By skyforbes 
In several of the ten titles, the Affordable Care Act tackles innovating public health by enhancing government-provided health insurance. Medicare and Medicaid are both government-sponsored programs designed to cover healthcare costs for the elderly and poor. The Centers for Medicare and Medicaid Services (CMS) is a federal agency within the Department of Health and Human Services (HHS) that administers Medicare and works with states to provide Medicaid. The ACA’s plan is to provide more affordable and accessible care by strengthening these public health services of both Medicaid and Medicare.
Before Obama signed the ACA, the United States was the only industrialized nation without universal access to health services (Marshall, 2015). Providing universal access enhances population health by providing services to the public that are both accessible and effective. As of January 1, 2014, Obamacare expanded Medicaid eligibility to more low-income adults. Historically, to be eligible for this coverage you had to meet certain criteria of income, age, disability or parenthood. As of January 1, 2014, the Act encompasses “most people whose incomes are under 133 percent of the federal poverty level” (Somers, 2010). AFA changed the guidelines to determine Medicaid eligibility by using a modified adjust gross income to determine individual and family income.
While the CMS can establish guidelines, it is up to the state to expand Medicaid. CMS Representatives work with the states to adapt the policy changes and implement the new guidelines. There are several advantages the CMS Representative would explain to persuade the state. First, the federal government will fund the majority of Medicaid expansion costs. The total estimated expansion costs from 2013–2022 will be $952 billion for the federal government and only $76 billion for the state. “The federal government reimburses participating states for at least half of their Medicaid costs” (Somers, 2010). Secondly, out of this investment, Medicaid is predicted to cover 21.3 million new enrollees by 2022 (Stephens, 2013). Lastly, according to the American Medical Association, “states are likely to see savings or offsets to costs such as reduced uncompensated care and increased economic activity.” State expansion can be looked at as both an economic and public health investment.
The innovations in Medicaid eligibility are achieving a healthier population. Clients that were typically covered under Medicaid may view these changes as negative since the package entails a more limited range of services. The coverage will most likely be provided as a “benchmark” or “benchmark-equivalent” coverage that will provide at least the essential health benefits. I would detail that these benefits still cover a substantial amount of services including: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health, prescription drugs, rehab services, preventive and wellness services, chronic disease management, and pediatric services (Somers, 2010). Under this standard, a greater population can receive both curative and preventive care — improving patient outcomes by encompassing education and preventive services.
The Act is also transforming home and community-based services under the Medicaid program. HHS created and expanded these services to be covered in the Medicaid state-plan benefit. CMS and other agencies developed guidelines for procedures, standards and uniformity of care for both home and community-based services. PPACA focuses on providing care for the aging population away from unnecessary hospitalization and in more cost effective home and community-based services. By striving to provide services in non-institutional care, patients save money on health costs while still receiving services that are efficient and effective.
The Act targets and improves Medicaid in other ways besides income eligibility and community-based services. The provisions have expanded coverage for former foster care children up until the age of 26. It has given hospitals the authority to make presumptive eligibility determinations for Medicaid-eligible personnel. The Act has created a state-option to provide “health homes” for eligible patients with chronic illnesses to receive more accessible, coordinated care (Somers, 2010).
Through the changes established in the PPACA, public health is being reshaped through Medicaid and Medicare to provide health insurance to a greater population. Patients can receive more targeted care through the development of innovated home and community-based services. Since 2013, 9.7 million Americans have been added to Medicaid’s benchmark coverage and coverage will continue to rise. It is clear that we are beginning the journey towards universal health insurance by the federal government’s initiatives to cover more individuals under the poverty line and shape health care to become more accessible and affordable for all populations.
References:
Marshall, Brenda (2015). The intersection of public health and the Affordable Care Act: the changing role in public health. Journal of public health management and practice, 21(1).
Somers, S. and Perkins, J (2010). The Affordable Care Act: A Giant Step Toward Insurance Coverage for All Americans. Clearinghouse Review: Journal of Poverty Law and Policy, 1–18.
Stephens, Jessica (2013). Medicaid Expansion Under the Affordable Care Act. The Journal of the American Medical Association, 309(12).