Affordable Health Care Act
The Affordable Care Act has led to a number of sweeping reforms across the entire healthcare industry, and there are many more changes to come. In fact, the whole act was so revolutionary that many believed it would be overturned in the Supreme Court. However, the courts have decided to uphold the act, so it looks like it's with us to stay.
Due to the number of changes addressed in the Affordable Care Act, it's a very large and long document - it's over 2,400 pages long! So it's no wonder that there are so many questions about how it will affect us all in our lives.
To begin with, the act is not just about health insurance reform. That is a key part of the act, to be sure. But it also prescribes fundamental changes in health care delivery, an increase in the availability of primary care, and new approaches to address and prevent chronic disease.
As you could imagine, a full interpretation of the Affordable Care Act would take considerably more space than we have available to us in this piece. For this reason, I will introduce the key points of the act and then focus on the insurance implications.
The act consists of ten sections, or "titles." They are:
1: Quality Affordable Health Care for All Americans
It is this section that lays down the most sweeping changes in insurance and makes it mandatory for all US citizens to have health insurance.
2: Role of Public Programs
This section in the Affordable Care Act expands the role of Medicaid and the Indian Health Services. It then lays down a fundamental change in the treatment of chronic illness, through the model of the Patient Centered Medical Care Home.
By the way, it was this section that drew the fire of the Supreme Court. The requirements that all states extend Medicaid or else lose their funding was a particularly sore point.
3: Improving Quality and Efficiency of Health Care
This section lays out changes to Medicare and details changes in how medical care will be paid for. The most revolutionary concept is a shift from paying for each service rendered to payment based on the quality of delivered care.
4: Prevention of Chronic Disease and Improving Health
This section of the Affordable Care Act focuses on preventing chronic disease through promoting healthy lifestyle choices and health education. It also emphasizes the need to treat diseases early to prevent complications and the onset of chronic conditions.
5: Health Care Workforce
This section makes the interesting observation that the US is strong in specialized healthcare but weak in primary healthcare. This is due to the way in which we have been rewarding specialists for decades. It makes a further observation that there is less illness in countries with stronger primary healthcare, along with lower costs. Then it outlines how we can redress the imbalance and increase the size of the primary care workforce.
It also lays out provisions for health disasters and bio-terrorism, including the Public Health Service Corp and the newly created Ready Reserve Corp.
6: Transparency and Program Integrity
This section of the Affordable Care Act looks at the costs caused by fraud and dishonesty within the healthcare and insurance industries and lays down measures to combat them.
7: Improving Access to Innovative Therapy
This section is actually about increasing the accessibility of generic medication to all Americans.
8: Community Living Assistance Services and Support
This section has been put on the back burner following an HHS analysis, which revealed there would be considerable difficulties implementing it.
It described a state-administered long-term care insurance program which would share many qualities with our current Social Security disability system.
9: Revenue Provisions in the Affordable Care Act
This section is all about how all these changes will be funded.
10: Strengthening Quality Affordable Health Care for All Americans
This is a complex section that outlines a number of pilot programs illustrating how these broader changes will be affected. It also includes a number of exceptions, modifications, and provisions for special groups.
How This Impacts Your Insurance
While the Affordable Care Act is full of complex terminology, rules, and exceptions, the impact of these changes can be summed up in 3 points:
1: Insurance companies cannot refuse to provide cover to anyone, even if they are already ill or dying.
This means that even chronically ill people can access healthcare through insurance. But if people are able to buy insurance when they are ill, what's to stop them from only buying insurance when they get ill and need care?
2: Every American must have health insurance
So, every American must pay for health insurance even when they're well through the Affordable Care Act. Otherwise, nobody would get insurance until they were sick, the insurance companies would all go broke, and everyone would have to pay the full price of their healthcare.
But what about people who can't afford to pay for health insurance?
3: The government will pay up to 95% of the cost of health insurance for people who cannot afford it, and Medicaid is being expanded to cover the rest.
So that's the impact in big sweeping points. But as always, the devil is in the details.
So here are some points to answer the common questions that people have:
Can I keep my existing insurance plan?
As long as your plan meets the requirements of the Affordable Care Act, you will be able to keep it. If it doesn't, you will be able to keep it for now, but you will need to find a new one in the future.
The date for changing the plan is different from state to state. Some states will let you keep your existing plan up until 2017.
How can I find an affordable insurance plan?
You can find an affordable plan that complies with the Affordable Care Act through the Health Insurance Marketplace.
What happens if I don't have medical insurance?
If you don't have insurance, you will need to pay a monthly fee on your federal income tax return for every month you spent without insurance. This fee is $95 or 1% of your income, whichever is higher.
Do I qualify for Medicaid?
Up to 82% of uninsured adults qualify for federal subsidies or Medicaid, so if you are uninsured, the probable answer is yes.
When you apply for the marketplace, you will be able to discover if you qualify for Medicaid or any applicable subsidies.
