Evaluation of Health Insurance
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Evaluation of Health Insurance
Healthcare, one of the oldest human functions, serves as a basic human need and the United States is currently in the midst of a major reform in this field and changes in the reimbursement of Medicare. Over the last few years, the American public has seen a political contest about government policy on a scale an intensity and scale not witnessed in decades. Perhaps astoundingly, this no-holds-barred political battle has been about how, whether, and to what extent the country should broaden the coverage of health care insurance to over 30 million currently uninsured citizens. The strategies include both the ordinary and extraordinary, with the recent one being a repeal, withdrawal, and replacement of the 2010 Patient Protection and Affordable Care Act (PPACA), more frequently denoted as the Obamacare. This paper reviews the 2010 PPACA and provides an overview of the law by including specific dates of policy implementation, subsequent changes, a review of the health insurance marketplace, and the authors’ opinion on the potential successes and failures.
Overview of the PPACA
Also known as the 2010 Affordable Care Act (ACA), the Patient Protection and Affordable Care Act (PPACA) was designed with the intention of ensuring that all U.S. citizens get access to quality, affordable healthcare that will ultimately reduce the cost of medical care, which has been on the rise over the past years. According to the Congressional Budget Office (CBO), the PPACA is wholly paid for and has the ability to provide coverage to over 94 percent of the United States citizens while remaining under the $900 billion maximum limit that was established by President Obama. The thought behind the Act is to impact the curve of the healthcare cost in a positive manner and to reduce the U.S. deficit over a period of one decade and beyond (Murdock, 2012). PPACA comprises of 10 components that address a critical element of the ACA reform, ranging from quality, affordable medical care for all United States citizens to the re-approval of the Indian Healthcare Improvement Act.
The enactment of PPACA into law occurred on March 23, 2010, shortly after which the act’s name was changed to the 2010 Health Care Reconciliation Act. The act’s primary goal is to expand healthcare insurance coverage and simultaneously condense the medical expenditures that Medicare has been encountering over the years. Additionally, the PPACA intends to increase for individuals and families in the high-income bracket the payroll tax of Hospital Insurance (HI) that employers pay by 0.9 percent (Kaiser Family Foundation, 2013). The act has also allowed for “a 3.8 percent unearned income Medicare contribution on income from annuities, dividends, interest, and other non-earning sources for high-income taxpayers” (Harrington, 2015, p.94). According to Harrington (2015), policymakers estimate that the average net savings to the Medicare Part A Trust Fund will be that the projected exhaustion of the fund assets will be extended by a period of years from 2017 to 2029 under the PPACA. Nonetheless, the estimated savings through efficiencies and productivity gains are not fully sustainable over the projected extension, the overall savings, and the anticipated date that the Medicare Part A Trust Fund will be shortened.
The first component of the PPACA deals with the provision of quality healthcare that is affordable to all Americans. The Obama administration designed the Act so as to enable businesspersons, families, and individuals to have full control over their health care. Under its first component, the PPACA aims to reduce premiums by providing tax relief for millions of working families and small business owners, which will end up being the largest tax cut for the middle class in the U.S. history. The Act also addresses the amount of money that families will have to provide as payment by reducing it through limiting the amount of out-of-pocket costs that families must pay. Additionally, according to the provisions of the PPACA, there will be preventive services offered to the families that may not have had access to such services in the past, which will be fully covered by the insurance coverage that they have. However, it is important to mention that if an individual or family is contented with their current coverage for health care, they do not have to change it to a plan that is offered through the PPACA (Harrington, 2015).
The PPACA provides persons and families without coverage the ability to select a plan of health care insurance that best fits their needs. This proves to be a comforting option for those Americans that are currently underinsured or uninsured, especially because they can get a healthcare insurance plan that fits their needs and they do not have to worry about whether the plan is dependable and good enough. To realize affordable plans, the insurance exchange will combine the buying powers of individuals to reduce premiums in such a manner that the insurance companies have to compete for their members – an approach that is entirely different from those that have been in use in the past years (Kaiser Family Foundation, 2013). What is more, as per the PPACA, the insurance companies will have to adhere to the rules of not denying coverage for an individual owing to a pre-existing condition. In consort with this, a person will have a new-found power to appeal the decision of insurance firms to deny a service or treatment ordered by a doctor and found to be therapeutically indispensable (Carlson, 2015).
Another important component of the PPACA is the enhancement of the health care quality and efficiency. The Act addresses the Medicare status and ensures the protection of the Medicare Trust Fund and the overall commitment to senior U.S. citizens who rely on the coverage. It also allows for primary physicians, nurses, and hospitals to manage the pharmacy expenses of Medicare beneficiaries, as well as the provision of incentives to physicians and nurses to improve the quality of care offered to the beneficiaries. In addition to healthcare cost reduction and the enhancement of access to the Medicare beneficiaries in urban areas, the PPACA pays attention to improving access to areas that are in rural settings. Moreover, the act helps to tighten up and reduce the overpayments made to insurance firms (Harrington, 2015). The cost savings of billions of dollars that will result from avoiding overpayment to insurance companies will help to corroborate the commitment to conserving Medicare for the next generation of beneficiaries so that they can get the care that they have come to expect through the years.
Other noteworthy components of the PPACA are chronic disease prevention, improvement of public health, and the re-approval of the Indian Health Care Improvement Act (IHCIA). The PPACA ensures that there is sufficient funding and devotion to those areas that deal with the prevention of illnesses and the promotion of public health and wellness. The act aims to develop a national model for the promotion of health and disease prevention that will look to integrate the most effective and obtainable methods of improving the overall health of the U.S. citizen. Additionally, the aim of the PPACA is to reduce the prospects of preventable ill health and diseases that currently prevail in the U.S. The final component of the PPACA deals with the reauthorization of the IHCIA that provides care for Alaskan Natives and American Indians (Harrington, 2015). Reauthorizing the IHCIA will ultimately modernize the healthcare system and improve the quality of health delivered to the millions of beneficiaries that are currently receiving services under the program.
Specific Dates of Policy Implementation and Subsequent Changes
According to Milstead (2013), policy implementation includes the mechanisms and actions whereby policies are brought into practice – in other words, where that which is written in the legislation document is turned into reality. One of the major policy implementation of PPACA relates to new consumer protection, whereby in 2010 the Act put insurance coverage online for the consumers to allow them to carry out comparisons between coverage plans and to pick the best one that suits their needs. Subsequent policy implementation of the PPACA occurred in 2011, whereby the state provided for discounts on prescription drugs, increased access to home care and focused on the accountability of insurance firms. In 2012, the federal government introduced value-based purchasing and established Accountable Care Organizations (ACO), while in 2013 it improved preventive health care coverage and initiated the health insurance marketplace. This was followed by the elimination of discrimination against persons with pre-existing conditions in 2014 and the prohibition of insurance firms from charging higher rates due to health status or gender in the same year (Harrington, 2015).
Several changes have also been made to the PPACA over the last few years. According to Turner (2016), there are at least 70 noteworthy modifications that have been made to the act. The Obama administration made at least 43 of the changes unilaterally, Congress passed 24 of the changes and President Obama signed them into law, while the Supreme Court made 3 alterations. Some of the changes include credit extension to individuals in receipt of employer-sponsored coverage, doubling of allowed deductibles, and allowance of self-attestation of eligibility and income by those applying for health insurance coverage. The elimination of caps on deductibles, especially for plans of the small group category, and allowing for the expansion of Medicaid to be voluntary also comprise of the changes that have been made to the PPACA (Turner, 2016).
Review of the Health Insurance Marketplace
The marketplace for health insurance is a new way to shop for coverage if a person is currently looking for one and needs options. The marketplace enables an individual to learn if he or she can find coverage at a subsidized rate and make comparisons of different plans side-by-side. A person must provide some basic information regarding themselves, such as household income and size, so as to be able to view plans in the specific area that best fits their needs. Additionally, the marketplace allows individuals to know if they are eligible for lower cost coverage through Medicaid or CHIP. One can apply online by a smartphone or computer as well as in person (Harrington, 2015). There is a qualified support staff available to help individuals find their way around choosing a coverage for themselves or family members 24/7.
Authors’ Opinion on the Potential Successes and Failures
The provisions of the PPACA that extend coverage and modify the rates of Medicare payment have the potential to impact on the costs of liability insurance through various conceivable mechanisms. More specifically, the PPACA is capable of ensuring unswerving changes in the rates of reimbursement for providers as well as modifications in the availability and accessibility of payments from health care insurance firms, and these have the potential of affecting liability insurance costs to the favor of the average American citizen. The Act also offers the potential to deal with persistent discrepancies in quality and incorporation of services at the line between primary care and behavioral health. Nonetheless, there are potential failures of the PPACA which may possibly be evidenced by the negative effects on poverty-stricken minority families who do not utilize the health care resources available. Moreover, the PPACA does not specify how it will make a difference with racial discrimination by insurance companies and physicians.
We often hear the term “Obamacare” used to refer to the 2010 Patient Protection and Affordable Care Act (PPACA). It is spoken with disdain by critics while supporters recoil when they hear it. While the act marks a major milestone in the public policy history of the U.S., we must remember that it is not the final goal of universal health care but rather a significant foundation for policies and programs that will continue to move the United States forward to the coverage of universal healthcare. The U.S. has been wrestling with putting in place some system to provide Americans with quality health care coverage that is affordable, and until the passage of the PPACA, each attempt has failed. Fortunately, the country has managed to pass important programs like Medicaid and Medicare to cover the most vulnerable population groups thanks to the PPACA. However, the U.S. remains far behind most of the developed countries in terms of providing healthcare coverage to all population groups which calls for the revision of the PPACA, the effective implementation of its policies, and the development of an all-encompassing health care coverage legislation.
Carlson, D. (2015, February 8). 5 Major Components of Health Care Reform and What They Mean for You. Retrieved May 4, 2017, from http://www.youngadultmoney.com/2013/04/08/5-major-components-of-health-care-reform-and-what-they-mean-for-you/
Harrington, M. (2015). Health Care Finance and the Mechanics of Insurance and Reimbursement. Burlington, MA: Jones & Bartlett.
Kaiser Family Foundation. (2013, April 23). Summary of the Affordable Care Act. Retrieved May 4, 2017, from http://kff.org/health-reform/fact-sheet/summary-of-the-affordable-care-act/
Milstead, J. (2013). Health Policy and Politics: A Nurse’s Guide. Burlington, MA: Jones & Bartlett.
Murdock, K. (2012). Affordable Care Act: Obamacare. Munich, Germany: GRIN Verlag.
Turner, G. (2016, January 28). 70 Changes To Obamacare… — So Far. Retrieved May 4, 2017, from http://galen.org/2016/changes-to-obamacare-so-far/