The Patient Protection and Affordable Care Act

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The Affordable Care Act (Patient Protection and Affordable Care Act), commonly called “Obamacare,” is a federal statute that was signed into law in March of 2010 (Van de Water, 2011). It basically requires most people in the United States who do not have insurance coverage to acquire that coverage or face penalties. People who already have insurance through their employers or on their own will not be asked to change companies. Additionally, anyone who is on federally-funded insurance such as Medicaid or Medicare and still qualifies for those programs will not be removed from their insurance. They will still be covered and protected. In order to find out more about the Act and really understand its main points and principles, however, it is very important to be aware of how it became a law and any changes that have taken place to it from its inception all the way through where it is today. Only then can a person have a clear understanding of the Act and form an opinion as to the value it may (or may not) provide to the American public. There is still much speculation and a great deal of misunderstanding about the Act and what it involves.

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The issue regarding the lack of healthcare in America is prominent but is a more significant issue than what is commonly known. For instance, it is not publicly recognized that those who are mentally ill are covered by the same healthcare as those with conventional ailments. Because of this, money becomes an issue; health insurers cannot cover every case or cannot fully cover any case. The Affordable Care Act (ACA) and Patient Protection Act, both part of Obamacare, were passed to fix this very issue; these acts are ultimately attempts to reach parity. However, the chance to have healthcare that fulfills parity, equality of coverage, has passed, the ACA is too late, and it is time to come up with new solutions. To settle for the ACA as the final step towards parity is mediocre at best.

The Affordable Care Act has been at the center of political debate within the United States for the since current President Barack Obama signed it into law in 2010. The act represents the most significant regulatory healthcare overhaul of the United States healthcare system since the passage of both Medicaid and Medicare collectively Initially, the ACA was enacted with the goals of increasing the availability of affordable health insurance, lowering the uninsured rate by expanding public and private insurance and reducing cost of healthcare for individuals and the government (Robert, 2012). Proponents of the act’s passage have articulated that the ACA provides service for free, such as preventative health coverage for those registered, it requires that insurance companies can no longer deny person’s or children with pre-existing conditions and will close the Medicare Donut Hole for prescription drugs. While the Act has the potential to provide better quality of healthcare for the American populace, opponents argue that the ACA is flawed and could create a quagmire of cost and confusion with its implementation. Arguments against it hold the belief that it would force employers with religious affiliation to provide services to employees through their health plans that directly contradict their values. Because of cost, companies may void out of their employer health insurance and pay a penalty as opposed to pay for employee insurance. Lastly, the act is said to focus more on registration the addressing cost of healthcare. While these issues are pertinent, the overall accessibility to healthcare created by the ACA and outweighs the negating arguments.

A primary reasoning for promoting the act for the fact that it offers free preventative health care coverage (Obamacarefacts.com, 2013). Because of the ACA’s passage into law, most health plans must cover a set of preventive services like shots and screening tests at no cost. This includes marketplace private insurance plans. All marketplace plans must cover a broad list or preventative services without charging a copayment or coinsurance (Healthcare.com, 2014). The list required is long and expansive it what it includes. Services provided now include coverage for such things as HIV screening, cholesterol screening, blood pressure screening for all adults. The list also extends to cognitive dysfunction such as depression screening offered for all adults. This coverage is available to most health insurance plans whether they are privately insured, or the enrollee is a benefactor of Medicaid (Medicaid.gov) or you are an enrollee in Medicare (Medicare.gov). As a result of this preventative coverage, it places healthcare in the hands of the enrollee. Rather than wait until a health issue has boiled over and has evolved into a chronic debilitating disease, enrollees now have the ability to be more active in disease prevention by not worrying about incurring cost and seeking help. Prior to this, those with insurance or without would have to be much more cognizant of how they disperse their funds regarding their health. While this is still very much the case, people no longer must be in the dark regarding their health. They can actively seek their health status without fear of financial repercussions. By preventing chronic diseases from being manifested, healthcare cost, insurance cost and emergency rooms visits will hopefully be reduced because of having a populous in good general health.

The ACA continues this trend of placing more power in the enrollee’s hand by holding insurance companies more accountable. By accountable, it connotes the fact that insurance companies can no longer deny children based upon pre-existing conditions (About.com, 2013) Until now, plans could refuse to accept anyone because of a pre-existing health condition, or they could limit benefits for that condition. Now, under the health care law, plans that cover children can no longer exclude, limit, or deny coverage to a child under age 19 solely based on a health problem or disability that the child developed before you applied for coverage. This rule applies to all job-related health plans as well as all individual health insurance policies (HHS.gov, 2014) This new regulation provides financial ease for families who are burdened by their child’s debilitating disease. Money can now be placed towards other life necessities for the families to improve their overall quality of life. As opposed to worrying about mounting healthcare cost, finances can be allocated towards things like food, education and other investments.

Accountability is again kept at a constant through the ACA by not allowing insurance companies to drop anyone from coverage once they get sick. If a company denies someone coverage, that person can go to an external appeals process (About.com, 2013). The appeal process states when an insurance plan denies payment for a treatment or service, you can request an appeal. When your plan receives your request, it is required to review its own decision. It is now required that the company explains, the reason your claim was denied, your right to file an internal appeal your right to request an external review if your internal appeal was unsuccessful (HHS.gov, 2014). By extending coverage to those with preexisting conditions, developed conditions and establishing an appeal process for enrollees, the ACA laments that it seeks to protect the interest of the individual.

The interest of the individual is further established within the ACA by seeking to close the Medicare Donut Hole for prescription drugs (Obamacarefacts.com, 2014). Most prescription drug plans have a coverage gap. This creates a temporary limit on what the drug plan will cover for drugs. This coverage gap begins after the enrollee has spent a certain amount for covered drugs (Medicare.gov, 2014).

Essentially, under Medicare plan D; the enrollee pays 100% out of pocket until they reach the deductible. After reaching this deductible, the enrollee then pays 25% of the drug cost until while the Medicare plan pays for the rest until you reach the total of your plan of $2,800. Once this limit is reached the enrollee has entered the donut hole and pays the total cost of the drug until it incurs to a total of $4,550 (Medicare.gov, 2014). This cost can be burdensome for the elderly who are either retired or are unable to work, yet still require the assistance of prescription drugs to sustain a certain quality of life. The ACA seeks to preserve a well-established quality of life for this specific population by closing this gap in coverage. Medicare.gov (2014) states that a progression of assistance has been established to mend this issue. As of 2010, if the enrollee had entered the Part D donut hole he/she will receive a one-time, $250 rebate check.

Starting in 2011, they will receive a 50% discount on brand-name drugs in the donut hole, and you will start to pay less and less for the generic Part D drugs in the donut hole. By 2020, it is anticipated that the coverage gap will be closed of Medicare recipients. Recipients will pay 25% of the cost until they reach the yearly out-of-pocket spending limit (Medicare.gov, 2014). By closing the gap for Medicare enrollees, it places money into the hand of the recipients to ensure an improved quality of life. This is a similar approach to the free preventative health care and extending coverage to those with chronic diseases. Essentially, it diminishes the load of ascending healthcare bills and seeks to place power into the hands of the American individual.

Opponents would argue that placing power into the hands of the individual is not the case referring to the ACA. Instead, the ACA forces hardship upon employers. Starting in 2015, companies with more than 50 full-time employees are required to provide health insurance for their employees (Understanding Obamacare). An annual fee of $2000 will be required for each employee. When an employer offers health coverage they also need to meet an affordability test. This requires that an employee should not have to pay more than 9.5% of his/her income on self-coverage. If the plan fails to meet this, then the employer will have to pay an annual $3000 annual fine for each worker that goes on health coverage and get a subsidy for it. This cost could be potentially hazardous for employers who are barely above the minimum requirement with regards to the number of employees. While the ACA seeks to help the individual, employers can anticipate rising cost for establishing employee health care under the new law. Speculation has emerged that some employers may seek to pay the annual penalty and let employees purchase insurance on the market place (About.com), if this were to be the case this would cause 3-5 million people to lose employers-based health insurance. Ultimately, it would affect the individual as a result and ironically hinder the overall aim of the ACA.

Rising cost for employers is but one example, another predicament arises concerning religious based employers and federal mandates of health coverage. Under the ACA, a minimum requirement of services is required in each health plan. While these plans include dental coverage as well as eye care, health care coverage is also expected to extend to contraceptive. Currently, the Supreme Court is court is reviewing provisions of the Affordable Care Act requiring for-profit employers of a certain size to offer insurance benefits for birth control and other reproductive health services without a co-payment (Mears, 2014). At issue is whether certain companies can refuse this coverage due to the violation of their long-established beliefs. The concern is that the approach of the federal government mandating this coverage is that it is unconstitutional and violates the employer’s rights. The perception is that it is further encroachment by the federal government and takes away any power or choice from the individual.

In conjunction with failing individual liberties and placing cost upon the individual, the belief held by opponents of the ACA is that it only focuses on registering people for health insurance as opposed to helping diminish the cost of health care. With an intense focus on having people register for health insurance under the new mandate penalties have been established for those who miss the March deadline for registration. If the individual does not qualify for Medicaid, then the person can expect to pay a $95 tax in 2014. This tax will increase to $325 in 2015 and in 2016 the cost rises to $695 (About.com, 2013). As collateral during the registration, it is expected that 4 million people will end up paying taxes as a result rather than sign-up for insurance (Obamacarefacts.com, 2014). In a rush to have people registered, a certain percent of the population will fall through and end up acquiring more cost to bear. The goal of the act was to insure coverage and care for the American population. The ACA, in general, was synthesized to prevent any disparities. This does not appear to be the case as some will fall into a similar pattern of baring 100% of the cost and b required to pay an additional tax.

As stated prior, the ACA is far from perfect; however, improvements can be made to fix the holes within the law. First, the ACA can seek to provide more choices when it comes to selecting a health plan. This can by restore startup funds for new consumer-driven health insurance cooperatives. This would allow for individual to have more options to access health coverage beyond traditional insurance companies. By creating more competition with the marketplace, premiums would diminish.

Secondly, in order ease the transition for employers, it would be beneficial to expand the option for voluntary coverage for employers with fewer than 100 employees, This would enable small and those on the cusp of the current 50 employee rule to make their own choices for their businesses, and employees can shop for coverage on the individual marketplace.

Lastly, The ACA can setup another way to register for health insurance. By offering more than one-way for individuals to enroll. It should seek to provide a permanent path, in addition to HealthCare.gov, so that consumers may seamlessly enroll directly through insurers. This is in response to the website crash the day of enrollment on March 31st, 2014 (Elperin, 2014).

While the ACA has its faults, its aims to provide more coverage to American’s and place power within the hands of the individual. Because of this it should regarded in favor. This has been achieved by including free preventative care, holding insurance companies accountable and closing the Medicare Donut Hole. Issues are still relevant pertaining to the rush to enroll, employer grievances and tax penalties; however, these problems can be dealt with by the implementation of more competition in the health insurance marketplace and increasing the requirement for voluntary employer healthcare coverage.

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The Patient Protection and Affordable Care Act. (2019, Dec 18). Retrieved October 3, 2022 , from
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