- Choose a major reform under the Affordable Care Act that you wish to explore in greater depth from one of the following classes: Classes 12 – 17, 19. The reform should be of sufficient scope to allow you to answer the questions posed below in #3.
Major reform under the ACA ACA Medicaid Expansion
- Write a paper that addresses Question A and the appropriate questions under B:
A. What was the aim of the ACA reform and what has been its effect(s) to date? Describe the reform and the aspect of the health care system it was intended to change (e.g., insurance market, payment methods, delivery system, long-term care, etc.). What (if anything) has it accomplished? Which stakeholder groups have benefited? Have any been harmed?
Insurance reform Medicaid Expansion under the ACA
• When signed into law in 2010, the ACA required each state to expand Medicaid eligibility to 138 percent of the FPL
• To finance coverage for the newly eligible, states were to receive 100% federal funding for 2014 through 2016, 95% for 2017 through 2019, and 90% for 2020 and beyond
• According to the CBO, the original Medicaid expansion provision was expected to account for roughly half of all new coverage of uninsured citizens
B. Note whether the reform: (a) remains in effect; (b) has been repealed; or (c) has been modified by the Trump administration.
1) If still in effect: How does it currently operate, and what challenges or threats, if any, is it likely to face in the future? How could it be improved or strengthened?
The reform remains in effect today however; it was slightly modified after the NFIB v. Sebelius Trial
National Federation of Independent Business v. Kathleen Sebilius (Secretary of Health & Human Services)
• 26 states, 2 individuals, and an independent organization called NFIB
• Brought this case only two months after the ACA was enacted into law
• Challenging the constitutionality of Medicaid Expansion
Medicaid Expansion required states to expand their Medicaid program to cover those with incomes up to 133% of the federal poverty level, which the federal government would provide funds for, and gave HHS the power to revoke this and all Medicaid funding if states chose not to do so
• QUESTION: Court must address whether the federal government/HHS has the power to revoke funding from the Medicaid program if states refuse to expand, since Medicaid was an established contract and the expansion was not a part of this original agreement
• States argue that this was not part of the original Medicaid agreement, and that it was unconstitutionally coercive to revoke funding if states choose not to expand
• Sebelius argues that expanding Medicaid coverage is crucial to containing costs that arise when the low-income uninsured require medical attention that they are unable to pay for
DECISION: Supreme Court rules that this new condition for Medicaid funding goes beyond the original Medicaid program, and therefore is not a valid exercise of Congress’s spending power
• Finds that it would be ‘unduly coercive’ to either accept expansion or risk losing all Medicaid funding, but allowed the government to refuse to give federal funding for the expansion if states did not want to expand their Medicaid programs
Discuss changes in law, policy and/or management strategy that you would recommend to improve the current situation. Justify your recommendations by explaining why you think they are worthy of consideration.
Data asymmetry is additionally a basic part of this market and of its disappointment. Particularly for the individuals who are first in their family to go to school, or who generally have no close to home involvement with advanced education and its promoting methods, the interests of savage revenue driven schools are practically overwhelming. These high-weight schools use deals procedures to get understudies to consent to visit, helping them apply for credits yet neglecting to give them sufficient data about the dangers required (to avoid mentioning the low estimation of a revenue driven degree). The general population selling the credit items have data that the buyers don't. In some bigger hypothetical or emblematic sense, the very data asymmetry is something that individuals need to defeat through their quest for a higher education. Notwithstanding, the understudy advance emergency is generally viewed as more profoundly thought among those going to two-year schools. Financial specialists have noticed that there is a genuine potential for a monetary emergency to happen if many default on understudy credits, however the absence of collateralization, as was pervasive in the lodging bubble, may contain the harm – yet may likewise in any case cause extreme decreases in white collar class obtaining power (Looney and Yannelis, 2015). The creators of one examination expressed, "… it is fascinating to think about the default out-happens to borrowers who took out subprime contracts contrasted and the individuals who took out understudy credits to go to revenue driven schools. The two kinds of borrowers will in general have more unfortunate quality credit records, and the profits to their ventures were reliant on macroeconomic factors outside their ability to control—house costs on account of subprime home loans and compensation development on account of understudy advances" (Looney and Yannelis, 2015, p. 81). This section alludes to the interconnected idea of home loans and understudy advances, including the manners in which that understudy advance borrowers are burdened by the circumstance and by the enlightening asymmetry. The reimbursement frameworks for understudy advances, in the mean time, additionally speak to advertise disappointments in a solid manner. A 2008 paper investigated the manners by which different proposed credit pardoning programs adequately comprised an optional expense (Dynarski, 2008, pp. 19– 20). The creator inferred that despite the fact that school costs rise and understudy credit borrowers stay owing debtors for an extremely substantial measure of time, the degree itself is as yet beneficial. Be that as it may, "… there is a crisscross in the planning of the entry of the advantages of school and its expenses, with installments due when profit are least and generally factor. Incidentally, this befuddle is the very inspiration for giving understudy advances in any case">GET ANSWER