Affordable Care Act and Medicaid Funding Criteria: Issues and Options

This report provides an executive summary and in-depth discussion of the Affordable Care Act (ACA) and Medicaid funding criteria. It explores the law's objectives, major issues such as rising premiums, lack of insurance options, and state burdens, and the reasons behind the need for change. The report examines potential options for reform, including illegalizing certain health insurance plans and redesigning care activities, while also considering the advantages and disadvantages of these reforms. The report concludes with a discussion of the best option for moving forward and offers a comprehensive analysis of the ACA and Medicaid's impact on healthcare access and affordability, supported by references to relevant sources.

Running head: AFFORDABLE CARE ACT AND MEDICAID FUNDING CRITERIA
AFFORDABLE CARE ACT AND MEDICAID FUNDING CRITERIA
Name of the Student
Name of the University
Author Note

1AFFORDABLE CARE ACT AND MEDICAID FUNDING CRITERIA
Executive Summary
Affordable Care Act refers to a reform law regarding the health care that was enacted
in March in the year 2010. The law is also referred to as ACA, Obamacare or PPACA. The
law has three main objectives. The law serves to provide health insurance service to more
clients at the rates that they may afford. The report discusses the issue of the Affordable Care
Act and the Medicaid funding criteria. The report attempts to look into the major issues of the
ACA and the options that can be considered in order to reform the law and make it more
affordable to the citizens.

2AFFORDABLE CARE ACT AND MEDICAID FUNDING CRITERIA
Table of Contents
Introduction....................................................................................................................4
Discussion......................................................................................................................4
Major issues...............................................................................................................4
Reasons behind the initiation of changes...................................................................5
Considerable options..................................................................................................5
Advantages and disadvantages of the reforms...........................................................6
Best option.................................................................................................................6
Conclusion......................................................................................................................7
References......................................................................................................................8

3AFFORDABLE CARE ACT AND MEDICAID FUNDING CRITERIA
Introduction
Affordable Care Act refers to a reform law regarding the health care that was enacted
in March in the year 2010. The law is also referred to as ACA, Obamacare or PPACA. The
law has three main objectives. The law serves to provide health insurance service to more
clients at the rates that they may afford. The law aims to expand the Medicaid program so as
to include all the adults whose income is below 138% of the poverty levels of the federation
(HealthCare.gov). The act also aims to support the delivery methods of the medical care that
prove to be innovative in their ways.
Discussion
Major issues
The Affordable Care Act or the Obamacare faces a number of issues. The premiums
that were decided for the Obamacare Act kept increasing with the number of passing days.
The number of people who would not be able to qualify for the subsidies that are allowed and
thus will be economically pinched by the rising premiums. The premiums have increased at a
high rate of 33% in Georgia and 33% in Minnesota. The deductibles of the Affordable Care
Act have also increased by 17% for all the silver plans under the act and by 6% for the bronze
plans that have been included in the act (Medicaid.gov). There is a lack of insurance options
under the Affordable Care Act. There exists only one insurer for seven states. The major
insurers have been leaving the exchanges due to the unsustainabilities. The co-operatives that
had been created under the Affordable Care Act have been observed to be failing because the
insurers that had the client base of healthier customers to redistribute the wealth towards
those that have sicker clients. The Medicaid expansion under the Affordable Care Act or the
Obamacare has proved to be a burden for the states because the federal government has
declined to make payments towards the Medicaid bills of the states (Allard and Smith, 1145).

4AFFORDABLE CARE ACT AND MEDICAID FUNDING CRITERIA
Reasons behind the initiation of changes
The reasons behind the initiation of the changes in the Affordable Care Act mainly
relate to the issues that the act has been facing since its activation. The present system of the
fee-for-service conditions focus on rewarding the incorrect behavior. The system generally
stresses more on the treatment of the sick people and does not reward the providers who help
the people to maintain good health and remain out of the hospital. The reduction in this issue
may lead to the larger overall reductions in the costs that is incurred in the caring for the
populations. The health insurance plans that exist under the act do not cover the preventive
cares and the necessary checkups without the copayments that need to be provided
(Blumenthal, Abrams and Nuzum, 2454). This is another reason behind the initiation of the
changes in the Affordable Care Act. The Act must allow the state and the federal exchanges
to offer a number of choices in the field of health insurances. These choices should be
inclusive of the plans that are meant for the clients who would want to insure only for the
major medical events that may follow during the course of the lifetime of the concerned
client. The tax penalties that have been allocated for the ones who do not sign up for the
insurance facilities are very low.
Considerable options
The options that may be considered in order to bring about changes in the policy may
include the illegalization of all the health insurance plans that may be termed as
“grandmothered”. These plans refer to the ones that were bought after the Affordable Care
Act received the status of a law in March 2010 (Beronio et al, 75). These plans have already
become illegal in many of the states in the month of January 2014 while in the others the
deadline for the phasing out had been extended until the end of 2017. The existing health
insurance plans should cover the checkups and the preventive care methods without the co-
payments directed towards the issue. The coverage gap of the part D of the Medicare must be

5AFFORDABLE CARE ACT AND MEDICAID FUNDING CRITERIA
phased out in order to bring about the changes in the policy. The other option that may be
required to bring about a change in the policy may refer to redesigning the care activities
around the concerned patient and not around the hospital or the doctor. The health care
reforms may get better if the rewards are awarded for the better outcomes of health in terms
of financial incentives. In order to bring about the changes in the policy, the clients should be
allowed access to all the information so that they can make better choices (Blumenthal and
Collins, 278).
Advantages and disadvantages of the reforms
The suggested reforms may face a number of advantages and disadvantages regarding
the changes in the policy. The illegalization of the “grandmothered” plans may pose to be a
problem for the clients who have purchased the plans already. They have to switch over to
the other plans that have been active. This may prove to be a cumbersome process for many
of the clients. The increase in the premiums may be interpreted as non-addressal to the root
cause of unaffordability of the health care facilities. The maximum share of the health care
cost is incurred in the delivery of that care. Reports suggest that part of the activities that are
related to the delivery of care are considered to be waste (Sommers et al, 168). The reforms
may prove to be advantageous as well. The reforms may help the citizens to have access to
the medical and the wellness services. The citizens may be benefitted from the expansions of
the benefits to the health care that have been offered to them by the government. These
benefits may include the services of the doctors, hospital treatments for both the outpatient
category and the inpatient category, coverage for the prescription drugs, prenatal and post-
natal cares, services related to the mental health and other such services (Frakt and Carroll,
168).

6AFFORDABLE CARE ACT AND MEDICAID FUNDING CRITERIA
Best option
The increment in the services that are related to the beneficial activities of the
Affordable Care Act may help in the moving forward of the nation as a whole as well as the
citizens of the nation. The cost of the premium towards the policies under the Affordable
Care Act or the Obamacare should be lowered in order to the increase the affordability of the
policies among the members of the society. The cutting down of the federal funding may lead
to the reduction of the ability of the New York government to provide for the critical services
as well as affect the access to the treatment at times when the opioid epidemic reaches a
critical level (Amsterdamnews.com).
Conclusion
In conclusion, to the above discussion, it may be said that the policy regarding the
Affordable Care Act, which may also be referred to as the Obamacare, may be improved and
reformed to meet the requirements of the citizens of the country. The affordability of the
policies must be looked into so that the citizens may have access to the benefits that are
provided by the federal government.

7AFFORDABLE CARE ACT AND MEDICAID FUNDING CRITERIA
References
Allard, Scott W., and Steven Rathgeb Smith. "Unforeseen consequences: Medicaid and the
funding of nonprofit service organizations." Journal of health politics, policy and law 39.6
(2014): 1135-1172.
Amsterdamnews.com. "Cuomo Denounces Senate Health Care Bill Cuts To Medicaid
Funding Used To Combat Opioid Epidemic." Amsterdamnews.com. N.p., 2017. Web. 21
Nov. 2017.
Beronio, Kirsten, et al. "Affordable Care Act will expand mental health and substance use
disorder benefits and parity protections for 62 million Americans." Mental Health 2 (2014).
Blumenthal, David, and Sara R. Collins. "Health care coverage under the Affordable Care
Act—a progress report." (2014): 275-281.
Blumenthal, David, Melinda Abrams, and Rachel Nuzum. "The affordable care act at 5
years." (2015): 2451-2458.
Frakt, Austin B., and Aaron E. Carroll. "Sound policy trumps politics: states should expand
Medicaid." Journal of health politics, policy and law 38.1 (2013): 165-178.
HealthCare.gov. "Affordable Care Act (ACA) - Healthcare.Gov Glossary." HealthCare.gov.
N.p., 2017. Web. 20 Nov. 2017.
Medicaid.gov. "Affordable Care Act | Medicaid.Gov." Medicaid.gov. N.p., 2017. Web. 20
Nov. 2017.
Sommers, Benjamin D., et al. "The Affordable Care Act has led to significant gains in health
insurance and access to care for young adults." Health affairs 32.1 (2012): 165-174.