Health Care Reform

The Affordable Care Act (ACA) was signed into law March 23, 2010, and aims to increase the quality and affordability of health insurance, lower the uninsured rate by expanding public and private insurance, and contain the rising costs of health care for individuals and the government.

Understanding Health Care Reform

'Making Sense of Health Care Reform' Series
This series highlights some of the issues from health care reform that are of concern to physical therapy. Each document in the series provides background, an explanation of the issue, implications for practice, tips, and links to further resources.

Online Feedback Form: Health Care Reform Implementation In Your Area Members Only Icon
Use this online complaint form if you are experiencing issues with the implementation of the Affordable Care Act in your area, including issues related to the Health Insurance Marketplaces, Medicaid Expansion, collaborative care models, such as ACOs, and patient access to care in the changing environment.

Themes of Health Care Reform

APTA has divided the contents of the law into four major themes, which are listed below. The ACA increases access to health care through its expansion of health insurance coverage provisions as well as the creation of new insurance protections; creates new models of care beyond traditional fee for service; shifts payment focus to rewarding providers for the quality of their services; and increases auditing and screening processes to enhance the integrity of federal health care programs.

Expansion of Coverage

The ACA expands health insurance coverage through use of the Health Insurance Marketplaces and the expansion of the Medicaid program population. Additionally, the ACA creates protections for coverage, such as "guaranteed issue" and restrictions on certain coverage limits.

Collaborative Models of Care - Innovation in Programs

Collaborative care models include accountable care organizations (ACOs), bundled payment models, and patient-centered medical homes.

Payment Changes and Linking Payment to Quality

The ACA makes refinements to payment systems and links payment to quality of care. Access resources on Medicare payment for information on changes in new payment rules and programs such as PQRS and hospital readmissions reduction. Access resources on private insurance payment changes and updates on the latest reimbursement issues and trends.

Program Integrity

The ACA provided for funding increases to the program integrity efforts, such as auditing programs.

CSM 2016