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Predictions of the affordable care act’s impact on neonatal practice

Journal of Perinatology volume 36, pages 586–592 (2016)Cite this article

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The 2010 Affordable Care Act (ACA) utilizes a multi-faceted approach which aims to increase health care access and insurance, improve health care quality and ultimately reduce cost. The law increases access to care by providing federal funds to expand the Medicaid program to those who earn ⩽133 to 138% of the Federal Poverty Level (FPL; Medicaid Expansion) from state-based eligibility standards (which range from 50 to 200% of the FPL – although states with Medicaid thresholds above this 138% FPL limit are not reduced) and prohibits insurance companies from excluding individuals with pre-existing conditions.1 The ACA mandates that employers with at least 50 staff members provide health insurance and that Americans without employer-based insurance either purchase health insurance or pay a penalty. The ACA also increased the age non-dependent children may remain on parental health plans to 26 years of age and eliminates co-payments from select primary care visits.1 Before this mandate, children who aged out of insurance coverage (most commonly at 18 years of age) were dependent on either state law or specific plan rules.2 Further, the law provides subsidies and tax incentives for those earning up to 400% of the FPL toward the purchase of health insurance. The ACA creates health exchanges – online marketplaces for purchasing insurance where consumers can compare policies.3

The regulation of a minimum set of services which all health care insurance plans must cover creates a national quality standard. Improvements in health care quality are motivated by reduced federal payments for potentially preventable occurrences such as hospital-acquired infections and readmission within 30 days for certain diagnoses.1 Quality care is incentivized by the creation of Accountable Care Organizations (ACOs). These large in/outpatient networks are eligible for financial bonuses if their actual number of hospitalizations is below established thresholds.1, 4, 5 A summary of ACA provisions relevant to neonatal practice is shown in Table 1.

Table 1 Potential impact of selected ACA provisions on neonatal practice: many ACA reforms have been aimed at adult medical practice, there exists the potential for impact on neonatal and perinatal care
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Acknowledgements

We acknowledge Dr Sergio Golombek Associate Editor of the Journal for his helpful comments on drafts of the paper.

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SIS conceived the idea for the manuscript, wrote the draft and revised the paper. HLB made substantive editorial revisions to the manuscript drafts and provided editorial assistance.

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  1. Division of Newborn Medicine, Department of Pediatrics, Maria Fareri Children’s Hospital at Westchester Medical Center, New York Medical College, Valhalla, NY, USA

    S I Shah & H L Brumberg

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Shah, S., Brumberg, H. Predictions of the affordable care act’s impact on neonatal practice. J Perinatol 36, 586–592 (2016). https://doi.org/10.1038/jp.2016.93

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