Health Care Environment Policy and Patient Protection by Affordable Care Act In United State

The Health Care Environment Policy and Patient Protection by Affordable Care Act In United State. The Affordable Care Act (ACA) is a comprehensive reform passed in 2010 that increased health insurance coverage for the uninsured and implemented reforms to the health insurance market.

What Is Health Care Environment Policy and Patient Protection by Affordable Care Act In United State

The Patient Protection and Affordable Care Act (ACA), also known as Obamacare, seeks to make health insurance more accessible and affordable for Americans, while improving the quality of care and reducing costs. Key aspects include expanding Medicaid, creating health insurance marketplaces, prohibiting discrimination based on pre-existing conditions, and ensuring that young adults can obtain coverage through their parents’ health insurance.

Key Provisions and Patient Protections

Expanded Access to Coverage

The ACA expanded Medicaid eligibility to more low-income people and established health insurance marketplaces where individuals and small businesses can purchase insurance plans.

Preexisting Conditions

The ACA prohibits insurance companies from denying coverage to people with preexisting conditions or charging higher premiums.

Basic Health Benefits

All plans that comply with the Affordable Care Act (ACA), including those offered in the health insurance marketplaces, must cover a variety of basic health benefits, such as preventive care, prescription drugs, and mental health services.

Insurance for Young Adults

The ACA allows young adults to remain on their parents’ health insurance until age 26.

Out-of-Pocket Cost Requirements

The ACA originally imposed a co-payment requirement that required most people to purchase health insurance or pay a penalty. However, this penalty was later repealed.

Cost-Sharing Reduction

The ACA offers subsidies to reduce health insurance premiums for people with incomes between 100% and 400% of the federal poverty level.

Preventive Services

The ACA requires that many preventive services, such as vaccinations and screenings, be covered without cost-sharing (copayments, deductibles, or copayments).

Internal and External Appeals

The Affordable Care Act (ACA) requires insurers to maintain internal appeals processes for coverage and claims decisions, and in many states requires compliance with external review processes.

Transparency and Accountability

The ACA includes provisions designed to improve transparency and accountability in the healthcare system, such as requiring insurers to allocate a certain percentage of their premiums to medical care.

Overall Impact

The ACA has significantly expanded health insurance coverage in the United States, reduced the number of uninsured people, and improved access to preventive care. While it has been praised for these achievements, it has also been criticized for its cost and complexity. The ACA remains the subject of debate and has been amended through various laws and regulations since its enactment.

The Patient Protection And Affordable Care Act

The ACA was enacted into law on March 23, 2010, after a lengthy political battle. The ultimate goal of this law was to reduce the number of uninsured persons in the United States by expanding Medicaid and implementing health-care exchanges. The health-care exchanges would allow the uninsured and other eligible persons to select health insurance coverage, which would include essential health benefits , through state or federal exchanges. Many eligible persons would also receive government subsidies that would make health care affordable to those who qualified based on their income (Henry J. Kaiser Foundation, 2016).

Provisions included in the ACA guarantee availability of insurance with the elimination of pre-existing conditions as a means of denial for insurance. Other requirements of the ACA include the following: no annual limits on coverage; mandated coverage by employers with at least 50 full-time employees; extension of coverage to adult children to age 26 years with individual and group health policies; the inclusion of preventive services without cost sharing, if recommended by the U.S.

Preventive Services Task Force; and limitation of annual cost sharing to the maximums allowed for health savings accounts ($5,950 for individual plans and $11,900 for families) (Henry J. Kaiser Foundation, 2016). Lesser-known stipulations of the ACA are annual taxes for individuals without health insurance coverage, a 10% tax on indoor tanning services, an annual fee paid by the pharmaceutical industry, an excise tax of 2.3% on any taxable medical device, and a fee of no less than $2,000 per employee for an employer not offering health insurance where an employee receives a tax credit (Henry J. Kaiser Foundation, 2016). On June 28, 2012, the U.S.

Supreme Court, in National Federation of Independent Business v. Sebelius, determined that the ACA was constitutional with the exception of the portion requiring states to participate in Medicaid expansion. This portion was deemed coercive because all Medicaid funds would be at risk, and states were not given adequate notice to consent voluntarily (Holahan, Buettgens, Carroll, & Dorn, 2012).

Before the U.S. Supreme Court ruling on the constitutionality of the ACA, expansion of Medicaid by the states was required or states would forfeit their federal Medicaid funding (Diamond, 2012). After the Supreme Court ruling, states would forfeit new Medicaid funding only if they opted out of Medicaid expansion. The requirement to expand Medicaid by the states was left to the discretion of each individual state after the court’s ruling. In 2015, 21 states had continued to decline expansion of Medicaid secondary to the Supreme Court’s ruling. Medicaid expansion by states can be tracked at www.statereforum.org/ Medicaid-expansion-decisions.

Medicare and Medicaid

In the United States, Medicare and Medicaid are forms of government-provided health insurance, primarily for disabled persons, older persons, and economically disadvantaged persons, including children. Both programs are overseen by the Centers for Medicare and Medicaid Services (CMS), a division of the U.S. Department of Health and Human Services. Medicare provides health insurance for disabled persons and persons age 65 and older and consists of four components: Parts A, B, C, and D.

The U.S. citizens must have worked a minimum of 10 years and paid into the Medicare Trust Fund. As of 2016, the eligibility age is 65 years, although there has been discussion about amending eligibility criteria for many years (Medicare.gov, n.d.). Medicaid provides health care coverage to low-income people (primarily for children, nondisabled adults, and pregnant women) and is one of the largest payers for health care in the United States.

The Children’s Health Insurance Program, also known as CHIP, is the Medicaid program for children and provides federal matching funds to states who provide health care coverage to children in families who cannot afford private insurance but have incomes too high to qualify for Medicaid. As of May, 2016, there were more than 8.3 million children enrolled in CHIP (Medicaid.gov, n.d.).

At the time the ACA became law, 32 million Americans lacked health insurance, and although provisions were provided in the ACA to allow greater access to Medicaid, many states were allowed to opt out of expanding Medicaid, a key provision within the law, as a result of the Supreme Court ruling in June 2012. Although this situation has denied a large percentage of the uninsured access to the system, pressure from health-care providers and health-care systems will likely prevail in expanding Medicaid after initial implementation (Jacobs & Skocpol, 2012).

A key provision of the ACA’s Medicaid expansion was the eligibility of adults without dependent children to qualify for Medicaid. Before the ACA, Medicaid eligibility was available only to low-income individuals such as children, older adults, or disabled persons. The income eligibility level for Medicaid, before the ACA, was significantly less than required by the ACA, which extended eligibility to 138% of poverty guidelines (Kaiser Commission on Medicaid and the Uninsured, 2014).

The Kaiser Commission on Medicaid and the Uninsured (2014) identified another unfortunate consequence of states’ not expanding Medicaid. The original law required Medicaid expansion by all states and did not anticipate the gap that would occur between those eligible for Medicaid at current state levels and those who would not be eligible for Medicaid if a state opted out of Medicaid expansion.

The persons within this gap, which equated with the state’s established income eligibility for Medicaid through incomes up to 138% of poverty guidelines, would subsequently not qualify for marketplace tax credits, even though they were not eligible for Medicaid. Those numbers equated with 5.2 million persons nationwide who would be denied access to the new health-care system (Kaiser Commission on Medicaid and the Uninsured, 2014).

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