Access to Affordable Healthcare

May 1986
June 1986 (revised)
May 1994 (revised)
December 1998 (revised)
March 2002 (revised)
November 2005 (revised)
November 2008 (revised)
November 2012 (revised)

Statement of the Issue

Providing appropriate access to affordable healthcare has been an ongoing challenge for the United States’ health system. The U.S. Census Bureau Report noted that approximately 49 million Americans did not have healthcare coverage in 2011. Coverage options are expected to improve for some given the passage of the Patient Protection and Affordable Care Act (PPACA) in 2011. While the PPACA was originally expected to extend coverage to approximately 32 million uninsured through individual mandates, the creation of state health insurance exchanges with public subsidized coverage and expansion of Medicaid, the Supreme Court decision that Medicaid expansion is a state option will likely reduce the number of newly covered individuals.

Even as healthcare reform decreases the number of uninsured and defines mandated benefits, the problem of access to affordable care will be exacerbated by limited community-based resources that provide preventive services, primary care access and ongoing care for patients with chronic conditions. In response, there will be a need to increase capacity to serve more patients, while improving outcomes, reducing health disparities and becoming more efficient—all within the context of significant challenges to receiving adequate payment levels.

Healthcare executives are committed to facilitating in the effort to enroll individuals in emerging coverage options and expanding needed services to help ensure access to affordable care. However, fulfilling those commitments can strain resources and put some organizations in financial peril unless adequate payment levels are established.  Fortunately, as leaders within the community, healthcare executives are well-positioned to be active participants in discussions about healthcare reform, providing their expertise regarding approaches to positively implement healthcare reform at a local level. They can be instrumental in reaching community consensus on how healthcare resources and needs should be balanced so that there is affordable access to the right level of care in the right setting at the right time.

Policy Position

The American College of Healthcare Executives (ACHE) believes no person should be denied necessary healthcare services because of an inability to pay or a lack of accessible services. Further, ACHE believes ensuring the availability of affordable healthcare is a shared responsibility of healthcare organizations as well as the government, community groups and the private insurance market. To this end, ACHE urges healthcare executives to lead the effort within their organizations and on behalf of the communities their organizations serve to address issues related to organizing and providing affordable, accessible healthcare services. Consistent with ACHE’s Code of Ethics and its policy statement, "Ethical Decision Making for Healthcare Executives," there is a responsibility to consider broader community and societal implications as well as individual and organizational impact when addressing issues such as those affecting access and affordability.

Leadership responsibilities for healthcare executives include, but are not limited to:

  • Supporting efforts to enroll uninsured individuals into emerging options for providing coverage.
  • Working to improve the distribution and quantity of needed services for vulnerable populations so that care not only is covered but also is available.
  • Developing and communicating access-to-care policies within their organizations and to the community so that individuals know that care is equally accessible regardless of specific type of coverage.
  • Managing their organizations efficiently and effectively to help control healthcare costs that might be associated with expanding coverage.
  • Encouraging and assisting trade and other professional associations to take proactive roles in access-to-care issues.
  • Organizing or participating in local, state and regional initiatives to resolve access problems.
  • Spearheading discussions with key decision makers (e.g., legislators) and key stakeholders (e.g., public agencies) to identify community health priorities so available resources can be allocated equitably and effectively.

An important role for healthcare executives has always been to translate social values into workable healthcare programs. In keeping with this role, healthcare executives have the opportunity to participate in the ongoing public dialogue about the implementation of new ways to finance and deliver healthcare so no one is denied care because of the inability to pay or limited availability of needed services.

Approved by the Board of Governors of the American College of Healthcare Executives on November 12, 2012.