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The Patient Protection and Affordable Care Act

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The Patient Protection and Affordable Care Act is the present reality of healthcare in American society; but unless this imperfect framework is continually improved, it will crumble under its own unbalanced weight, crushing those lives it means to improve. With recent news of rising premiums, falling enrollments, and absurdly low rates of effective care, actions must be taken now to preempt ACA's impending doom. The Affordable Care Act's Value-Based Purchase (VBP) provisions must be reformed and public health insurance option must be enacted in order for the survival and improved functioning of the ACA.

Value-Based Purchase provision reform

Current projections for the increasing cost of health care are largely the result of a Fee-for-Service (FFS) environment, in which hospitals are compensated for delivered services, regardless of patient outcomes. The ACA aims to move healthcare to a VBP model, offering incentives to hospitals who produce better patient outcomes than the overall FFS population.

The FFS structure must be functionally eliminated through incentivizing a VBP model. The FFS model is unsustainable in the long run, as healthcare costs are outstripping every other measureable factor of economic growth - from GDP to real wages. Improving the VBP model will decrease healthcare spending by disincentivizing care that does not produce statistically significantly better patient outcomes. The ACA will need to track multiple, but uniform, quality measures over all hospitals and above the minimum five medical ailments/procedures found in the law - producing greater depth and accuracy of data that allows hospitals to realize efficiencies in care (and therefore savings). In order to remain solvent, hospitals will have to maximize efficiency, eliminate waste, and streamline operations; becoming at last, businesses that answer to quality and are no longer able to ignore their customers by simply charging more for services as their enrollment drops.

Opponents of such reform include hospitals, doctors, and fiscal conservatives, as the former will incur losses in the short-run as VBP requires them to decrease services delivered to their patients, therefore reducing procedure frequency and revenue. Hospitals must also develop improved process management procedures to realize savings and reduce waste to improve already slim margins. The latter will bemoan further expansion of the already costly ACA and view it as further government regulation of private industry.

Proponents would include patients, slowly at first, as patient volume (spurred by increased quality of care) will grow as hospitals improve quality and reduce costs. Patients will come to differentiate quality hospitals and shift their care to them.

Insurers, Consumer Choice, and Premiums

The status of consumer choice in the context of health insurance in Pennsylvania is deteriorating. At its outset, Pennsylvania's health care exchange offered 3 or more insurance providers in each of the Commonwealth's 67 counties. These numbers have dropped, as only 42% of counties have 3 or more choices of insurers, 51% have 2 choices, and 7% have only one insurer.

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