The Affordable Health Care Act, known as Obamacare, is intended to reduce healthcare costs through multiple methods. One way is through a pilot program known as “Independence at Home” that utilizes technology to monitor a variety of health conditions. Known as “e-care”, the program was specifically designed for Medicare patients that traditionally cost the most to treat.

Program Basics

The program was implemented in Jan. 2012. It’s supposed to provide a better level of care, prevent hospital readmissions, achieve a greater level of patient satisfaction, and ultimately, save money.

Medical teams deliver care to Medicare patients in their homes or through a community-based center.

If the team achieves the goals of the Independence at Home program, they’ll receive substantial financial rewards.

E-care can be used to monitor an array of vital signs, providing seniors with convenient, primary care services at home. For the disabled, seniors who find it difficult to leave their homes, and those with chronic illnesses, Independence at Home offers an alternative to expensive long-term care facilities.

Care management teams include practitioners in multiple specialties, from social workers and medical professionals to mental health providers.

Convenience Over Care?

The program opens up new and convenient possibilities for seniors, but all services are no so easily delivered. Those who require extensive physical therapy may not benefit from the pilot program.

The Independence at Home program may have the best of intentions, but it’s confusing for many Medicare recipients who believe they can receive virtually any healthcare service while remaining in their home.

The program could easily encourage seniors to remain in their homes and limit themselves to the available care rather than leave their home to seek services that include physical therapy.

At the other end of the spectrum, patients have expressed concern that the in-home program will promote the use of only basic services and that other options may not be explored in an effort to restrain the cost of care.

Rehabilitation and therapy services will be terminated if the medical team members determine the patient has attained the minimal skills and range of motion needed to conduct daily living activities, or if family members are available to perform those daily activities for them.

The Independence at Home program under Obamacare has the potential to underutilize or limit some treatments in favor of cost savings to a segment of the population that typically has more need and higher healthcare costs.

For physical therapists, it has the potential of providing them with a means of expanding their services into new venues for increased revenues.

It wasn’t that many years ago that few people had healthcare insurance and they only went to the doctor when faced with life-threatening injuries and illnesses. For virtually everything else, they utilized a variety of home remedies and over-the-counter treatments.

Over the years, that changed. The Affordable Health Care Act, known as Obamacare, is on track to curb over-utilization as a means of reducing healthcare costs.

Comfort Over Care

When designing the Act, the views of Dr. Ezekiel Emanuel weighed heavily in developing Obamacare.

A key advisor to the president, he advocated reducing costs through a combination of methods that includes scaling back on “luxury” services, tests and technology.

The Act assumes that patients are self-indulgent and demand amenities that aren’t necessary for their treatment or recovery.

Those demands include expensive hospital rooms, attractively appointed waiting rooms, convenient parking and facilities designed for comfort rather than utility.

Practitioner Protection, Medication And Patient Ignorance

Obamacare works on the theory that clinicians prescribe tests, utilize high-dollar technology and schedule office visits that aren’t needed as a way to earn more money and protect themselves against potential litigation.

Obamacare further cites drug prices that are 10 to 30 percent higher in the U.S. than other countries, marketing costs, and the fee-for-service payment model for rising prices.

Malpractice insurance and consumers’ ignorance of the true cost of their healthcare were also named as factors for skyrocketing prices.

Back To Basics

Obamacare offers a multi-pronged attack that focuses on the cost element of the healthcare equation. Medical professionals and facilities that produce desired patient outcomes are rewarded financially.

The goal is for practitioners to use fewer “unnecessary” tests and technology to determine exact causes and rely more on exams and a patient’s health history to prescribe medications, devise treatments and expedite recoveries.

The cost for using the technology remains the same, but it’s utilized less as a means of lowering costs.

Patient Responsibility

Individuals are tasked with paying more of their healthcare costs and utilizing preventative measures to keep themselves healthy, as defined by their healthcare policy.

Employers and insurers are using financial incentives to promote healthy lifestyles, and encourage people to stop activities or practices that are deemed detrimental, from not getting enough exercise and giving up tobacco to eliminating soft drinks.

Taxes are imposed on people with “Cadillac” policies that Obamacare says encourages over-utilization of services, an outlook that could be an incentive for limited benefit packages in the future.

Those without insurance are penalized for their irresponsibility in not carrying coverage.

Physician Strategies And Struggles

Under Obamacare, practitioners are urged to return patients to a functioning condition as quickly as possible by less expensive means than currently employed. The Act reduces Medicare reimbursements and bundles payments for in-patient hospital stays and post-discharge treatments that were previously billed individually.

Obamacare advocates e-care monitoring at home to avoid hospital admissions, readmissions, and stays in skilled nursing and long-term healthcare facilities.

Independent Payment Advisor Board (IPAB)

Obamacare operates under the theory that access to technology automatically equates with overuse.

IPAB has been charged with finding ways to cut Medicare costs and making recommendations for treatments that automatically go into effect unless Congress moves to block them.

The organization is responsible for determining which treatments and procedures, in the collective opinion of its members, provide the best results/value for the money spent.

The rising costs associated with healthcare are due to a variety of factors associated with a capitalistic society. Obamacare attempts to address those issues with multiple methods that changes the way healthcare is purchased and delivered, combined with an array of taxes on policies and penalties for non-compliance.

Many patients fear that Obamacare signals a return to health coverage that’s only used in the direst situations and losing access to life-saving technology if a governmental panel deems it as too expensive.

The Affordable Health Care Act, colloquially known as Obamacare, was signed into law on March 23, 2010, legislation that encompassed more than 2,500 pages and destined to be the biggest change in healthcare in more than 150 years.

Many of the Act’s finer points haven’t been finalized or even written.

For instance, the office of Health and Human Services has not created a full set of rules and regulations to ensure the workings of the initiative.

Obamacare marks a milestone in the evolution of healthcare, but to fully appreciate the changes generated by the Act, it’s important to understand the history of healthcare insurance in the U.S.

Other countries typically utilize some form of socialized medicine, while the U.S. combines several methods that includes government subsidized programs, employer-based coverage, and direct sales.

Insurance During World War II

Prior to World War II, health insurance was a commodity that individuals purchased for themselves and was viewed much like the traditional rainy day fund – it was something to be used in an emergency.

As millions of men went to war from 1939-1945, the federal government placed a freeze on wages to prevent inflation. To acquire and retain workers, employers began offering healthcare to workers.

The practice gained widespread popularity with employees as manufacturing processes of the time became more dangerous and the potential for injuries increased. It was a non-taxed benefit that made it doubly attractive.

Policies were much less inclusive than those enjoyed by today’s workers and were primarily used for hospitalization needs.

Inequities For The Self-Insured

Those who had to purchase their own insurance received none of the tax breaks or discounts on premiums available to those who obtained insurance through large employer pools. Obamacare helps narrow that gap with insurance offered through the Marketplace for the approximately 9 percent of the population that purchase their own healthcare.

The self-insured can obtain coverage at rates estimated to be comparable to employer-based policies.

Medicaid And Medicare

To address the needs of the disabled, elderly and poor, the federal government instituted Medicare and Medicaid.  Obamacare increases Medicaid income eligibility requirements.

The change allows more people to enter the system, but those living in states that already have generous income requirements may no longer be eligible and will have to purchase coverage through the Marketplace.

Obamacare provides government subsidies to help individuals pay for Marketplace insurance.

Healthcare Through The Years

Healthcare has been an issue in the U.S. since 1854, when it was first proposed for the benefit of the indigent and insane.

The effort to overhaul healthcare in the U.S. gained prominence again in 1933 under President Franklin D. Roosevelt, who managed to enact healthcare as part of Social Security, but not for all citizens.

President Lyndon B. Johnson oversaw the passage of Medicare and Medicaid in 1964, but it took almost 17 years for all states to participate.

President Jimmy Carter and President Bill Clinton proposed sweeping changes in 1977 and 1994, respectively, but both plans failed and were met with significant resistance by the medical community and pharmaceutical companies.

President Obama vowed to fix what he perceived to be a broken healthcare system and in 2010, the Affordable Health Care Act became the law of the land.

It expanded Medicaid coverage, established the Marketplace where the uninsured can buy policies, and established a core of benefits that every policy must offer.

The evolution of U.S. healthcare took a major leap from the accepted norm with Obamacare, legislation that’s inarguably the biggest change in the nation’s healthcare practices in more than 150 years.