Application: The Impact of the Affordable Care Act on North Carolina�s Uninsured
Although there is often political pressure to create programs that increase access to
services, these programs often are unfunded mandates. The expansion of insurance
coverage is directly linked to health care costs, and controlling these costs presents a
tremendous challenge. This week’s readings present information on cost evaluation;
potential trade-offs related to cost, quality, and access; and financial and economic
principles that apply to cost evaluation in delivering health care services.
An example of the difficulty of addressing these competing interests can be seen in a
case study concerning “The Impact of the Affordable Care Act on North Carolina’s
Uninsured Population”. This Assignment focuses on ethical, financial, and quality of
care aspects surrounding the issue.
� Read the case study about “The Impact of the Affordable Care Act on North
Carolina’s Uninsured Population” on pages 202-203 in Health policy and politics: A
nurse’s guide (Laureate Education, Inc., custom ed.).
� Reflect on what you have learned from the readings and media segments about
health care financing as you read the case study.
To complete this Assignment, write a 3- to 5-page paper that addresses the following:
� Explain the impact of the Affordable Care act on the population that it affected.
� Explain the impact of the economics of providing care to patients from the
organization’s point of view.
� How will patients be affected in relationship to cost of treatment, quality of
treatment, and access to treatment?
� What are the ethical implications of this act for both the organization and the
This Assignment is due by Day 7 of Week 5.
� Kovner, A. R., & Knickman, J. R. (Eds.). (2011). Health care delivery in the United
States (Laureate Education, Inc., custom ed.). New York, NY: Springer Publishing.
o Chapter 3, “Health Care Financing” (pp. 47-66)
This chapter attempts to unravel several of the complexities in America’s health care
system, and it also provides an analysis of the health care/insurer/patient relationship
and how hospitals are actually funded.
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o Chapter 12, “Health Care Costs and Value” (pp. 257-276)
Rising costs of health care and potential approaches to constraining growth in health
care expenditures are examined in this chapter.
o Chapter 15, “Health Workforce” (pp. 315-329)
This chapter looks at the nature of the supply and demand for health care professionals
in the United States.
� Milstead, J. A. (2013). Health policy and politics: A nurse’s guide (Laureate
Education, Inc., custom ed.). Sudbury, MA: Jones and Bartlett Publishers.
o Chapter 10, “Overview: The Economics and Finance of Health Care” (pp. 191-206)
This chapter breaks down the basic elements of economics as they relate to health care,
explaining how consumer choice combined with limitations on what hospitals can
supply affects the type of care given.
� Reinhardt, U. E. (2010, Jan 20). State of the nation (a special report): Voices-A good
start. The Wall Street Journal, p. R5.
Retrieved from the Walden Library databases.
This article describes how the U.S. health care reform bill seeks to obtain better value
for the U.S. health care dollar by generating more research into cost-effective care.
The impact of the affordable Care Act on North Carolina’s Uninsured Population
Health insurance is an important cover in the world today. Because of the increasing
cost of healthcare, it is important for an individual to purchase a health cover to avoid loses
which might occur in the event of emergency health situations. In America alone, it is
estimated that above 48million people lack medical insurance. Most of these people and their
families feel the pain of paying for healthcare services because of lack of health insurance.
There are also less costly health insurance programs by the state. In North Carolina the high
number of children below age 18 suffer in poverty. However with the population of eight
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above eight million people it offers both public and private health insurance with the plans
that as per the private insurance companies cover students, families, short-term and dental.
The insurance schemes sponsored by the government offer low cost cover to residents who
meet certain requirements relating to income and age. Because of the big number of
uninsured people in North Carolina, the law makers have had a big debate on this issue.
The care act passed into law in 2010 was a combined bill on affordable care and
patient. Of which its implementation effort engaged eight different work groups to analyze
the different dimensions of this act concentrating on the insurance oversight and exchange of
health benefit, quality of health care, health professional work force, fraud and abuse,
prevention and safety. The mandate of these groups was to provide best decisions on the
implementation of health reforms (Silberman, P. (n.d.).
The affordable care act expects some challenges in areas of quality, access and
coverage barriers to healthcare. Cost of insurance and the overall population health have
contributed too as challenges. Lack of health cover has a huge impact on financial and health
status of people; this may delay the rate of response to disease conditions due to poor
financial status thus leading to hospitalization of fairly preventable conditions. The impact of
ACA would encourage more people to obtain health cover by 2014, people with low income
will be covered through Medicaid, while others will be covered through their employer but
the unemployed people would obtain subsidized health coverage under health insurance
According to the affordable care act, the expansion of Medicaid can result into the
change of the eligibility criteria which will allow adults whose income is less than 138% FPL
to qualify for Medicaid unlike restrictions provided for in the former act which states that
The affordable care Act in North Carolina 4
childless people, non-elderly adults and non-disabled people are not eligible to Medicaid and
due to categorical restrictions. Only 30% of adults in North Carolina with low income can be
covered by Medicaid. With the expansion of Medicaid the government will cover 65% health
cost on currently eligible residents while newly eligible residents to enjoy 100% medical
cover from 2014 to 2016 upon which it shall be lowered to 90%. The pharmaceutical
companies shall also be required to pay a rebate to the state and federal governments to cater
for some cost for the drugs (Anderson, (1987).
Since residents who are not insured will enjoy health coverage by Medicaid, the state
shall get revenues from all foreign federal dollars that enter the state. This new act is
expected to improve coverage of clinical services which are preventive in nature. Removal of
the “donut hole” by 2020 and enhanced financial worth of Medicare within the next seven
years shall improve Medicare benefits and provide protection of and access to Medicare
service providers. The employers who have at least 50 employees on full time basis will have
to pay for insurance to their employees or risk a penalty where as employers whose full time
employees are less than 50 will be exempted from penalties and employers with less than 25
employees with an average yearly wages not more than 50000 dollars are eligible for tax
credit (Silberman, P. (n.d.).
The new act also poses a penalty to legal immigrants and citizens who lack qualified
health insurance .These penalties will be 1% taxable income per individual or 95dollas in the
year 2014 and 2.0% or 695 dollars in the year 2015 and finally 2.5% or 695dollars in 2016.
However some group of people especially those who spend above 8% of their earnings for
the premium of least cost will be exempted. The cost of premium paid will also depend on the
size of the family whereby bigger families with three or more members will pay the greater
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The new act will enable residents to obtain standardized information from
Marketplace on issues of cost, quality and the network of providers and to help them decide
on the qualified health plans. It will ease the healthcare service procedures to allow people
enroll in to any of the three schemes (private coverage, Medicaid or CHIP) through the HBE
system. This will eventually simplify the enrolment and application process. This act provide
for a better benefit packages because covers in small group market will need to provide
professional services, hospital services, maternity care ,care on mental disorders, vision
services for children and oral health. Other services to be covered are preventive medical care
as well as immunization program. Denial of insurance cover or charging clients by insurers
due to pre-existing conditions will be a thing of the past and the difference in premiums will
only be based on age, family size, geography and the use of tobacco for the small groups and
individuals. The new act has provisions for expanding community health centers, increase
assistance to school sponsored health centers, motivating health professions who can accept
to work in less served areas by offering loan forgiveness. It will also help in the employment
of new health professionals to improve workforce. The act will provide for investment on
wellness, prevention and public health activities .The most critical areas of public health
concern include disease prevention, health promotion and address lifestyle behavior such as
smoking, behavioral health, proper nutrition, mental health, exercise, domestic violence and
substance abuse(Publications. (n.d.).
It is estimated that most deaths of between 44,000-98,000 are caused by medical
errors which are preventable. The patients under ambulatory treatment receive only about
half of the required amount. The affordable care act provides for the improvement of the
healthcare quality, it directs for the provision of fund s to help develop quality measures and
support research on service delivery as well as healthcare models. Quality will also be
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achieved by forcing hospital to treat infections acquired in the hospital free of charge by
reducing Medicaid funding to hospitals under red missions with the aim of improving quality
The cost of funding healthcare has risen in the US three times above any
industrialized nation. It has led to the rise in the funding of employer premium. Affordable
healthcare act seeks to explore new opportunities on how to improve care delivery and
payment methods both in Medicaid and Medicare with the aim of creating improvement in
quality and preventing expenditures on less important healthcare activities. These strategies if
successful will be rolled to the entire state (Silberman, P. (n.d.).
Quality of healthcare will improve and its cost reduced. Coverage will expand to most
uninsured people and it will be less expensive with improved budget for preventive medicine
as well as the general population health. The act will in great deal improve the healthcare
system. However there are challenges involved, the poorest people are at risk of losing
insurance cover and will not qualify for subsidies if the state fails to expand Medicaid.
Silberman, P. (n.d.). Implementing the Affordable Care Act in North Carolina