Ten years have gone by since the Affordable Care Act became law. It partially opened the doors to the uninsured or underinsured. Admittedly the first years were difficult, one due to it''s newness, and the technical hurdles for online enrollment. Enrollment (brick and mortar) or online sites were available as well. There was confusion. even at the grassroots level in clinics and hospitals.
A look back ten years we see a 'plugin" or one site enrollment and subsidies added for low-income patients.
When the Affordable Care Act (ACA) became law in 2010, public opinion of it was narrowly divided and deeply partisan. Our review of 102 nationally representative public opinion polls in the period 2010–19 reveals that opinion remains divided and has shifted in a sustained way at only two points in time: in a negative direction following technical problems in the first enrollment period, and in a positive direction after President Donald Trump’s election and subsequent Republican repeal efforts.
In late 2019 the ACA was more popular than ever, yet partisan divisions have gotten larger rather than smaller. Many core elements of the law remain popular across partisan groups, even as fewer people recognize the ACA as the source of some of these provisions. While Republicans may never embrace the law that is seen as President Barack Obama’s legacy, the public’s reluctance to see certain benefits taken away will continue to be a roadblock for people who would seek to repeal or dismantle it.
The Affordable Care Act increased insurance coverage and access to care, according to numerous national studies. However, the administration of President Donald Trump implemented several policies that may have affected the act’s effectiveness. It is unknown what effect these changes had on access to care. Survey data for 2011–17 from the Behavioral Risk Factor Surveillance System to assess changes access to care among nonelderly adults from before to after the change in administration in 2017. We found that the proportion of adults who were uninsured or avoided care because of cost increased by 1.2 percentage points and 1.0 percentage points, respectively, during 2017. These changes were greater among respondents who had household incomes below 138 percent of the federal poverty level, resided in states that did not expand eligibility for Medicaid or both. At the population level, our findings imply that approximately two million additional US adults experienced these outcomes at the end of 2017, compared to the end of 2016.
Reimbursement models also affect the provider's ability to conform with the ACA. The Centers for Medicare and Medicaid Services continues to propose and implement alternative payment models (APMs) to shift Medicare payment away from fee-for-service and toward approaches that emphasize health care value. As APMs expand in scope, one critical question is whether they should engage providers on a voluntary or a mandatory basis. Clinicians and policymakers may view the benefits and drawbacks of these two modes of participation differently. In this analysis, we compare the benefits and drawbacks of mandatory and voluntary participation, based on clinical versus policy perspectives, and we argue that both modes are necessary for APMs to achieve the goal of improving value. Policymakers should match the mode of participation and related financial incentives to each clinical scenario in which an APM is implemented. We propose ways to coordinate mandatory and voluntary APMs based on clinical scenarios.
The ACA is not socialized medicine or universal payor or Medicare for all. It has stimulated some reorganization of state Medicaid plans. States that did not want to mandate a federal program elected to do their own thing. Those. states rejected federal funds wishing to be free to form their own system. In many of those states, many uninsured remain so.
Other factors affecting the Social Determinants of Health.
Renovating Subsidized Housing: The Impact On Tenants’ Health
Health Care Spending And Use Among People Experiencing Unstable Housing In The Era Of Accountable Care Organizations
Higher US Rural Mortality Rates Linked To Socioeconomic Status, Physician Shortages, And Lack Of Health Insurance Overall, higher rural mortality at the state level can be mainly explained by three factors:
Foundation Funding To Improve Rural Health Care. Rural health care has passed the point of crisis, entering into a moribund state. Numerous funding opportunities are available at HRSA, In response to continuing workforce challenges in rural areas, HRSA has awarded about $20 million to organizations in twenty-one states “to develop new rural residency programs while achieving accreditation through the Accreditation Council for Graduate Medical Education,” according to a July 2019 press release. “Training residents in rural areas is one strategy shown to successfully encourage graduates to practice” there, Tom Morris of HRSA’s Federal Office of Rural Health Policy explained in the release.
Interested parties should research grant funding for rural health projects. Some of these can be found at:
State Programs
State Support to Rural Hospitals
The Past, Present, And Possible Future Of Public Opinion On The ACA | Health Affairs:
