The Affordable Care Act (ACA) significantly improved Medicaid coverage for low-income individuals, enabling millions more to access healthcare services. However, concerns are emerging that recent changes to reimbursement structures may lead healthcare providers to avoid treating patients from lower socio-economic backgrounds, undermining access to essential care. Recommendations emphasize the importance of fostering strong physician-patient relationships to enhance treatment adherence and ensure equitable access to healthcare.

1. Introduction
The introduction of the Affordable Care Act in America was
highly beneficial since it increased the number of low-income
covered by Medicaid. It ensures that they are able to acquire
medical coverage and access to healthcare services. Essentially,
they have an opportunity to increase their eligibility despite
their poverty level state. The Act has been able to improve the
quality of Medicaid in the country to the same level as
Medicare. Currently, people who fall between ages 19 to 64 and
below the federal poverty level of 133% can be covered under
Medicaid.3 Before the introduction of ACA, such patients
would not be eligible.
Stakeholders
The Medicaid program affects different groups of people in the
country. Millions of people have a direct stake in the program,
meaning any changes will directly affect their decisions on
health care coverage. They include low-income earners, the
federal government, private insurance companies, and
healthcare providers.
Overview
The Affordable Care Act certainly affected the number of
people covered under Medicaid. Moreover, the amount of
healthcare coverage in the county had a direct correlation with
the availability of the Act in the United Sates. Currently,
questions have been circulating as to whether the Act should be
revised. However, the pertinent issue that arises from such
questions is the manner in which any changes in the Federal
Law might affect the Medicaid program. The program covers
approximately 50 million Americans from low-earning
families.1 Medicaid involves a partnership between the Federal
and local governments over funding. It is optional for states to
participate in the program, but all local governments are
currently involved in the partnership. For a state to participate,
it has to meet federal requirements. One of the requirements is

2. that the state cover a particular group of people and offer
certain benefits.
However, most of the eligibility in the program is dependent
upon a person's income and the category in which he or she
belongs. Many young adults with no children previously lacked
coverage because they did not fall under the categories provided
for by the program.
However, the Federal poverty guidelines would help to solve
this problem since it lists a cut-off point for young adults with
low income. The program now has a component that facilitates
reporting of quality through patient measurements. An example
is patient satisfaction and adherence to treatment, which has
reportedly dropped by 40%.2 The challenge is that the program
may fail to be beneficial for patients who need it since they may
be turned away by healthcare providers. The component entails
utilizing the measurements to determine choices of
reimbursement. There is a risk that providers might begin
turning away patients from low-income backgrounds
Analysis
The program has come a long way since it was first enacted, but
there is the risk that such a measure might lock out large
sections of the public from healthcare coverage. Very few
healthcare providers want to be involved in a process that takes
more of their time and effort. As a result, they may end up
turning away patients without administering any treatment.
Recommendations
The most suitable solution for this challenge would be to reduce
the risks of patient non-adherence by fostering mutual
physician-patient relationships. This solution means that
physicians should make an effort to assess the patients'
understanding of the treatment regimen. Additionally, patients
should be allowed to give a thorough story of their experiences
with unique illnesses. Mutual collaboration between physicians
and patients results in higher adherence levels.2
Conclusion
Balancing the quality of healthcare with access can be an uphill

3. task if no strategies are applied. Moreover, it can be a
counterproductive process against the Medicaid program and
what it was introduced to achieve. As clearly elaborated,
physician-patient collaboration should be prioritized if both
goals are to be achieved.
References
1. Baicker K, Taubman SL, Allen HL, et al. The Oregon
Experiment — Effects of Medicaid on Clinical Outcomes. New
England Journal of Medicine. 2013;368(18):1713-1722.
doi:10.1056/nejmsa1212321.
2. Martin LR. The challenge of patient adherence. Ther Clin
Risk Manag .
http://www.academia.edu/581889/The_challenge_of_patient_ad
herence. Accessed January 30, 2018.
3. Wherry, L. R., & Miller, S. “Early coverage, access,
utilization, and health effects associated with the Affordable
Care Act Medicaid expansions: a quasi-experimental study.”
Annals of internal medicine 164.12 (2016):795-803
3
Carissa Lee
Analysis Report - Health Economics
For this assignment, you will complete an analysis report of the
case study below. Use the provided resources as a starting point
for your own research.
Case Study: Quality vs. Access
The Affordable Care Act raised the Medicaid reimbursement
levels to Medicare levels, resulting in improved appointment

4. availability for Medicaid recipients. One of the components of
the Affordable Care Act now coming into effect is the reporting
of quality measurements and tying these into reimbursement.
Some of the measurements are subjective, such as patient
satisfaction, while others are quantitative, such as percentage of
patients with their diabetes under control. Patient adherence to
treatment plans has been shown to be as low as 40%. Opponents
of the rating system say this system will result in more difficult
and low socio-economic group patients being turned away by
providers.
● How could the payment system be modified to reward
quality of care but not result in reduced access to those in lower
socio-economic groups or with poorer health?
Resources:
Wherry, Laura R., and Sarah Miller. "Early coverage, access,
utilization, and health effects associated with the Affordable
Care Act Medicaid expansions: A quasi-experimental study."
Annals of internal medicine (2016).
http://annals.org.une.idm.oclc.org/aim/article/2513980/early-
coverage-access-utili zation-health-effects-associated-
affordable-care-act
Martin, Leslie R., et al. "The challenge of patient adherence."
Ther Clin Risk Manag 1.3 (2005): 189-199.
https://www-ncbi-nlm-nih-
gov.une.idm.oclc.org/pmc/articles/PMC1661624/
Make sure to include all of the following sections in your
report. You can reorder the sections to ensure your report flows.
· Introduction: Briefly introduce the case study you have chosen
for this report. In addition, clearly state the purpose of the

5. analysis and what you hope to prove in the report.
· Stakeholders: Identify the stakeholders who are involved in
your case study. Discuss the entities who have an interest in the
situation. How do their interests affect your ability to find a
solution?
· Overview: Provide a succinct overview of the current situation
relating to your case study.
· Analysis: Provide an analysis of the situation. Make sure to
discuss the incentives or lack thereof. How have the current
incentives caused the problem? Address the specific questions
posed in your chosen case study. Apply the concepts you have
been exposed to throughout the course to aid in your analysis.
· Recommendations: Based upon your analysis, make
appropriate recommendations that could alleviate or solve the
presented problem.
· Conclusion
· References: Make sure to support your claims with reputable
resources. All citation should follow the most current version of
AMA style.
Guidelines for Submission: Submit a 7 page word document that
uses 11-pt Times New Roman font with 1 inch margins and
1.5 line spacing. All citations and other formatting conventions
should follow the most current version of AMA style.
Follow Rubric Below:
Exemplary
Satisfactory
Needs
Improvement
Not Evident
Introduction

6. Meets the
“Satisfactory”
Succinctly summarizes the
There are gaps in the summary of
Does not summarize the
criteria and utilizes course concepts and reputable resources to
support claims
case study and the purpose of the
report
the case study and the purpose of the report
case study and the purpose of the
report
Stakeholders
Meets the
“Satisfactory” criteria and utilizes course concepts and
reputable resources to support claims
Identifies the stakeholders involved in the case study AND
discusses how they affect potential solutions
Identifies the stakeholders involved in the case study OR
discusses how they affect potential solutions
Does not identify the stakeholders involved in the case study
AND discusses how they affect potential solutions
Overview
Meets the
“Satisfactory” criteria and utilizes course concepts and
reputable resources to support claims
Provides a succinct overview of the current situation
surrounding the chosen case study
There are gaps in the overview of the current situation
surrounding the chosen case study
Does not provide an overview of the current situation surround
the chosen case study
Analysis
Meets the

7. “Satisfactory” criteria and utilizes course concepts and
reputable resources to support claims
Analyzes the incentives or lack thereof, how the current
incentives lead to the problem, and addresses the specific
questions posed in the chosen case study
There are gaps in the analysis of the incentives or lack thereof,
how the current incentives lead to the problem, and/or in the
answers to the specific questions posed in the chosen case study
Does not analyze the incentives or lack thereof, how the current
incentives lead to the problem, or address the specific questions
posed in the
chosen case study
Recommendations
Meets the
“Satisfactory” criteria and utilizes course concepts and
reputable resources to support claims
Proposes appropriate
recommendations
that could alleviate or solve the identified problem based upon
the analysis
Proposed recommendations are not appropriate and/or are not
based upon the analysis
Does not make recommendations
Conclusion
Meets the
“Satisfactory” criteria and utilizes course concepts and
reputable resources to support claims
Summarizes main
points that support the purpose of the report stated in the
introduction
Summarized main points do not clearly support eh purpose of
the report or there are gaps in the summary
Does not summarize main
points
References

8. Meets the
“Satisfactory”
Correctly cites all sources used in
All sources are relevant to the
There are citation errors and sources
criteria and all sources are reputable and current
the analysis and all sources are relevant to the chosen disease or
condition
chosen disease or condition, but there are citation errors
are not relevant to the chosen disease or condition
Writing Mechanics
Meets the
“satisfactory” level and all sections are clear, concise, and
written in a professional tone
Paper is organized in the required format and contains no
grammatical errors
There are grammatical and formatting errors, but they do not
affect the readability of the paper
Errors in formatting or grammar affect the readability of the
Paper