Affordable Care Act (ACA)

Affordable Care Act (ACA)

The Affordable Care Act (ACA) law was signed in March 2010 by President Barack Obama and was designed as a healthcare reform bill for the United States. The Patient Protection and Affordable Care Act, or Obama Care, implemented a set of healthcare regulations aimed at increasing access to health insurance for millions of uninsured Americans.

The law increased Medicaid eligibility and established health insurance exchanges to permit and require Americans to purchase Health Insurance if they had no health insurance. It also prevented insurance companies from rejecting coverage (or charging extra) because of pre-existing conditions. In addition, the law permitted children to remain on their parent’s health insurance plan until they become 26 years old.

An Overview (ACA)

As mentioned previously, the ACA was designed to provide insurance coverage for people who were not insured, but met certain qualifications. Because the law provided tax credits and cost-sharing reductions, it assisted lower-income individuals and families so that they could afford health insurance.  The savings were from the tax credits that reduced the overall monthly health insurance costs, and the law decreased some of the associated costs of insurance including, cost-sharing reductions, out-of-pocket payments, deductibles, copays, and coinsurance.

All ACA-compliant plans, must cover certain essential health benefits, such as:

• Ambulatory patient services
• Breastfeeding
• Emergency services
• Family planning
• Hospitalization
• Laboratory services
• Services for psychological state and substance abuse disorders.
• Maternity, neonatal care, and pregnancy
• Prescription medications
• Chronic illness management, as well as preventive and wellness programs
• Pediatric services
• Service for rehabilitative purposes.

In addition, it mandates that most insurance plans include a list of free preventative care measures. These consist of check-ups, patient consultations, immunizations, and a range of health tests. It also permitted states that opted-in to cover a broader group of patients under Medicaid. That option has been adopted by 37 states and the District of Columbia as of June 2021.

Each year the healthcare marketplace opens an enrollment period during which customers can purchase or transfer insurance policies. If you miss this deadline, enrollment will be delayed until the following year. Exceptions due to marriage, divorce, having a child, or leaving a job that provides health care coverage permit enrollment outside the open period.

Improving the Quality, Efficiency, and Accountability of Healthcare Services

By enacting broad changes, Medicare and Medicaid payments changed. These new payment options and service delivery models included a new spectrum of ideas. Some of them paid for medical devices, clinically integrated & accountable care organizations, and allowed episode-based and bundled payments.

These modifications were meant to allow public payers to encourage the healthcare system to behave differently. This included terms of how health professionals were to work in a much more clinically integrated fashion. These changes affected how they monitor and report on the reliability of their care. Also, the law targeted serious and chronic health conditions and implemented monitoring hospital admissions and readmissions in order to find methods to improve the quality of care.

Improving Public Health and the Training of Health Professionals.

The Act also focuses additional public health and healthcare spending on certain subpopulations. These populations receive special attention targeted at enhancing the performance of health and healthcare programs. School-based health centers, dental health-care preventative activities, tobacco cessation programs for Medicaid-enrolled pregnant women, and the inclusion of individualized Medicare healthcare prevention planning received new funding. In addition, the Act permits significant investments in primary care health professional training.

Except for additional expenditures in teaching health centers, all changes were approved but not financed as part of the Act, and therefore, require separate budgeted funds.

The Affordable Care Act Necessitates Rapid Changes

Anyone who acquired a health insurance plan by March 23, 2010, maintained a
“grandfathered” plan. The grandfather clause guaranteed that current plans would continue as long as their insurer stayed in business.

After March 23, 2010, anybody who purchased health insurance would need to enroll in a new plan that fulfilled all of the Affordable Care Act’s new requirements.  The original deadline for this shift was January 1, 2014, or the renewal date of a plan during the 2014 plan year.

After 90 days, the Affordable Care Act required implementing the following changes.

• June 23, 2010:

• • Tax credits of up to 35 percent of premiums were available to some small enterprises.
  • A total of $5 billion was set aside for people who were unable to obtain insurance.  Instead, they were able to purchase insurance from the government with these amounts.
  • A temporary reinsurance scheme was created to pay employers for a portion of the expense of providing health insurance coverage to early retirees.

• July 1, 2010:

• • The Pre-Existing Condition Insurance Plan (PCIP) was created to provide health insurance to those who had been denied coverage by private insurers due to a pre-
    existing condition.

• September 14, 2010

• • A list of frequently asked questions published by eHealth, along with a timeframe for the implementation of major improvements. Remember that several of these elements changed throughout the implementation of the Affordable Care Act.

After 180 days, the Affordable Care Act required the following changes:

• September 23, 2010:

• • To overcome the Medicare Part D coverage gap, seniors can receive a $250 reimbursement.
  • People may search for information on health insurance firms, available plans, and other important details on a government website.
  • Pre-existing conditions cannot be excluded from coverage for children by insurers.

• October 19, 2010:
  • eHealth publishes the first in a series of materials to assist uninsured children in navigating state disparities.

In summation, the Affordable Care Act caused a major change in America’s healthcare.  Each year challenges occur, but they become nullified by the continued advancements in public health policy and practice. The Act provides reformed healthcare coverage and care, but also considers public health’s essential role to provide its citizens with universal health coverage.

What the ACA Means for You

The Affordable Care Act, which covers a large percentage of Americans, is possibly the most significant transformation of the US healthcare system yet. In addition, one of its significant innovations is the inclusion of health coverage for persons with pre-existing diseases, which previously did not universally exist. These significant changes in healthcare insurance have become beneficial to individuals and families across the nation.

With all of the good things said about the HCA, there are lots of other Health Insurance Companies.  These other Health Insurance Companies offer customized Health Insurance.  Finding the best insurance at the best price for an individual or family is still necessary to guarantee that you and your family receive great healthcare insurance at an affordable cost.

Criticizing the Affordable Care Act 

The Affordable Care Act (ACA) was criticized by many as an unprecedented extension of federal authority in the healthcare business. The reason:  it obligated everyone to acquire health insurance — whether they wanted to or not. This side of the law was a serious focus of dialogue, and it was challenged within the U.S. Supreme Court in 2012 by the National Federation of freelance Business. The court upheld the individual mandate as a constitutional use of Congress’s taxing authority, classifying the fines imposed on the uninsured as a tax.

Today, the Affordable Care Health Insurance Plan does not work for everyone, and is known as only one of the many health insurance plans available to all.  We invite you to learn more about Health Insurance for you and your family.  Our experts can help you select an affordable great plan that will pay the doctor and hospital in case you or a family member needs coverage.