Issues Concerning PPACA and the Health Insurance Policies Discussion Responses

WEEK 5 DISCUSSINO
Gina Lugo posted May 12, 2023 1:19 PM
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Despite the great controversy of a patient being able to keep their
original Doctor due to the PPACA (Patient Protection and Affordable
Care Act). Due to many inconsistencies and interrelated requirements.
Would they be able to continue with the policy if any cancelations of
the policy, and the rationale behind the plan cancelation? Additionally,
identify the effect of expanding state Medicaid roles and the impact it
has on cost and non-reimbursable care.
First, (n.d.) the right to choose any Doctor whether it be in or out of
network is always an option. However, it’s up to the provider in some
cases and at their discretion if they choose to see you. So many rights
today have been taken away that I’m unsure if today the patient has
too many rights left with the ever-changing bills proposed and
potentially passing into law. In my opinion with so many barriers to care
today, I’m not sure if insurance is worth having really.
Second, (BEUTLER, 2013) anyone can cancel their policy at any
time. However, thankfully with the PPACA, the government has
grandfathered in many policies to provide those especially the elderly
with continuity of care which is important to their well-being. Patients
can cancel their plan, not the service that’s ultimately up to the
healthcare facility, and the provider at the time of the visit.
Third, (n.d.-b) the link with identifying the effect of expanding state
Medicaid roles and expansion is interrelated with the increase to access
to care which is a good thing. Also, improvements in healthcare
outcomes and the reduction of the minority population that can’t afford
or does not have access to health coverage insurance. Typically, policy
cancellations have an advisory of thirty days prior. So this gives the
patient time to seek a new Primary care doctor if needed for continuity
of care purposes. I have answered these questions to the best of my
ability.
References
BEUTLER, B. (2013). GOP About to Hurt Itself Again: New Ploy to
Kill Obamacare Will Blow Up. Progressive Populist, 19(22), 8.
Doctor Choice & Emergency Room Access . (n.d.-b).
HealthCare.gov. https://www.healthcare.gov/health-care-lawprotections/doctor-choice-emergency-room-access/
The Affordable Care Act’s New Patient’s Bill of Rights | CMS .
(n.d.). https://www.cms.gov/CCIIO/Resources/Fact-Sheets-andFAQs/aca-new-patients-bill-of-rights
Discussion 5
Rose Cates posted May 14, 2023 5:05 AM
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Patient-Physician Continuity: Analyzing Plan Cancellations and Rationale
According to Brown et al. (2021), the Patient Protection and Affordable Care Act
(PPACA), also known as Obamacare, lacks a direct provision mandating patients to switch
their medical practitioners. Nonetheless, certain insurance schemes may become incompatible
with the edicts of the fresh legislation, inducing insurance firms to terminate or discontinue
such policies. As a result, insurance contracts that fail to adhere to the provisions of the
PPACA may not offer commensurate benefits and coverage as those that comply with the
statute. If a patient’s present healthcare provider is not associated with the novel scheme,
conformance with the PPACA may require them to switch to an alternative plan, which could
force them to change their medical practitioner (Koku, 2020). Ultimately, the decision to
retain their doctor hinges on the availability of insurance schemes featuring the patient’s
preferred medical experts within their network. In other words, patients can only preserve
their current physicians if they select an insurance plan that includes their favored healthcare
professionals within their network. The discontinuation of incompatible insurance plans
represents a concerted attempt to ensure that all Americans have access to high -quality
healthcare policies that meet certain minimum standards (Koku, 2020).
The state Medicaid enrollments expansion can have both positive and negative outcomes.
It may enhance the availability of healthcare services for low-income individuals and families
who otherwise lack the necessary financial means to access such care (Zhang & Zhu, 2021).
This could translate into a decrease in the utilization of costly emergency department visits,
resulting in an overall reduction in healthcare expenses. Conversely, the expansion of
Medicaid may lead to an increase in healthcare costs due to heightened usage of healthcare
amenities by recently registered individuals (Zhang and Zhu, 2021). Additionally, healthcare
providers often receive lower reimbursement rates for treating Medicaid patients in contrast to
those insured by private insurance plans. This may dissuade healthcare providers from
accepting Medicaid patients, ultimately reducing healthcare accessibility. In addition, the
expansion of Medicaid may have implications for non-reimbursable care, as healthcare
providers may feel compelled to prioritize Medicaid patients over those with private insurance
who can provide more substantial reimbursement rates (Zhang & Zhu, 2021). The potential
outcome of this situation could be prolonged waiting periods and a reduced capacity to obtain
non-compensable healthcare services, including discretionary medical procedures or non urgent surgical interventions.
References
Brown, E. A., White, B. M., Jones, W. J., Gebregziabher, M., & Simpson, K. N. (2021).
Measuring the impact of the Affordable Care Act Medicaid expansion on access to
primary care using an interrupted time series approach. Health Research Policy and
Systems, 19(1), 1-10.
Koku, P. S. (2020). Effect of the Patient Protection and Affordable Care Act on for-profit
hospitals in the USA. International Journal of Pharmaceutical and Healthcare
Marketing.
Zhang, P., & Zhu, L. (2021). Does the ACA Medicaid Expansion Affect Hospitals’ Financial
Performance? Public Finance Review, 49(6), 779-814.

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