Affordable Care Act
Affordable Care Act
Also known as ObamaCare or The A.C.A.
On March 23, 2010, President Obama signed the Affordable Care Act. The law puts in place health insurance reforms that rolled out over 4 years and beyond.
Like all legislation- The ACA is long and most Americans do not have the time or energy to read it. The ACA has been the topic of a lot of debate and each candidate has plans for it. Regardless of its future, this article outlines the main goals of The ACA.
OverView of the HealthCare Law:
2010: A new Patient's Bill of Rights goes into effect, protecting consumers from abuses of the insurance industry. Cost-free preventive services begin for many Americans.
2011: People with Medicare can get key preventive services for free, and also receive a 50% discount on brand-name drugs in the Medicare “donut hole.”
- 2012: Accountable care organizations and other programs help doctors and health care providers work together to deliver better care.
- 2013: Open enrollment in the Health Insurance Marketplace began on October 1.
- 2014: All Americans will have access to the Marketplace which allows individuals and small businesses to compare health plans.
- Middle- and low-income families will get tax credits that cover a significant portion of the cost of coverage.
- The Medicaid program will be expanded to cover more low-income Americans.
The following is a (lengthy) yearly breakdown adapted from “Key features of the Affordable Care Act By Year “
Provided by the National Academy of Sciences 2014
2010
NEW CONSUMER PROTECTIONS
Putting Information for Consumers Online allowing them to compare and pick options right for them.
Prohibiting Denial of Coverage for Children under the age of 19 with PreExisting Conditions.
Prohibiting Insurance Companies from Rescinding Coverage.
Eliminating Lifetime Limits on Insurance Coverage. Insurance companies will be prohibited from imposing lifetime dollar limits on essential benefits, like hospital stays.
Regulating Annual Limits on Insurance Coverage. Insurance companies' use of annual dollar limits on the amount of insurance coverage a patient may receive will be restricted.
Ability to appeal Insurance Company Decisions and claims, establish an external review process.
Establishing Consumer Assistance Programs in the States that apply for grants to help set up or expand offices to help consumers navigate the private healthcare system.
IMPROVING QUALITY AND LOWERING COSTS
Small Businesses Health Insurance Tax Credits worth up to 35 percent of the employer's contribution to the employees' health insurance. Small non-profit organizations may receive up to a 25 percent credit.
Eligible seniors with Medicare Prescription Drug plan will receive a one-time, tax free $250 rebate check for gaps in coverage.
Free Preventive Care. All new plans must cover certain preventive services such as mammograms and colonoscopies without charging a deductible, co-pay, or coinsurance.
$15 billion Prevention and Public Health Fund will invest in proven prevention and public health programs- like smoking cessation and combating obesity.
Investing in new screening procedures to prevent Health Care Fraud
INCREASING ACCESS TO AFFORDABLE CARE
Access to uninsured Americans with pre-existing conditions.
Extending coverage for young Adults, allowing them to stay on their parents plan until 26 years old.
Expanding Coverage for Early Retirees between the ages of 55 and 65 until more affordable coverage is available through the Marketplace.
Rebuilding the Primary Care Workforce of Primary Care Physicians, nurses and Physician assistants by providing incentives like scholarships and loan repayments.
Holding Insurance Companies Accountable for Rate Hikes, insurance companies with excessive or unjustified premium exchanges may not be able to participate in the new health insurance Exchanges in 2014.
Federal funding for States to cover more people on Medicaid .
Increasing payments for Rural Health Care Providers.
Funding to support construction of Community Health Centers.
2011
IMPROVING QUALITY AND LOWERING COSTS
50% Prescription Drug Discounts for seniors when buying Medicare covered brand name and generic drugs.
Free Preventive Care for Seniors on Medicare, such as annual wellness visits.
Establish a new Center for Medicare & Medicaid Innovation that will begin testing new ways of delivering care to patients. Aiming to Improving Health Care Quality and Efficiency.
Transitions program for Seniors with Medicare after they leave the hospital.
The Independent Payment Advisory Board is expected to focus on ways to target waste in the system, and recommend ways to reduce costs, improve health outcomes for patients, and expand access to high-quality care.
INCREASING ACCESS TO AFFORDABLE CARE
Increasing Access to services at home and in the community for disabled individuals through Medicaid.
HOLDING INSURANCE COMPANIES ACCOUNTABLE
Health Care Premiums; at least 80 percent of all premium dollars are to be spent on health care services and health care quality improvement. If insurance companies do not meet these goals because their administrative costs or profits are too high, they must provide rebates to consumers.
Addressing Overpayments by Medicare to Medicare Advantage Companies .
2012
IMPROVING QUALITY AND LOWERING COSTS
Linking Payment to Quality Outcomes. Offering financial incentives to hospitals to improve the quality of care. Hospital performance is to be publicly reported.
Encouraging physicians to join Integrated Health Systems to better coordinate care.
Reducing paperwork and administrative costs by instituting a series of changes like electronic medical records.
The Secretary of Health and Human Services will collect and report racial, ethnic and language data to help identify and reduce disparities.
2013
IMPROVING QUALITY AND LOWERING COSTS
Provide funding to state Medicare programs that choose to provide Preventive Health Coverage.
Bundle Payments provide incentive to providers to deliver healthcare services more efficiently.
INCREASING ACCESS TO AFFORDABLE CARE
Increasing Medicaid Payments for Primary Care Doctors
Open Enrollment in the Health Insurance Marketplace Begins.
2014
NEW CONSUMER PROTECTIONS
Prohibiting insurance companies from refusing coverage or charging higher rates due to Pre-Existing Conditions or Gender.
Eliminating Annual Limits on Insurance Coverage.
Ensuring Coverage for Individuals Participating in Clinical Trials.
IMPROVING QUALITY AND LOWERING COSTS
Tax credits to those with an income of ~ 43,000 for an individual or $88,000 for a family of four. Aimed to be applied to insurance premiums
The Health Insurance Marketplace. Starting in 2014 if your employer does not offer insurance, you are able to buy it directly in the Health Insurance Marketplace.
Second phase of the Small Business Tax Credit who provide health insurance to employees.
INCREASING ACCESS TO AFFORDABLE CARE
Increasing Access to Medicaid. Americans who earn less than 133% of the poverty line ~ $14,000 for an individual and $29,000 for a family of four will be eligible to enroll in Medicaid.
Promoting Individual Responsibility. Most individuals who can afford it will be required to obtain basic health insurance coverage or pay a fee to help offset the costs of caring for uninsured Americans.
2015
IMPROVING QUALITY AND LOWERING COSTS
Value based Physician reimbursement
-Be well, Dr. D
Sources:
Forum on Medical and Public Health Preparedness for Catastrophic Events; Board on Health Sciences Policy; Board on Health Care Services; Institute of Medicine. The Impacts of the Affordable Care Act on Preparedness Resources and Programs: Workshop Summary. Washington (DC): National Academies Press (US); 2014 Aug 27. F, Key Features of the Affordable Care Act by Year. Available from: https://www.ncbi.nlm.nih.gov/books/NBK241401/#
https://www.hhs.gov/healthcare/about-the-aca/index.html
https://www.ncbi.nlm.nih.gov/books/NBK241392/