A National Health Care Workforce Commission was developed to review workforce needs and make recommendations to the federal government to ensure that national policies are in alignment with consumer needs. As of January 2013, Congress had allocated funding for the commission, which is approximately $3 million.
As part of educational incentives to increase the workforce supply, the Nursing Student Loan Program will be expanded. Special loan programs will be implemented to providers who will be working in underserved areas. Workforce training will be provided to rural physicians, dentists, nurse practitioners in community health centers, and long-term care workers.
The Primary Care Extension Program (PCEP) will be established to provide technical assistance to primary care providers about health promotion, chronic disease management, mental health, and preventive medicine. These initiatives are focused on the emphasis of prevention and health promotion. However, as of 2013, there has been no funding allocated to this program. Family medicine groups have recommended annual funding of $120 million to administer the program. The PCEP would establish patient-centered medical homes by creating community-based Health Extension Agents. Their role would be to collaborate with local health agencies to identify community health priorities and determine the workforce needs for local areas (The Clinical Advisor, 2013).
Title VI–Transparency and Program Integrity
The Department of Health and Human Services will publish standardized information on long-term care options for consumers so they can compare facilities.
Establish a national system for direct patient access to employee background checks.
Creation of a screening process for Medicare and Medicaid providers.
Elder Justice Act was established to prevent and eliminate elder patient abuse.
As the U.S. population is graying, many individuals may spend part of their lives in nursing homes. There will be continued enrollment in both Medicare and Medicaid. These mandates focus on the importance of providing information about long-term facilities to consumers so they can select the appropriate facility for their relative. This title also focuses on providing additional information about the quality of the care given at long-term facilities. There is also a screening mechanism to ensure that the providers of these services are providing quality care.
The Elder Justice bill was introduced in the Senate in 2003 and contained landmark initiatives in the development of a national policy to prevent elder abuse and neglect. The Elder Justice Act was finally passed as part of the ACA. It targets abuse, neglect, and exploitation of the elderly. There will also be incentives for employees who want to work at such facilities (Biancato, 2010). Funding was allocated to provide grants to study elder abuse. However, Congress did not award funding until 2012 for the activities associated with the act. In 2012, nearly $6 million in funding was awarded to implement Elder Justice Act activities in tribal organizations and programs in Texas, New York, Alaska, and California (Biancata, 2013).
Title VII–Improving Access to Innovative Medical Therapies
The existing section 340B of the Public Health Service Act of 1992 will be expanded so there will be more affordable drugs for children and underserved community residents.
The 340B section expansion will increase the allowance of more drug discounts for inpatient use at children’s hospitals, cancer hospitals, critical care hospitals, and rural centers. This mandate increases the affordability for these patients who may need long-term care. Drug companies who participate in the Medicaid drug rebate program must sign pricing agreements for discounts on outpatient drugs purchased by qualified public health facilities. As of this writing, there are 14,500 facilities and 800 drug companies. The ACA will expand the participation to 5,000 additional facilities (Wakefield, 2010).
Title VIII–Community Living Assistance Services and Supports
The establishment of the CLASS Independence Benefit Plan, which is a self-funded long term care insurance program for individuals with limited financial assistance.
The CLASS Plan, effective January 1, 2011, enables consumers to purchase community living assistance.
Although supported by many community organizations, the Obama administration indicated it was not a viable program and the act was repealed on January 1, 2013 (The Arc, 2012).
Title IX–Revenue Provisions
Requires employers to report on the employee’s annual W-2 form the value of the health insurance benefit coverage provided by the employer. An excise tax will be levied on expensive employer health insurance plans.
An annual flat fee is imposed on the branded prescription pharmaceutical companies and exporters, medical device manufacturing industry, and the health insurance providers, according to market share. Also, there is an excise tax on indoor tanning services.
Establishment of a cafeteria plan for healthcare benefits to employees, which enables them to select different benefits based on current lifestyle.
The requirement for employers to inform their employees about the cost of the health insurance benefit as well as report the cost on W-2 forms emphasizes transparency. The employer must report it accurately because it will be reported on a federal form. In addition, a 40% excise tax will be placed on expensive employer-sponsored health plans.
Annual pharmaceutical fees of approximately $2.5 billion will be applied to the drug manufacturing sector and are based on the market share of the U.S. drug market. This is allocated across the industry sector with some exclusions. The fees began in 2011. The fee component, for example, was $2.5 billion in 2011 and $2.8 billion in 2012. The fee will steadily rise to $4.1 billion in 2018 and will be $2.9 billion a year thereafter. These fees will cost the industry approximately $85 billion over a decade (Silverman, 2012). The same type of fee is applied to the health insurance industry in 2014. The fee will be $8 billion and will increase in years thereafter. It is important to note that these fees are nondeductible. A tax will be imposed on medical devices equal to 2.3% of the sales price and it is deductible. The fees and taxes will contribute to the operation of the healthcare reform mandates. Effective July 1, 2010, a 10% excise tax is imposed on indoor tanning services.
A cafeteria plan is a type of employer-sponsored benefit plan that allows employees to select the type of benefits appropriate for their lifestyle. This plan could benefit both employers and employees because not all employees need the same type of benefits. Although cafeteria plans can be difficult to administer, they can be more cost effective because employees have different healthcare needs and may require less healthcare insurance coverage in some instances.