What is the ACA?
- Before 2010, 50 million Americas did not have any kind of health insurance
- The affordable Care Act of 200
- A common
... [Show More] misconception: The ACA is a government-run healthcare system
- The ACA is built off of current public and private insurance companies
- Patchwork solution (not a government run funding program but that the government patched it together.)
There are 3 key features of the ACA:
- New customer protections
- Improving quality and lowering costs
- Increasing Access to Affordable Care
New Customer Protections
1) Prohibits discrimination due to Pre-existing conditions or gender
- Prohibits insurance companies from refusing to sell coverage or renew policies to people with pre-existing conditions (smokers get charged 50% more, if you had depression before you cant get charged more)
- It also prohibits insurance companies from charging higher rates based on health status (worse or good health cant make someone pay more or less)
2) Establishes customer Assistance Programs in the States
- States can apply for federal grants to help consumers navigate the new health care system
Lowering Costs
- Making health care more affordable: for individuals making 43000 a year or less or families of four making 88000 a year
- Tax credits are available to help lower the cost of their insurance.
Improving quality
- Establishing the Health insurance marketplace: beginning this year (2014), if an employer doesn't offer an individual insurance
-*** (important) people will be able to buy directly in the HEalth Insurance Marketplace instead of only getting insurance through their employer
- The marketplace offeres a choice of plans that meet certain benefits and cost standards: creates a highly transparent and competitive market, website: healthcare.gov
Increasing Access to Medicaid
- In 2014, the qualifications for MEdicaid expanded to 133% of the poverty level
- (14000 a year for an individual and 29000 for a family of four)
- States will receive 100% federal funding to support expanding coverage
- Extending coverage to Young Adults: under the law, young adults will be allowed to stay on their parents health plan until they turn 26
Case Studies: diabetes- eligible or not
- Uninsured male, 67, Type I diabetes: the annual costs for diabetes is about 13,700 a year, under the ACA, Diabetes is categorized as a "Pre-existing condition"
- PCIP: Pre-existing Condition Insurance Plan- provides insurance to US citizens with a pre-existing condition who have been uninsured for over 6 months
- Covers major medial and prescription drug expenses, hospital care, preventative care, and annual physicals
- PCIP users required to pay any premiums, deductibles, co-payments
- This male is also eligible for Medicare, which can help cover the remainder of his health care costs.
Case Study: Pneumonia- Eligible or Not?
- Female, 25, Pneumonia: before the ACA became a law, young adults "aged off" of their parents health insurance when they turned 19
- Effective September 2010, if you are covered under your parents insurance, you can remain covered up to age 26: in this way this female is eligible for health care to treat her pneumonia.
- If her parents are also uninsured: This female qualifies for Medicaid if she is unemployed or she can purchase individual health care: colorado.gov/healthcarereform
Coverage Options: 26-36
- For this age group ("aged off" of parents insurance), individuals are generally healthy, so the ACA relies on this age group to buy into the Marketplace's insurance plans to help pay for the increased pool of insured Americans
- Here are their options:
public coverage: provided by the government, and is based on criteria such as low income, age, disability, etc.
Private Coverage: Insured sold through a private company. Under the ACA, there is more access to private coverage and limits on costs, found on the Health Insurance Marketplace (healthcare.gov)
Summary:
- Before the ACA, 50 million Americans could not afford health care, so they were left uninsured
- This creates a great amount of risk for the country as a whole, with an enormous population that risks bankruptcy if they fall ill and require medical attention
- This also discourages a healthy lifestyle because this large population is forced to ignore illnesses, or have chronic diseases go untreated=preventative vs. reactive (people act differently if they know going to the doctor is 3 dollars or 1000 dollars)
More summary
- With the ACA, the pool of insured Americans is dramatically increased, and "patches" have been created to cover the gaps: Low income individuals and families, elderly, small business owners and non profit organizations, children ages 19-26, individuals with pre-existing conditions
- Ultimately, the ACA allows more people to qualify for more health coverage: the long term goal is to encourage and promote a healthier and more health conscious nation, without the stress of high costs and limitations barring Americans from gaining coverage. [Show Less]