1. Affordable Care Act & Its Effect on Managed Care
Presented
by
Elsa M. Gomez
Our Lady of the Lake University
Health Care Planning and Policy- HCMG 7380
Presented to Dr. Martinez
April 1, 2015

2. Managed Care in need of the ACA
The Affordable Care Act might be the only
solution for America to salvage itself from going
bankrupt by the year 2050.
If the ACA is to be a success it will be because
Managed Care personnel & providers make it a
success. From complying to assure free
vaccinations to children under any plan to taking
care of pre-existing condition patients.
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3. Definition of Managed Care
“At the very least, it is a system of health
care delivery that tries to manage the cost of
health care, the quality that tries to manage
the cost of health care, the quality of that
health care, and access to that care
(Kongstvdt, 2013, p. 657).”
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4. The Unknowns
What is clearly known is that managed care before the ACA
was driving health care expenditures to a point of bankrupting
America in the next 35 years.
What is not known is how many years it would take & how
effectively Managed Care administrators will be able to
implemented cohesively on national level such federal
directive.
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5. Affordable Care Act’s (ACA) Objectives
“Its greatest impact is on the payer industry and on the access
to health benefits coverage for all Americans (Kongstvedt,
2013, p. 17).”
The Supreme Court upheld that Congress has right to make
American citizens pay a penalty for lack of health insurance
due to the fact that Congress has the authorization to “levy
taxes(Liptak, 2012, p.5).”
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6. What is known of Managed Health Care
Since its inception into the healthcare industry in
the early 1970’s up to now, Managed Health
care has been based on profitability.
“Plans have pursued this strategy, at times
forgoing near-term profitability, through low
pricing, adding new product lines, and market
expansion(Draper, et al.,2002, p.12).”
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7. Table 1. Types of Manage Care
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8. Key Aspects of What is not known
The main issue with implementing this new Managed Care federal
government directives by Health Care professionals are the same as
with Medicaid enrollees:
“Administrative obstacles almost surely play a key role. Unless
they complete the multipage application and provide documentation
of income and residency, eligible individuals simply never get
enrolled (Sommers & Epstein, 2010, p. 2086).”
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9. Diversity of Opinions
Many doubt if the ACA will be effective in
achieving its ultimate goal to provide access to
the American citizenship while solving the Health
Care expenditure issues.
However, the fact that citizens have signed up
under the ACA proves they want to abide by this
law.
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10. Analysis of Present Trends
The ACA so far is a success made possible by
Managed Health Care professionals.
The ACA has in its first year insured 32 million
American citizens:
16 million of these did not know or were not
aware they qualified for Medicaid.
16 million others obtained private insurance.
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11. Table 2. Future Implications
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FEDERAL GROWTH BY 2010 EXPENDITURE
SAVINGS
SAVINGS BY 2020
FEDERAL 16 million insured 1-2% 135 Billion
STATE
INSURANCE
Total of New Insured 32 million
Expected Uninsured 20 million
Federal Deficit
Reduction
100 Billion by 2010 1 Trillion by 2020
Expenditure Savings 600 Billion by 2020

12. Future Strategic outcomes
The American government by the year 2020,
because of its ACA enactment will have saved
600 Billion dollars in Health Care.
In the first year its deficit reduction was 100 Billion
dollars.
By the year 2020 its federal deficit reduction is
expected to be 1 Trillion dollars.
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13. Summary & Conclusion
The Affordable Care Act is America’s legislative body’s first
attempt to deal with the rise of health care expenditures while
making care available to all its citizens.
Managed Care following ACA directives assures that should
an emergency occur to any citizen; such citizen take financial
responsibility for cost incurred.
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14. References
Draper, D. A., Hurley, R. E., Lesser, C. S., & Strunk, B. C. (2002). The changing face of managed care. Health Affairs, 21(1), 11-23.
Fox, P. D. (2001). An overview of managed care. The managed health care handbook, 3-15.
Keehan, S. P., Sisko, A. M., Truffer, C. J., Poisal, J. A., Cuckler, G. A., Madison, A. J., ... & Smith, S. D. (2011). National health
spending projections through 2020: economic recovery and reform drive faster spending growth. Health Affairs, 10-1377.
Kongstvedt, P.R. (2013). Essentials of Managed Health Care (6th ed.). Burlington, MA: Jones and Bartlett Learning, LLC.
Liptak, A. (2012). Supreme Court upholds health care law, 5-4, in victory for Obama. The New York Times, 28.
Martinez, Ricardo, . (2015, March 20). Managed Care For Commercial Medicare and Medicaid Populations: [PowerPoint slides].
Retrieved from Our Lady of the Lake University Managed Care For Commercial Medicare and Medicaid Populations Blackboard:
https://engage.ollusa.edu
Orszag, P. R., & Emanuel, E. J. (2010). Health care reform and cost control. New England Journal of Medicine, 363(7), 601-603.
Sommers, B. D., & Epstein, A. M. (2010). Medicaid expansion—the soft underbelly of health care reform?. New England Journal of
Medicine, 363(22), 2085-2087.
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15. Appendice
1. Title page
2. Managed Care in need of the ACA
3. Definition of Managed Care
4. The Unknowns
5. Affordable Care Act’s (ACA) Objectives
6. What is known of Managed Health Care
7. Table 1. Types of Manage Care
8. Key Aspects of What is not known
9. Diversity of Opinions
10. Analysis of Present Trends
11. Future Implications
12. Future Strategic outcomes
13. Summary & Conclusion
14. References
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