Patient Protection and Affordable Care Act (ACA) is a federal law signed by then-President Obama in 2010 addressing the growing number of uninsured US residents. Gaffney and Waitzkin (2016) report that more than 41 million Americans under 65-year-old had no health insurance.
The majority of them received low or moderate income as blue-collar workers and predominantly represented racial minorities. It was caused by a declining number of insurance provided by employers since the beginning of the twentieth century and was compounded by the economic crisis in 2008. Sharma et al. (2017) reveal that the total number of uninsured Illinoisans reached 1.6 million in 2013, a year before the ACA reform implementation. It put additional financial burdens on uninsured people and expanded the state’s inequality in access to care.
Purpose of the Reform
Thus, Illinois healthcare reform in 2014 focused on providing more people with affordable health care insurance to meet the related federal requirement for mandatory health coverage. Under the ACA, there are two options to consider: Federal Health Insurance Marketplace or Medicaid program of the state. States expanded Medicaid health coverage to adults with incomes up to 138% of the federal poverty level (IPHA, n.d.). Other residents who live in the US are eligible to enroll in health care insurance through the Health Insurance Marketplace. The primary purpose of the reform was to improve health care quality by expanding health coverage options.
Overview of the Reform
The Medicaid State Plan of Illinois consisted of three main initiatives: Mobile Crisis Response, Integrated Assessment and Treatment Planning (AITP), and Integrated Health Homes (IHH). The IHH was mainly focused on coordinating social, behavioral, and physical care (individualized care planning) to the holders of Medicaid coverage with complex needs. It did not require providers to offer all possible services and treatment to Medicaid members (Dresden et al., 2017).
The beneficiaries had a right to change their providers or stop their membership whenever they want. The Mobile Crisis Response initiative established a team that offers a same-day intervention to individuals with mental health problems in times of crisis, connecting the patient with care resources. The AITP was a service that encourages providers to assess, carefully document, and update the needs and strengths of their patients at least every 180 days. If medical facilities expect reimbursement, they should use IM-CANS approved by HFS. The special training office was designed to support this new Medicaid service application by providing training to supervisors and front-line practitioners.
In general, Illinois put more effort into Medicaid implementation rather than incorporating Obamacare to improve health coverage compared to other states. It seems that the state was guided by a technical approach and local political agendas less influenced initiatives. Enhanced coordination of the provision of the services and immediate responses became reforms’ centerpiece (Dresden et al., 2017). The Integrated Health Homes established a system that controls and evaluates providers’ results to decide their benefits. Illinois also focused on control over providers and a home-based approach.
Benefits to the Community
Everyone needs access to affordable and high-quality health care to maintain a safe and happy life. The main benefits from the reform are more possibilities and mechanisms to acquire health coverage, cheaper prescription drugs, increased screenings, and affordable health insurance. Thus, in times of health crisis, more insured individuals will avoid financial ruin related to the high costs of the treatment.
The ACA implementation in Illinois immediately ushered in health, economic, and social achievements due to its comprehensive scope. According to Sharma et al. (2017), the number of uninsured citizens in Illinois declined to 900,000 in 2015. The share of uninsured adults aged 18-64 dropped to 10.6% in 2015 (Sharma et al., 2017). It means that more than half a million people that were living in danger before, ultimately gained proper access to health care.
The ACA mitigated health care inequality and discrimination by eliminating the possibility of denying coverage for 6 million Illinoisans with pre-existing conditions. In addition, Medicaid expansion resulted in health coverage for 650,000 low-income residents, while up to 400,000 were insured through the Marketplace, receiving more than $700 million in premium tax credits (IPHA, n.d.). The higher premiums for women were also abandoned all over the involved states. Insurance expansion usually positively affects the availability and quality of care in the community.
Newly insured individuals tend to rely on emergency care due to reduced cost barriers to care. Although uninsured residents accounted for 42% fewer visits than before, the overall emergency department (ED) visits significantly increased (Sharma et al., 2017). The study also points to recent legal and undocumented immigrants’ issues ineligible to receive coverage under ACA expansion. Approximately 460,000 immigrants primarily of Mexican origin lacked documents and health insurance in 2014 (Sharma et al., 2017). Despite ACA’s significant achievements to date, there is strong political opposition to the law suggesting to repeal it.
This law was signed by the Democratic president and passed by a Democratic Congress; thus, the Republican Party, candidates, congress members, and governors naturally became its primary opponents. Most of them attack the Marketplace, mandatory health insurance for adults, higher premiums, and oppose the current government role in health care. According to Gordon et al. (2017), 60% of Americans continued to be against the reform in 2015.
Among the possible reasons are its negative image fostered by Republican candidates on mass media and overall lack of trust in the federal government. What is more, the Trump administration unsuccessfully tried to overturn the reform in 2020 when 55% of people were against repeal, especially against the repeal of ACA’s pre-existing condition protections (Hamel et al., 2020). Nevertheless, the fine for violating individual mandate was voided in 2017 thanks to the efforts of Republicans. Contrary, Democrats continue to back the law and insist on its positive achievements.
Implications of the Reform
The ACA mostly brought positive changes to our hospital since it helped reduce costs and increase the budget. More people became insured what resulted in lower care costs due to improved compensation. Medicaid expansion provided the hospital with additional reimbursement making the latter able to treat those who do not have money to pay for the care. Nevertheless, it significantly increased ED pressure, while the situation with fees on services based on “medical necessity” remained unchanged. Some implemented programs helped to grow savings thanks to improved coordination of care between hospitals and social services.
It also spurred the consolidation process with medical groups and hospitals to achieve Triple Aim goals (Dresden et al., 2017). In terms of nurses, ACA resulted in higher standards of care and higher demands, especially for nurse practitioners. Some health care facilities suffered a shortage of professional staff, putting additional pressure on existing nurses.
To conclude, Illinois health care reform under ACA proved beneficial both for previously uninsured citizens and the entire medical system. It significantly increased the number of insured Illinoisans, made care more affordable and equal for everyone, and even improved healthcare providers’ financial positions. Despite ten years of improvement, Republicans still attack the initiative and its mechanisms backing its repeal. The reform set higher standards for health care professionals and generally improved the quality of health care in Illinois.
Dresden, S. M., Powell, E. S., Kang, R., McHugh, M., Cooper, A. J., & Feinglass, J. (2017). Increased emergency department use in Illinois after implementation of the Patient Protection and Affordable Care Act. Annals of Emergency Medicine, 69(2), 172-180. Web.
Gaffney, A., & Waitzkin, H. (2016). The Affordable Care Act and the transformation of US health care. Cuadernos De Relaciones Laborales, 34(2), 239-261. Web.
Gordon, P. R., Gray, L., Hollingsworth, A., Shapiro, E. C., & Dalen, J. E. (2017). Opposition to Obamacare: a closer look. Academic Medicine, 92(9), 1241-1247. Web.
Hamel, L., Kirzinger, A., Muñana, C., Lopes, L., Kearney, A., & Brodie, M. (2020). Five charts about public opinion on the Affordable Care Act and the Supreme Court. KFF. Web.
The Illinois Public Health Association (IPHA). (n.d.). Illinois ACA fact sheet. Web.
Sharma, A. I., Dresden, S. M., Powell, E. S., Kang, R., & Feinglass, J. (2017). Emergency department visits and hospitalizations for the uninsured in Illinois before and after Affordable Care Act insurance expansion. Journal of Community Health, 42(3), 591-597. Web.