Affordable Care Act in Maryland Essay

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Health Policy Analysis

The author of this report has been asked to cover two major subjects over the course of four pages. The first half of the paper will pertain to a health policy topic of the author's choosing. The author will use a health policy provision that could or should be implemented and then it will be discussed why that provision might not be implemented. The topic in question will be the Patient Protection and Affordable Care Act as it will be implemented in the state of Maryland. The second half of the paper will pertain to the seven factors that are present within an environment of continuous implementation and fostering of a plan. As before, this will pertain to the Affordable Care Act in Maryland. While some states and government personnel may be apt to resist federal mandates and programs, doing so can come with some strong drawbacks and this is especially true if there is not a contingency plan in place.

Analysis

When it comes to the impacts for the Affordable Care Act in Maryland, the results that have happened and are bound to happen are decidedly mixed. Per the Kaiser website, the Affordable Care Act is designed to extend coverage to many of the 47 million non-elderly people in the United States that lack healthcare coverage. Indeed, the elderly are covered by Medicare and many of the poor are handled by Medicaid. However, there are many in those forty-seven million that are not covered by either act and thus they should be addressed. As for the reasons the Patient Protection and Affordable Care Act might not be implemented, there are a couple of reasons. One reason is that the Patient Protection and Affordable Care Act might be repealed at the federal level. The GOP-controlled House of Representatives has certainly tried this multiple times. However, it always gets stopped in the Senate. Even if that were not the case, the sitting President, that being President Barack Obama, would veto any repeal of the Patient Protection and Affordable Care Act. As for the second reason the Patient Protection and Affordable Care Act might not be implemented, that would be the fact that there might be problems implementing the healthcare exchanges that are supposed to be set up. They are currently apparently in place but funding issues and federal spending spats might lead to problems with that being maintained and upheld (KFF, 2015).

A third reason the Patient Protection and Affordable Care Act might not be sustained is state funding of Medicaid. Indeed, states have discretion to fund Medicaid as they wish with the understanding that the federal government will match a lot of the dollars spent. However, the state is largely not required to do anything in particular and thus the outcomes for the patients will be different from state to state. This would be to the extent that some people might realize the benefits and upsides of the Patient Protection and Affordable Care Act while others may not. Further, not everyone in subsidized and helped by the Patient Protection and Affordable Care Act. Indeed, the Kaiser foundation shows that whether it be childless adults, parents and children, there are chunks of all three population groups that are not subsidized in the least because they are at or above four times the federal poverty level (KFF, 2015).

When it comes to the implementation process, the most important parts, at least as the author of this report sees it, would be the planning and getting the buy-in from the powerbrokers and stakeholders that exist for the project. When the change is something regulatory or legal like the Affordable Care Act, getting buy-in is not optional because it is a matter of law and thus is not negotiable. The planning process would be the first overall thing that would have to be done of those two. Indeed, it has to be figured out where things are right now, where things need to be and what barriers exist between "here" and "there." The barriers could be fairly simple or they could be exceedingly hard to traverse. Either way, there needs to be a measurement of how things came to be as they are and what needs to happen to change things. Of course, major changes will require a large amount of people, resources, money and buy-in.

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For example, if a computer system needs an upgrade to be compliant with and otherwise able to handle the new healthcare law, there are a few pieces to the puzzle that will need to be figured out. These include the necessary hardware upgrades that will be necessary, the necessary software upgrades that will be necessary and the infrastructure that will need to be address (network cables, workstations and so forth) and so forth. There is also the training that will be necessary for the people that will be administering, updating, using and otherwise wielding the system. All of this really has to be figured out before one goes any further. To be sure, even that would have to be preceded by a notion that something is amiss or not working well. For example, if the network is rather slow or there are data integration and compatibility issues, this would obviously be a major reason to start making plans and thus starting the project, implementation and upgrade process. Further, there is obviously a huge push in the healthcare information technology realm to keep things modern and make everything as electronic yet secure as possible so that information flows freely but safely (McLaughlin & McLaughlin, 2014).

As mentioned above, the other major thing that has to be dealt with is the buy-in from the people involved. Indeed, it is easy enough for an executive or manager to say that a change is being made. However, translating that to the change actually occurring and occurring with no problems is quite another matter. TO be sure, if the people and stakeholders involved do not know why the change is being done and/or why it is necessary, then the people on the front lines will not know what is going on, why things are happen and they may even resist the changes being made. As such, any change management provision should be accompanied by what is called a guiding coalition. This is a team of people that is within a cross-section of the entire company. This will make it easier to convince others of the change because there will be people throughout the company that know what the change is, know why it is necessary and they can then translate this to the other people in the firm. If this is not done, some might go so far as to undermine the change management process and thus make the implementation of the change hard (if not impossible) to pull off (Al-Abri, 2007).

The other side of the coin above is that the company or organization has to know what they are doing. Indeed, there are some companies that simply do not know what they were doing. One example of this would be healthcare companies that avoid things like Accountable Care Organizations and electronic records. These are healthcare organizations that are clearly behind the times and they are not embracing the future. They are literally the Circuit City and Blockbuster of the healthcare realm. Further, when a healthcare firm is clearly behind the curve, they need to get with modern times or, even better, start to future-proof their operations. It is much easier to do that and then make incremental updates rather than doing changes that are literally five to ten years (or more) worth of technology at a time (Swayne, 2008).

Conclusion

In the end, healthcare organizations need to understand that change is a constant. Avoiding major changes at one time by making incremental updates is the wisest course. However, the people that are brought on to the culture (e.g. employees) need to be part of that apparatus. As such, the employees selected for hire need to be part of the solution rather than working against the change. At the same time, leadership should be competent, they should not nickel and dime things and they need to pour in the needed resources. Employees can obviously be a drag on the productivity and modernity of a firm but bad leadership is a lot worse. The leaders that are selected need to have the right skills in place and they need to know that the outcomes of the patient are just as important as the financial outcomes of the firm. Indeed, the profit motive of most healthcare organizations should not lead to neglect of the patient......

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