- The Affordable Care Act (ACA) is a comprehensive health reform legislation, which was signed into law by President Obama on March 23, 2010. The new law aims at expanding healthcare coverage, increasing healthcare access and affordability, controlling health care costs, ending insurance abuses, improving health care delivery systems, lowering Medicare costs, and improving Medicare services (Gardner 136).
- The major health coverage provisions included in the ACA involve the individual mandate requirements, health insurance exchanges, employer requirements, expansion of public programs, changes to private insurance, and cost/coverage estimates. Under the new law, most U.S. citizens are expected to have obtained health insurance as of 2014 or risk paying a tax penalty, and most citizens lacking access to affordable employer coverage will access coverage through health insurance exchanges. Moreover, with the exception of small businesses, all employers will pay penalties for their employees who will be receiving tax credits in order to purchase health insurance through health insurance exchanges. Furthermore, the new law will prevent insurance companies from denying health insurance coverage to persons who have a pre-existing condition or for any other reason such as gender. Additionally, the law is expected to expand Medicare coverage by 133% of the federal poverty level, which is currently pegged at $14,404 for individuals and $29,327 for a family of four (Gardner 136; Clemans-Cope et al. 920).
- Health coverage plans, which put a lifetime limit on the covered benefits, are prohibited under the Affordable Care Act. Moreover, the new law will restrict and phase out all health plans, which place an annual dollar limit on the benefits received. More specifically, the lifetime and annual dollar limits will be removed by 2014 (Clemans-Cope et al. 923). Therefore, if the Supreme Court overturns the ACA, millions of the U.S. citizens will be thrown into chaos and confusion considering that most if not all of the programs created under the ACA will be invalid. This implies that over 32 million Americans who were expected to obtain health coverage by 2014 will remain uncovered or underinsured. Moreover, some of the contracts signed under the ACA will have to be suspended, re-written, or withdrawn altogether.
- The ACA seeks to lower the Medicare costs by restructuring payments to the Medicare Advantage (MA) plan, freezing the threshold for Medicare Part B, reducing the premium subsidy for Medicare Part D, removing the Medicare Improvement Fund, and reducing the Medicare Disproportionate Share Hospital (DSH) payments. On the other hand, the ACA will improve Medicare services for senior citizens by enabling over 26 million seniors to access free preventive care services. Here, the role of preventive care is to cut back on the billions of dollars that go into treating preventable conditions such as diabetes, heart disease, hypertension, and obesity. As a result, if the ACA is overturned by the Supreme Court, millions of senior citizens will miss out the free preventive care services, and hence the Medicare costs will continue to swell in order to support the suspended services among other things such as the subsidized payment for prescription drugs (Gardner 138).
- The ACA seeks to eliminate the extra charges attached to women’s health plans besides discouraging plans which exclude coverage for maternity care. Therefore, under the new law, most women can access plans which offer preventive care services such as prenatal screening, colonoscopies, and mammograms at no extra cost. Furthermore, the new law proposes plans to incorporate well-women visits, contraception costs, and HPV testing into women’s health plans without co-payment or extra deductions (Kenny et al. 899).
- Young adults in the age of 25 and below will access health coverage through their parent’s health insurance plans; all thanks to the new healthcare law. This implies that the young people will receive health care services up until they are able to purchase their own health insurance covers. Besides, under the new law, no insurance company is expected to deny the young people insurance coverage due to the pre-existing condition (Gardner 138).
- The ACA introduces tax credits and other programs, which will allow small businesses and other non-profit establishments to provide affordable care for employers, employees, and even retirees. Here, the ACA introduces the Small Employer Tax Credits for small businesses in order to reduce the cost of health insurance. Moreover, under the new law, there is the Early Retiree Reinsurance Program (ERRP), which seeks to provide small businesses with financial help to support health insurance coverage for retirees in the ages of 55-64 (Gardner 138).
- The ACA will ensure that insurance companies do not deny insurance coverage to children under the age of 19 on the basis that they have a pre-existing condition. Moreover, adults with pre-existing conditions can access health insurance through the Pre-existing Condition Insurance Program. Furthermore, by 2014, no insurance company is expected to deny insurance coverage to any U.S. citizen or charge them an extra cost on the basis that they have a pre-existing condition (Gardner 140).
- The ACA introduces Rate Reviews, which seek to control the increases in health insurance premiums. This implies that any rate hikes are subject to review in order to ensure that premium increases remain within the reasonable limits besides ensuring fairness and transparency in the insurance industry. On the other hand, the new law introduces the Medical Loss Ratio, which seeks to safeguard the taxpayers’ money by ensuring that insurance companies spend more on providing health care services compared to what is spent on CEO bonuses, advertising, and other profit-based services (Kenny et al. 900).
- The ACA provides for clinical preventive services in order to ensure that insurance companies offer affordable group and individual plans at no out-of-pocket cost. This implies that the ACA’s preventive services provisions will encourage people to embrace early prevention and health promotion practices such as counseling, immunization, and screening (Gardner 145).
- The ACA was signed into law on 23, March 2010, and by June 10, 2010, senior citizens started to receive the rebate checks to pay for their drug costs. By July 1, 2010, most citizens with pre-existing conditions could purchase insurance covers. As of September 23, 2010, the U.S. citizens started to enjoy the first set of protections against any form of exploitation from insurance companies. Moreover, it is expected that the government will introduce new standards by July 2012 to ensure that patients receive better and quality medical care. Furthermore, it is projected that the ACA will introduce additional preventive care services such as mammograms and cervical cancer screenings to women’s health plans by August 2012. In addition, by January 2013, the ACA will seek to strengthen the quality of care for patients by improving Medicaid and Medicare services. By January 2014, additional patient protection rules will take full effect, and insurance companies will no longer deny citizens insurance coverage due to pre-existing conditions. Lastly, more U.S. citizens are expected to have purchased insurance coverage by January 2014 (Gardner 136; Clemans-Cope et al. 925; Kenny et al. 900).
- The individual mandate of the ACA dictates that the U.S. citizens and legal residents must have health coverage by January 2014 or risk paying a tax penalty of more than $695 per annum or $2,085 per family (2.5% of the household income) up until 2016 when the penalty will increase annually relative to the prevailing cost-of-living adjustment (Gardner 147). As a result, if the Supreme Court decides that the individual mandate is unconstitutional, then it is most likely that the essential protections for insurance consumers provided for by the ACA will become invalid considering that the two are closely related.
- The “doughnut hole” refers to the period when seniors with Medicare are required to pay for their prescription drug costs as provided in Medicare Part D. However, the ACA will ensure that senior citizens in the drug coverage gap are eligible for a 50 percent discount on prescription drugs starting from 2011 and beyond. In fact, the discounts are expected to be effective until the end of the drug coverage gap in 2020 (Gardner 140).
- Studies indicate that the United States spend about 15% of the GDP in providing health care, which implies that healthcare is the largest consumer of taxpayers’ money in the United States compared to other developed and developing countries. However, despite the high levels of expenditure on healthcare, most U.S. citizens are uninsured, underinsured, or receive half of the recommended standards of healthcare services. Furthermore, in the United States, the quality of care does not vary with the prevailing socioeconomic factors such as availability of insurance, poverty, and the supply of hospital beds and clinicians. It then follows that there is no direct relationship between costs and access to the healthcare industry because the amount of money one spends does not necessarily mean that access to healthcare services will improve. This implies that there are many factor, which influence the healthcare accessibility besides the cost of healthcare (Goldman et al. 1).
From a personal perspective, there are many benefits, which can be derived from the ACA now and in the future. For instance, as a young person, the ACA provides me with the opportunity to access quality healthcare through my parents’ health insurance plan till I get ready to purchase my own health insurance cover in the near future. This will also ensure that I am adequately prepared to purchase the most favorable health insurance cover by the time I am 26 considering that there are many options in the market currently.
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