The Impact of the Affordable Care Act on North Carolina’s Uninsured Population Chitra Sarada
NURS-6050N, Section 14, Policy and Advocacy for Improving Population Health October 10, 2014
The Impact of the Affordable Care Act on North Carolina’s Uninsured Population
The Affordable Care Act (ACA) 2010 is one of the most radical healthcare moves in legislation of United States after Medicare and Medicaid. The main goals of ACA were to decrease the number of uninsured and provide cost-effective high-quality care to all in US. According to Kaiser Family Foundation, the potential plan of ACA was to expand coverage to 47 million nonelderly uninsured in the nation, which included 1.6 million uninsured North Carolinians (2014). The purpose of this paper is to review the effect of ACA on the North Carolina uninsured population, the influence of the economy of care provided care and the ethical implications. Impact of ACA on North Carolina Population
North Carolina has the highest index of the uninsured population approximately 1.6 million. Being uninsured has a profound impact on the health and well-being of the people. The ACA had a significant impact on the different population categories of North Carolina. According to The Affordable Care Act 2014, Medicaid will cover most low-income people if Federal Poverty Level (FPL) is no greater than 138 percent (Milsted, 2013). The people that have more impact are the children six to eighteen, working parents, nonworking parents, and childless adult. Prior to Affordable Care Act, Medicaid was limited to a specific group of low-income individuals, such as children less than six, pregnant women, elderly and disabled. Childless adult who was homeless or unemployed did not qualify for Medicaid. The Medicaid also did not enroll undocumented immigrants and lawful immigrants that resided lesser than five years in United States (Milstead, 2013).
Medicaid expansion became optional with Supreme Court rule 2012, and North Carolina chooses not to expand Medicaid and put their most vulnerable in jeopardy (Kaiser Family Foundation, 2014). Consequently, the newly eligible uninsured adults in North Carolina will remain without coverage. The reason for this was, ACA envisaged that Medicaid would expand and provide coverage for people below 138% FPL and thus did not provide Marketplace subside for these low-income people. Therefore, the people that did not qualify for Medicaid nor subsides fell into a “coverage gap” which was estimated as 318,710 or 28 percentage of all uninsured nonelderly adults (Angster & Colleluori, 2014). This brought up ethical dilemma. The people in the coverage gap are facing barriers to health services and financial consequences. The Safety net of clinics and hospitals that had been traditionally serving these populations are still stretch in the state to provide care for the uninsured. Financial Impact of ACA on North Carolina
The biggest challenge that US health care is facing is the rapid escalation of health care costs. The United States spends more when compared to other developed centuries in the world. The United States spends 17.7 percent of gross domestic product (GDP) in health, and in terms of per- capita cost, US spend $ 8,247 in 2010 (Silberman, 2013). The ACA has put forward many provisions to reduce the health care cost. Some have immediate results, and some may take time to bend the cost curve. The Patient-Centered Medical Home (PCMH) is a model of care that aims to deliver comprehensive care which includes preventive, acute and chronic care to children, adolescents, and adult (Kovner & Knickman, 2011). North Carolina was the first state to get a demonstration grant for the Medicaid and Medicare innovation, and this was used for test PCMH model in seven rural counties. Bundle payments, Accountable Care Organization (ACO), Medicare diagnosis-related group (DRG), and Value-Based Purchasing (VBP)...
References: American College of Physicians (2014). How North Carolinians can access affordable, comprehensive health insurance. Retrieved from http://www.acponline.org/advocacy/state_health_policy/aca_enrollment/states/nc.htm
Angster,D., & Colleluori, S ( 2014, April1). Study: Top NC newspapers Miss Coverage Gap in reporting on Medicaid expansion. Media Matters for America. Retrieved from http://mediamatters.org/research/2014/04/01/study-top-nc-newspapers-misses-coverage-gap-in/198701
Kaiser Family Foundation. (2014, April 7). How will the uninsured fare under the affordable care act. Retrieved from http://kff.org/health-reform/fact-sheet/how-will-the-uninsured-fare-under-the-affordable
Kaiser Family Foundation. (2014, January 6). How will the uninsured in North Carolina fare under the affordable care act. Retrieved from http://kff.org/health-reform/fact-sheet/state-profiles-uninsured-under-aca-north-carolina/-care-act
Kovner, A. R., & Knickman, J. R. (Eds.). (2011). Health care delivery in the United States (Laureate Education, Inc., custom ed.). New York, NY: Springer Publishing.
Milstead, J. A. (2013). Health policy and politics: A nurse 's guide (Laureate Education, Inc., custom ed.). Sudbury, MA: Jones and Bartlett Publishers.
North Carolina Institute of Medicine. (2014). Examining the impact of the patient protection and affordable care act in north Carolina. Retrieved from http://www.nciom.org/wp-content/uploads/2013/01/Medicaid-summary-FINAL.pdf
Silberman, P ( 2013, January 25). The ACA: an essential first step towards improved population health. Retrieved from http://publichealth.nc.gov/shd/presentations/2013/AffordableCareAct-2013SHDConf-Silberman-012513.pdf
Silberman, P. (2013, August 1). Implementing the affordable Care Act in North Carolina: The rubber hits the road. North Carolina Medical Journal. 74(4), 298 -307. Retrieved from http://www.ncmedicaljournal.com/wp-content/uploads/2013/07/74403.pdf
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