HSM 546 - Week 4 - Managed Care Enrollment - Managed Care...

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Managed Care Enrollment On March 23, 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act, achieving a feat that had eluded other presidents since the 1930s (Quadagno 2005). The main features of the legislation included state insurance exchanges, mandates on individuals and employers, an expansion of Medicaid, and subsidies to help lowincome people afford coverage. Also included were stringent regulations on insurance companies, cuts to Medicare Advantage but an improved drug benefit for seniors, and restrictions on the use of subsidies to pay for abortion. Other features, such as Accountable Care Organizations, bundled payments, and funds for cost-effectiveness research, were designed to slow spending growth and to improve quality and efficiency. This conglomeration of measures was necessary not only to expand coverage, the key objective of the legislation, but also to reduce opposition from the numerous constituencies with a vested interest in the health care system. The preferences of these interest groups helped shape the final law in ways that had little to do with reducing the number of uninsured. This essay will focus primarily on the interest-group activity surrounding coverage expansions, although interest groups were involved in all aspects of the legislation. A key constituency was the private insurance industry. Insurers were willing to accept stricter regulations, including price controls and guaranteed-issue health insurance without preexisting condition exclusions,
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if these regulations were accompanied by an individual mandate. An individual mandate would bring young, healthy people into the system to help pay the costs of older, sicker people (Mitchell 2009). What was entirely unacceptable to insurers, however, was the public option, which would have offered an alternative to private insurance. Fearing that a new public program could outcompete private insurance on price and quality, insurers launched a campaign against it, arguing that a government-run
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