyman & Trenz, 2016). This has greatly improved with the introduction of the Affordable Care Act, which can be shown below: Post ACA Pros: Allows those with pre-existing conditions to be covered, increases preventative health and maintenance, reduces prescription drugs Cons: Forces those who still cannot afford insurance to get insurance or face a penalty, increases patients going to get seen, which increases the wait to be seen in a timely manner, different insurance rates and coverages can be confusion to individuals since there are many options that are available and may be paying for services that they do not need Synthesis Taxation for healthcare is not a new idea, however my idea would be to tax all tax-paying individuals 5% of their earnings. This 5% gets split into a large healthcare pool that will then get divided into 3 separate categories, which is shown below. This money that gets divided up respectfully among each category will then be used for deductibles and other out-of-pocket expenses, which can be used for any type of medical care or insurance carrier and is a guaranteed set amount of money. This money that does not get used in that given year can then be added into the person’s Social Security or towards a tax-return at the end of the year. An example of this structure is found below, which would be done on a much larger scale than this. 3 Categories: Adults, Children and Disabled & Elderly Only allots for 2 children per household. Ex: $25,000 salary contributes 5%= $1,250 $50,000 salary contributes 5%= $2,500 $100,000 salary contributes 5%= $5,000 = $8,750 total in this pool (for these three examples) This pool gets split among the three categories as followed (based on above example) Adults= 30%, which equals $2,625 Elderly and Disabled=50%, which equals $4,375 Children 20%, which equal $1,750 Evaluation This new form of healthcare can be straining on an individual’s paycheck, however in order to improve on our healthcare system, it is needed to address the issues that the Affordable Care Act fails to fix. The current failure is the ability to help to ALL tax-paying citizens by providing them with a security-blanket of money if they find themselves needing medical attention. This type of system could help with the healthcare field and the abuse of emergency rooms with non-emergent cases and frequent emergency room visits. According to a study performed in Texas of Medicaid enrollees, those who visited the hospital more than 10 times in the year accounted for 15.5% of all ED visits and 17.4% of the emergency room’s cost (Delcher, et al., 2017). This would most likely reduce the amount of people who overuse services like the emergency room for non-emergent purposes by striving to get money back the next year for not using it. The problems with this type of healthcare provision would be as the older population 65+ increases, the disbursement would be much lower. This would require trend analysis to set up a change of percentage of allocation of funds based on changes in demographics. Also, as mentioned previously, the financial hardship may be unrealistic to some people. The real median income is $38,009, which would be $1,900 the average person would be missing out on (Fontenot, Semega & Kollar, 2018). Post Three The Affordable Care Act has been up for the debate especially since the 2016 election. My opinion on the Affordable Car Act is that it has provided more accessibility for individuals who otherwise could not afford health insurance but also at an affordable price. Another key factor of the Affordable Care Act is that it also allowed for those individuals with pre-existing conditions a chance to be insured as well. When the law was passed, it was stated that insurance companies could no longer deny coverage for pre-existing conditions. They also could not drop the coverage or raise premiums for those individuals if their beneficiaries got sick (Amadeo, 2018). And as I mentioned it helped provide accessibility to healthcare for more individuals. The ACA slowed the rise of health care costs and by doing this it provided insurance for millions and made preventative care free (Amadeo, 2018). This opened up the opportunity for people to receive treatment that they needed before going to the emergency room and paying double. In 2016, the cost of health care services increased by 1.2 percent for the year which was much less than the price increase of 4% in 2004 (Amadeo, 2018). Knowledge: The Affordable Care Act a comprehensive health care reform law, was enacted in March of 2010 with three primary goals in mind. The first goal is to make affordable health insurance available to more people. The law provides consumers with subsides (premium tax credits) that lowers the costs for the households with incomes between 100%-400% of the federal poverty level (HealthCare, 2018). The second goal of the law is to expand the Medicaid program to be able to cover all adults with income below 138% of the federal poverty level. Lastly, the third goal of the law is to support innovative medical care delivery methods designed to lower the costs of health care generally (HealthCare, 2018). Comprehension: The Affordable Care Act has increased the number of people covered by insurance and helped reduce health care costs. Twenty million people have gained health insurance coverage through the law. In 2013 16.6 percent of the population under the age of 65 were uninsured, and in the first quarter of 2016, only 10 percent of the population under the age of 65 were uninsured (APAH, 2018). Opposition regarding the healthcare reform has been ongoing which has to do more with the access of healthcare then the insurance aspect of it and healthcare costs. Application: The Affordable Care Act has been able to increase the opportunity of insurance coverage for consumers but also, the Affordable Care Act makes investments in programs designed to reduce the cost and improve the quality of health care. An example of these efforts is Partnership for Patients, an initiative dedicated to reducing hospital-acquired conditions (APAH, 2018). It has been estimated that the program has helped save 125,000 lives and $28.2 billion in health care costs from 2011 to 2015 (APAH, 2018). The ACA has also helped in reducing costs, for example health care spending represents 17.5% of our gross domestic product in 2014 and is expected to reach 20.1% by 2025. Medicare alone accounted for 14% of the federal budget in 2014 and this share is only expected to continue to grow as the baby boom generation continues to retire (APAH, 2018). Analysis: The reason for the creation and enactment of the Affordable Care Act was the state’s progressive vision of universal coverage alongside the conservative idea of market competition that everyone should have access to quality, affordable health care, and that no one should ever go broke simply because they got sick (Simas, 2013). As with any new health care reform it will not be perfect and there is pros and cons. To have a better understanding of the Affordable Act, it is best to understand the pros and cons in order to gain a full perspective surrounding debate regarding this reform. First, we will look at the pros of the ACA. The biggest benefit of the ACA is that it slowed the rise of health care costs, by providing insurance for millions and making preventive care free (Amadeo, 2018). Insurance companies can no longer deny anyone coverage for pre-existing conditions. Children can stay on their parents’ health insurance plans up to age 26 which has helped more than 3 million uninsured young adults (Amadeo, 2018). Lastly it will lower the budget deficit by $143 billion by 2022, by reducing the government’s health care costs, raising taxes on some businesses and higher income families and shifts cost burdens to health care providers and pharmaceutical companies (Amadeo, 2018). On the other hand, this healthcare reform has it’s share of cons that need to be closely looked at and understood. Three to five million people lost their employment-based health insurance because many businesses found it to be more cost-effective to pay the penalty and let their employees purchase insurance plans. It has already increased the overall healthcare costs in the short term because many people received preventive care and testing for the first time (Amadeo, 2018). For those individuals who choose not to purchase insurance, the ACA gave those a penalty tax. Lastly, in 2013 the ACA raised the income tax rate for 1 million individuals with incomes above $200,000 and raised taxes for 4 million couples filling joint returns on incomes exceeding $250,000 (Amadeo, 2018). Synthesis:The debate over the Affordable Care Act is regarding accessibility more then insurance coverage. The purpose of the healthcare reform was to create a law in which individuals had better access to more quality and affordable health care insurance. There’s no doubt that opposing against this reform this exists to this day, whose focus is on minimizing taxes, and keeping federal subsides for health care to a minimum. If the ACA would be repealed we need to keep in mind that 82% of those losing insurance would be in working families, 80% of adults losing insurance would lack a college degree, and 56% would be non-Hispanic white, while 38% would be between ages of 18 and 34 (web). One solution to assist in lowering health care costs and federal subsidies would be to increase the penalty tax for those choosing to opt out of the plan based on how much their premium would be if covered under the ACA. Evaluation: One of the cons of the ACA is that 3-5 million people lost their employment-based health insurance because companies’ fount it to be more cost-effective to pay the penalty. Four million people who choose to pay the tax rather than pay for coverage paid $54 billion, all that could have been saved in the long run if those individuals would have gotten insurance and used the benefits of have preventive measure covered instead of waiting until medical conditions get worse. Making the penalties close or equal to what the individual would be paying monthly on the premium will assist with reducing the number of healthy individuals who do not sign up and rather pay the penalty. Shortening the enrollment period and making it mandatory that individuals stay with the healthcare benefits for a year will also tighten the risk poll and help insurer have a better understanding and be able to predict cost of coverage for the following year. Since currently consumers with the ACA have the freedom to opt in and out as they choose, tightening regulations will likely cause a decrease in those individuals enrolling or paying the penalty tax. Unfortunately paying the penalty has ways to get around it through exemptions which could also be an alternative way to tighten regulations in order to have a better control on costs.
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