The Patient Protection and Affordable Care Act; this bill will mark the beginning of huge medical changes here in America. The number of Americans uninsured have dropped because of President Barrack Obama’s success in getting, most popularly known as Obama Care, The Patient Protection and Affordable Care Act (hereafter known as ACA) passed in 2010, which will also yield much more positive results once the bill has been enacted in 2014.
The ACA will place much needed limits on what insurers can use to exclude coverage for certain people, while also creating new departments for innovative improvements to be developed with the existing Medicare and Medicaid programs. This bill will be a legal mandate for all persons to possess health insurance coverage, and for employers to offer health insurance, all while establishing a minimum benefit package that can be offered. Obama-Care will be beneficial for the United States by making health insurance more accessible, while also prompting insurance to be more affordable.
The Patient Protection and Affordable Care Act (ACA) places limits upon the pre-existing exclusions and expenditure caps that insurance companies are allowed to use (Lance Gable, 2011). This will also lead to the removal of the insurer’s ability to place yearly aggregate and lifetime limits on the expenditures of health, as Lance Gable (2011) explained. Placing these limits will clearly provide more accessibility to people that have already been diagnosed with pre-existing health conditions. Lance Gable (p. 43, 2011) explains, “Expert analysis predicted that without the changes to the health care system in the United States enacted by the ACA, 54 million nonelderly persons would have lacked insurance by 2019, a number that is projected to be reduced substantially under the ACA”. Lance Gable (2011) also goes on to state how the only way that insurers can rescind, or revoke, coverage would be in a case of fraud. In saying that, this portion of the health care reform will still offer protection to insurers, but definitely offers more to the insured than those doing the insuring.
The provisions are indicating very significant changes to be made in the current practice of insurance, namely by the changes that will extend protections to an individual’s insurance only available to the group insurance market, previously. Lance Gable (2011) covers the portion of how the ACA will also be preventing insurers from using past medical history to include exorbitant premium rates. This particular feature of the ACA provides more affordability, alongside accessibility.
A very important feature that is arising from the ACA, and should not be overlooked, is the new “Center for Medicare and Medicaid Innovation” (CMMI), which will perform tests for innovative payment and delivery options (Davis, Abrams, Stremikis; 2011). With the new feature of this CMMI coming into play through the health care reform of the ACA, the program will be using the innovative tests to help ensure that cost growth is very limited. Davis et al. (2011) mentions an important aspect of this feature, it is designed to improve or maintain the quality of care provided in Medicaid, Medicare, and the Children’s Health Insurance Program.
With the integration of the CMMI program into our already established health care delivery system, there will be more affordability of health care across the country, namely to young children and the elderly. Davis et al. (2011) clearly state that the responsibility of carefully selecting which innovations will be tested is given to the secretary of the Department of Health and Human Services. Within that responsibility, the priority of testing will be focused on new models for primary care. Davis et al. (2011) briefly mentions that one such new model that will be tested is the patient-centered medical homes.
The main idea of this model will be to provide enhanced patient access with the use of care facilities that have organized, regular, health care teams so as to build better ongoing relationships through the patients and the clinicians. Everyone will be required to have insurance coverage, meaning that the cost of insurance will be directly affected in the sense that prices will be lower. Through the ACA, individuals are required to have insurance coverage, be it by purchase through an employer-sponsored program or via individual market through a health insurance exchange (Cartwright-Smith L ; Rosenbaum S, 2012).
Lance Gable (2011) briefly mentioned that individuals who have inadequate or none-qualifying health coverage can suffer a penalty, and employers who have more than fifty employees will have to meet the demand for providing health insurance coverage, and paying a designated percentage of the coverage. With this mandate in the ACA, people will be required to have health care coverage, all while making it more accessible and affordable.
With the help of the ACA, there will also be a number of provisions that will seek to expand the eligibility of people enrolling into Medicaid, by allowing higher income parties to be eligible for the coverage of Medicaid (Lance Gable, 2011). With such programs becoming active, more people than ever before will have access to insurance, and it will help close the coverage gaps that exist between low-income families and middle-class families. There is a large number of people in the coverage gap that exists between the middle class and low class families.
Lower class income families have government support to help with insurance and health care. Middle class families have the ability to afford, or access through work, health insurance coverage, the gap is sometimes referred to as the “donut-hole” of health care. The “donut-hole” includes all the people in between the lower and middle class families.. With the integration of the ACA, there will be an established requirement for the minimum amount of benefits to be covered by any insurance plan, mostly pertaining to preventative care.
Lance Gable (2011) specifies how there will have to be a base level of insurance benefits across all insurer. He also goes on to express that the ACA will establish prevention coverage availability across the country, which will help drive down medical cost, because of the preventative measures and health care taken (Lance Gable, 2011). The ACA will also be playing a big role in reducing the amount of ‘out-of-pocket’ money that we will have to fork over, namely for the elderly though. Cartwright-Smith L. and Rosenbaum S. 2012) talk about how contraception will be included within the ACA as a coverage of preventive services. The preventive services for contraception will include FDA approved contraception methods, patient education, sterilization procedures, and counseling to any women that have reproductive capacity (Cartwright-Smith L ; Rosenbaum S, 2012). With this they are including all forms of health care, so as to not leave any loop holes, or stones unturned. All forms of health care are included within this bill; contraception, prevention, treatment, patient education and even counseling to females capable of bearing children.
That is why this bill is not only about treatment, but also very heavily based on prevention as well. The ACA will be adding, much needed, limitations to what, and who, insurers can exclude from that which is covered in their health coverage plans. Medicare and Medicaid will only become more beneficial for those covered through those programs, by the addition of the innovative improvements department. The elderly will reap prescription benefits from the changes that will be tested through the Center for Medicare and Medicaid Innovation.
The executive branch will be enforcing the law of all individuals who need to possess health insurance, and that employers who have more than fifty employees, provide a healthcare plan while paying a percentage of the premium. With all the new limitations the ACA places on the exclusions that insurers can have, everyone will have access to coverage. There is one feature that, above all else, stands out by enabling everyone to have better coverage through the establishment of minimum benefits to be covered by an insurance plan.