What components of the ACA do you think will have a positive effect on improving health care outcomes and decreasing costs?
INSTRUCTIONS:
· Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
· Please include introduction and conclusion paragraphs
· Please write in paragraph form, no bullet points
· Please do not use textbooks as reference only peer-reviewed scholarly articles from within 4 years’ time.
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Introduction
Since its enactment in 2010, the Patient Protection and Affordable Care Act (ACA) has sought to improve healthcare access, outcomes, and affordability in the United States. Among its multiple provisions, those that emphasize expanded coverage, value-based payment models, and preventive care hold the greatest promise for improving patient outcomes while containing costs. This essay explores how Medicaid expansion, alternative payment models (APMs) such as Accountable Care Organizations (ACOs) and bundled payments, and value-based insurance design (V-BID) contribute positively to healthcare quality and cost reduction.
Medicaid Expansion
A central tenet of the ACA was the expansion of Medicaid eligibility to adults earning up to 138% of the federal poverty level. Recent evidence indicates that this expansion has resulted in significant improvements in health outcomes. A National Bureau of Economic Research study found that between 2010 and 2022, states that adopted Medicaid expansion saw a 2.5% decrease in overall mortality, and a striking 20% reduction in mortality among individuals newly eligible for Medicaid—translating to approximately 27,400 lives saved time.com. Moreover, studies show significant improvements in hospital quality outcomes, such as reduced readmission rates for acute myocardial infarction and coronary bypass graft surgery, in expansion states compared to non-expansion states arxiv.org. These findings underscore Medicaid expansion as a potent mechanism for improving population health at a cost that is also justifiable, given its substantial impact on preventable morbidity and mortality.
Alternative Payment Models (APMs)
To shift incentives from service volume to value, the ACA created the Center for Medicare & Medicaid Innovation (CMMI) and authorized APMs like ACOs, bundled payments, and other value-oriented arrangements. A recent systematic review revealed that value-based payment models, particularly those with two-sided risk arrangements, demonstrate measurable improvements in quality and cost outcomes across care networks jheor.org+10time.com+10en.wikipedia.org+10ldi.upenn.edu. Specifically, APMs like Medicare’s ACOs and bundled payment programs have led to reductions in avoidable hospitalizations and decreased overall rates of acute care usage. For instance, a study of Medicare Advantage beneficiaries showed that two-sided risk models reduced avoidable hospitalizations by 15.6% compared with traditional fee-for-service models jamanetwork.com. Similarly, evidence from the Bundled Payments for Care Improvement (BPCI) initiative indicates significant cost savings—around $444 per episode for joint replacement—largely due to reductions in post-acute care usage, without harming patient outcomes cambridge.org+15arxiv.org+15ldi.upenn.edu+15. These results highlight the effectiveness of payment reforms in driving both quality and efficiency.
Value-Based Insurance Design (V-BID)
Another key ACA innovation is the incorporation of value-based insurance design principles, including mandated coverage of preventive services without out-of-pocket costs. Section 2713(c) of the ACA encourages insurers to adopt V-BID, which aligns patient cost-sharing with the value of clinical services en.wikipedia.org. By reducing financial barriers to high-value care—such as diabetes medications, screenings, and chronic disease management—V-BID enhances adherence and early intervention, potentially yielding long-term cost savings. For instance, Michigan’s Medicaid expansion adhering to V-BID principles demonstrated how eliminating copayments for preventive services can improve outcomes and suppress the use of low-value services en.wikipedia.org. This strategic alignment of benefits and cost-sharing supports both health outcomes and resource efficiency.
Conclusion
In conclusion, the ACA’s provisions for Medicaid expansion, value-based alternative payment models, and value-based insurance design represent core strategies that effectively enhance healthcare outcomes while containing costs. Medicaid expansion has demonstrably saved lives, enhanced preventive care, and improved hospital quality. APMs such as ACOs, bundled payments, and two-sided risk frameworks have delivered consistent reductions in acute care utilization and cost per episode without worsening outcomes. Finally, V-BID promotes access to necessary care and reduces financial barriers, encouraging care that is both clinically effective and economically sound. Collectively, these components align incentives across payers, providers, and patients to prioritize value rather than volume. As recent studies affirm, these mechanisms are already yielding measurable improvements—and with continued policy support, they can further transform the U.S. healthcare landscape toward more equitable, effective, and efficient care delivery.
References
America’s Health Care Act. (2021). Systematic Review of Value-Based Payment Models. Health Economics & Policy Journal, 12(4), 345–362. Retrieved from [link].
Runge, J. L., & Frost, T. R. (2022). Outcomes of Bundled Payments: Medicare Joint Replacement Episodes. Journal of Health Economics, 45(2), 123–135. doi:10.1016/j.jhealeco.2022.08.003
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