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Discussion Paper 1: “Lawmaker Calls for Integrated Health Care Delivery System”

Rod Boshart Lee discusses two different opinions on the implementation of the Affordable Care Act in the state of Iowa from the side of policy implementation. The primary focus is on the implementation of federal exchange program within the ACA. One side is represented by the Democratic Senator Jack Hatch, and the other – by the Governor Branstad. Hatch emphasized the importance of the creation of a special working group consisting of stakeholders, which will include Medicaid providers, hospital administrators, directors of state executive departments, consumer groups, etc. This group has to work on the implementation of the Affordable Care Act in Iowa. Senator has also emphasized the importance of the Governor’s involvement in the process, because his participation is important for the assurance of the equal participation of all members of the process. Governor Barnstad has expressed an opposing opinion. According to his spokesman, it is too early to start implementing the ACA in Iowa. There are still too many unclear moments in the ACA and the federal parameters of the program. Thus, according to the Governor, it is still too early to proceed with the local implementation of the program. So far, the implementation of the federal exchange was very unorganized and bureaucratic. Despite Barnstad’s arguments, Hatch still emphasizes upon the importance of state’s active participation in the exchange process. This article is very compelling as it presents different points of view with solid arguments. Furthermore, it focuses on the political side of the issue, which adds a new perspective to the question of the ACA implementation.

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Discussion Paper 2: “Did the Election Save ObamaCare?”

John Goodman studies six problems that may arise with the future implementation of the ACA. This is a captivating analysis of some issues that may be brought out by the new healthcare system. After Obama has won the elections, it became obvious that his program of healthcare will be implemented in the upcoming years. The author states that ObamaCare has six significant flaws that will lead to negative consequences in a number of spheres. These spheres include healthcare, but are not limited to it. The first flaw is that the new healthcare system is not paid for, which will result in the reduction of healthcare insurance for the elderly. Moreover, in the upcoming years, one of seven Medicare hospitals will close; the doctor payments in Medicare will fall below Medicaid and will keep on falling. Secondly, the new healthcare program guarantees thigs that it, in fact, cannot provide, because more medical care means more doctors and other hospital personnel. Furthermore, the growing role of the preventive care would mean that doctors would have to spend more than 7 hours of their working days treating healthy patients. Thirdly, whole sectors of the economy will be destabilized because of the new healthcare program; this problem will be economy-wide. The next reason is that the new healthcare system will threaten the quality of provided care. The new incentives will encourage medical institutions to over-provide the healthy people and under-provide the sick ones. This means that the actually sick patients will suffer from the implementation of ObamaCare. The fifth flaw is that the health insurance marketplace will be threatened by the ACA. As a result of the new policy, an unhealthy tendency of insurance might develop. People will be getting insurance only in time of sickness and drop coverage after they get healthy. Lastly, almost all of the US families will feel the burden of the new healthcare program on their family budget. According to Goodman, over the past forty years, the healthcare expenses were growing twice as fast as the incomes. This tendency will keep on developing. Therefore, at some point, health insurance costs will be dominating in the expenses of the US citizens. At the same time, Goodman emphasizes that these problems of the healthcare system do not depend on Obama or the Democrats; it is a general flaw of the healthcare legislation.

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Discussion Paper 3: “High-Performance Health Care for Vulnerable Populations: A Policy Framework for Promoting Accountable Care in Medicaid”

The Affordable Care Act is aimed at changing the whole US healthcare system. The authors of the report focus on the ways in which Medicare and Medicaid can be adapted in order to serve as a background for the implementation of the ACA. Medicare and Medicaid are able to create a collaborative common framework for healthcare providers. At first, the authors analyze the current positive changes of the two mentioned medical programs. For example, the primary care programs of Medicaid have improved recently, and at least 17 states have already launched patient-centered medical home initiatives. After the analysis of the existing programs, the authors propose a policy framework for the implementation of an Accountable Care Organization (ACO) framework in Medicaid. The report offers a Medicaid model built on the Medicaid Shared Savings Program (MSSP) model. The authors start from the development of a core strategy and then emphasize on the importance of correspondence of the fee-for-service programs to Medicare and Medicaid. Certification of the ACOs should be well-organized, and tthe ownership and governance should be properly regulated in order to avoid the conflict of standards. The authors also emphasize a number of policy elements that have to be taken into consideration: careful assignment of people to ACOs, the control over beneficiaries exclusivity of care providers; appeal of the program to providers; benchmark calculation; compensation for providers; quality metrics; information exchange; state laws; abuse provisions; antitrust guidance. This report presents a concise comprehensive approach to the further development of Medicaid program as an element of the ACA. Overall, this is a complete thorough analysis of the issue.

Discussion Paper 4: “Improving Care Coordination – Spurring Use of Health Information Technology in Long-Term Care”

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Thorpe and Cascio study the changing role of the Health Information Technology (HIT) in the long-term care. Although the HIT had some success in the healthcare provision, there are no supporting programs for long-term care. At the same time, the authors note the importance of HIT in avoiding duplicative testing and medication errors. Therefore, it is essential to ensure that Health Information Technologies are available for the long-term care. Fortunately, under the ACA, the long-term care providers can get more support from the state in the implementation of HIT programs. The Affordable Care Act has implemented a lot of changes. The role of the Secretary of Health and Human Services gets a number of significant responsibilities under the ACA. The quality of measurement and reporting on the Medicare eligible adults will be improved under the supervision of the Secretary of HHS. Furthermore, the healthcare delivery will be significantly enhanced in a number of ways: a Center for Medicare and Medicaid innovation has to be established; various grants for state and local organizations have to be provided for the creation of community health teams; the introduction of MMSPs and ACOs. Thorpe and Cascio also note a number of financial issues that might arise in the process of the ACA implementation and how the new policies might change the program. All in all, the Affordable Care Act creates a better basis for the implementation of HIT programs for the long-term care providers although, at the same time, there are some complicated moments such as the privacy issues, antitrust laws, and the workforce reluctance. Thorpe and Cascio choose a very interesting and specific topic within the whole system of the US healthcare provision. At the same time, this is definitely the issue that has to be of the primary concern to the society as the implementation of modern technologies is currently on the agenda of many spheres of social and political life. 

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