PAD 632 (7-1)

PAD 632 (7-1) Student’s Name Institution Affiliation Course Name & Code Instructor’s Name Date PAD 632 (7-1) The Affordable Care Act (ACA) represents a landmark United States federal statute. The policy epitomizes the US healthcare system's critical regulatory reform and expansion of coverage since the introduction of Medicaid and Medicare in 1965. The ACA enactment represents a law projected to expand access to healthcare and improve access by expanding public and private health insurance coverage. It also aimed at enhancing quality by merging physician and hospital payments to the healthcare quality they offer. The policy was created to minimize costs. This was evident since it invested in new patient care models such as bundled payment. This paper reflects on the ACA's accountability mechanisms, including how efficiently and effectively it was monitored, its funding approaches, and plans to guarantee accountability. The paper also examines the policy's recommendation to realize politically and feasible acceptable process improvements, such as diverse funding mechanisms for process improvements and strategies to evaluate the recommendation's effectiveness. Program Accountability Monitoring Federal and state agencies have played a substantial role in monitoring the effectiveness of the ACA. These agencies monitored the program's effectiveness through implementing different auditing, compliance, and accounting approaches. The Centers for Medicare and Medicaid Services (CMS), and the Department of Health and Human Services (HHS) were among the organizations that facilitated the monitoring process. Through its Centers for Consumer Information and Insurance Oversight (CCIIO), CMS assisted in implementing ACA laws and provisions associated with private health insurance and offered educational resources to the general public. On the other hand, CCIIO would oversee the incorporation of the provisions that had a relationship with private health insurance, mostly when it collaborated with states. This collaboration helped to set up new health insurance marketplaces. During this period CCIIO collaborated with state consumers, regulators, and other stakeholders to help ACA to serve Americans' interests in the best way possible. Different monitoring approaches implemented to ACA effectiveness included regular audits of insurance companies, healthcare providers, and state exchanges to ensure adherence to the policy's mandates. Government Accountability Office (GAO) and Office of Inspector General (OIG) carry out independent investigations and audits to measure the efficiency and effectiveness of ACA policies. OIG aims to foster the ACA program's effectiveness, economy, and efficiency across HHS (OIG, n.d). Notably, the agency conducts health insurance marketplace reviews alongside other associated programs, and Medicare and Medicaid reforms reviews (OIG, n.d). Undertaking performance audits was necessary to boost the program’s operations, contribute to public accountability, and accelerate decision-making by those responsible for managing corrective action. Furthermore, in discussion with the HHS Office of Inspector General (OIG), ACA required the secretary of HHS to launch main elements for healthcare providers and supplier compliance programs within a specific sector. A well-collected compliance program in the ACA would skyrocket the possibility of submission and payment of claims, enhance the results of reviews performed on Medicare claims, and decrease billing errors. To evaluate its success, ACA also employs performance metrics, including decreased uninsured and underinsured people and improved health outcomes. Funding The ACA initiative receives funds from government (federal, state, and local) contributions. Federal government contributions include the Medicaid expansion, which contributes net savings for numerous states. The net savings have been possible since the federal government contributes a large percentage of expansion coverage while expansion yields net savings. Most of the revenue that it raises in most states is from taxes that the state has been levying on private health providers and plans. The federal government has used this program to cater for the whole cost of expansion coverage from 2014 to 2016 (Harker & Sharer, 2024). However, the federal government's share was reduced in 2020, requiring the states to cover a portion of the share. Conversely, ACA receives funding from premium tax credits paid by low-income folks. The program established a federal tax credit that assists individuals afford health coverage in ACA marketplaces. These credits are accessible to people and families whose incomes are at or above the federal poverty level (FPL) who buy insurance in the ACA marketplace in their home states. Individuals can choose to have payments of the credits redirected to insurers to pay part of their coverage premiums or pause until they file taxes. State governments provide funding by matching federal funds for Medicaid expansion, whereas local governments support various initiatives aligned with ACA goals. Nonetheless, uncertainties involving the sustainability of funding the program ...