WHAT IT DOES – HEALTH INSURANCE PROVISIONS

THE PATIENT PROTECTION AND AFFORDABLE CARE ACT OF 2010

BASICS
WHY IT PASSED
WHAT IT DOES – HEALTH INSURANCE PROVISIONS

BASIC ELEMENTS

Makes affordable private health insurance available to the most chronically and persistently uninsured families in the U.S.

Reforms the employer-based private insurance system to limit long-term premium increases, eliminate or restrict annual and lifetime dollar benefit caps, limit rescissions, eliminate pre-existing condition provisions, and to ensure that more of the premium dollar goes for direct health care services.

Significantly expands the Medicaid program by mandating standardized national income eligibility standards for each State that participates in the expansion and by providing significant Federal funding.

Reorients the U.S. private health industry toward responsible coverage of that part of the population not covered by Medicare, Medicaid, or the VA Health System: Establishes an Individual Insurance Mandate, eliminates medical underwriting and creates State Health Insurance Marketplaces/Exchanges.

BASIC ELEMENTS – contd.

Reconfigures the health service delivery system by encouraging the development of Accountable Care Organizations, expanding the use of Patient-centered Medical Homes by Medicaid members, and doing the same with respect to home-based care for elderly and disabled Medicaid and Medicare members.

Encourages a national focus on Wellness through the expanded use of Primary Care and Preventive Services through special incentives to State Medicaid programs, elimination of copayments and coinsurance for critical Primary Care Services for Medicaid and Medicare recipients, health care workforce expansions, enhanced Medicaid physician payments, and increased support for Community Health Centers.

Improves quality of care and slows the increase in national health expenditures through the implementation of bundled payment and value-based payment experiments in Medicare and Medicaid, by establishing a CMS Innovation Center, by limiting Medicare payments for selected readmissions, and by reducing Medicare payments to certain hospitals for hospital-acquired conditions.

BASIC ELEMENTS – contd.

Promotes quality of patient care by supporting the development of a national quality improvement strategy. Supports development of quality measures to be used for reporting and payment purposes under Federal health programs.

Promotes quality of patient care by establishing a Patient-Centered Outcomes Research Institute which prioritizes and funds Comparative Effective Analysis for critical medical interventions.

WHY IT PASSED IN 2010
Intensified problems within the U.S health care system:

Private health insurance was increasingly unaffordable for employees of small businesses and for individuals buying individual policies for themselves and their families.

Because of medical underwriting in the private insurance industry, individuals and small business employees were often not able to access health insurance at any price.

Insurance industry uses rescissions and purges to reduce its medical liability for those who are enrolled in individual and small business health insurance plans.

Since 2000, there have been significant annual increases in national health expenditures and in premium levels for private health insurance plans of all kinds.

Variability in State Medicaid income standards for eligibility has meant that many living below 133% of the Federal poverty level are uninsured.

The recession beginning in 2008, in conjunction with the conditions listed above, resulted in even higher percentages of the U.S. population being uninsured. On any given day 15-16% of the U.S. population is uninsured.

Long-run projections for Medicare program expenditures indicate that the program is a major problem for U.S. long-term indebtedness and fiscal soundness.

WHY IT PASSED IN 2010 – contd.
Political Environment:

14 years after the defeat of the Clinton Health Security Act of 1993 the Democratic Party presidential candidate ran on a platform endorsing substantive changes to the U.S. private insurance industry, as well as reforms in the Medicare and Medicaid systems, to address issues of Access, Expenditure, Quality, and Medicare program sustainability.

Obama won the 2008 presidential election by a substantial margin.

The Democrats maintained and expanded their Congressional majorities in the 2008 election.

The President and Congress affirmed their commitment to restore the economy through the February 2009 Recovery Act. Key elements of that Act focused on long run measures to improve the functioning of the health care industry, and short-term measures to significantly expand the availability of affordable health insurance to the poor and the unemployed.

Congress and the President, working within the broad framework of the Democratic Party platform, made passage of a health reform act a major administration priority.

The Administration learned from the mistakes made by the Clinton administration:

Congress was given primary responsibility for drafting and passing the legislation, and the Administration made a series of agreements with key health care industry stakeholders to ensure their support for the reform, thus neutralizing a substantial portion of the potential opposition.

AFFORDABLE PRIVATE HEALTH INSURANCE: INDIVIDUALS AND SMALL BUSINESSES – 1

State Health Insurance Marketplaces/Exchanges are established pursuant to the ACA. They create virtual large insurance groups by enrolling individuals and small businesses in the Exchange, thus giving the enrollees purchasing power comparable to that of a large employer group.

Exchanges are ideally run by the States, but may be run by the Federal government. There may be separate or merged small business and individual exchanges.

Bids are solicited by the Exchanges from private health insurance companies to provide reasonably priced comprehensive health insurance which will be made available to the Exchange enrollees. Private insurance companies may choose to participate or not in the Exchanges.

The comprehensive plans reflect Essential Benefits established by the Federal government and translated into actual detailed standard plans by the States.

There are 4 levels of Exchange plan which an insurer may offer in the Exchange. Each level contains the same comprehensive benefits, so that plans vary only in terms of premiums, deductibles, coinsurance, and copayments. There are annual cost-sharing limits established.

AFFORDABLE PRIVATE HEALTH INSURANCE: INDIVIDUALS AND SMALL BUSINESSES – 2

Individuals and small businesses may interact with the Exchange electronically via the Internet, or through Navigators (subcontracted parties who help advise and enroll potential Exchange customers).

All Exchange plans are characterized by guaranteed issue, no discrimination based on preexisting conditions, no rescissions except for cases of fraud, and no annual or lifetime dollar caps on benefits.

Plan premiums are largely community rather than experience rated, with some exceptions based on age of enrollee, and status as a smoker or non-smoker.

Income-related public subsidies for premiums and in some cases also for cost-sharing are available through the Federal government to further ensure plan affordability.

Eventually private health insurers will have to follow most of the rules established for the Exchange plans when they sell small business or individual plans outside the Exchange, thus accelerating an eventual movement of most of that business to the Exchanges.

The Exchanges must perform certain functions as per the ACA.

The insurance plans participating in the Exchanges must meet certain Exchange qualifications and reporting standards on an ongoing basis.

MEDICAID EXPANSION

As per the Supreme Court decision of 2012, States may choose not to participate in the expansion without endangering their current Medicaid programs and related arrangements with the Federal government.

The Medicaid expansion is largely paid for by the Federal government, rather than following the traditional Medicaid State/Federal cost-sharing formulas. The Federal contribution starts at 100%, stays at that level for 3 years, and by 2020 stabilizes at a level of 90%. This contribution is not capped.

States may negotiate special waivers with the Federal government to implement the expansion in a different way from that specified in the ACA.( e.g. the Arkansas approach).

Medicaid expansion enrollees are guaranteed a health benefits package that in content at the least mirrors the Essential Benefits Plans that are marketed by private insurers on the Exchanges.

Federal dollars are provided to help States upgrade their Medicaid and Child Health Plus enrollment systems.

States are expected to coordinate their current Child Health Plus, Medicaid and (if they choose) expanded Medicaid enrollment processes with those of the State or Federally run Exchange for a given State.

Aside from participation in the Medicaid expansion, States are eligible for Federal dollars for a variety of other Medicaid-related programs established by the ACA.

PRIVATE INSURANCE CHANGES FOR ALL: BEYOND EXCHANGES AND MEDICAID EXPANSION – 1

All employers with more than 50 Full Time Equivalent Employees must provide health insurance plan options to their employees. Firms with more than 200 employees must automatically enroll employees into those options, though employees may then opt out.

There is a universal individual insurance mandate: All U.S. citizens and legal residents must have qualifying health coverage in a given year. There are financial penalties for remaining uncovered by such a plan for more than three (3) months. In certain specifically defined circumstances, the individual insurance requirement may be waived. (EFFECTIVE 2014 THROUGH 2018.)

Private insurance companies issuing plans outside the Exchanges in the individual and small group markets must follow Exchange rules in terms of guaranteed issue, premium rating, and prohibitions on preexisting condition exclusions.

PRIVATE INSURANCE CHANGES FOR ALL: BEYOND EXCHANGES AND MEDICAID EXPANSION – 2

All U.S. employer-based health insurance plans:

Allows children to remain on their parents’ health insurance up until their 26th birthdays.
May not establish lifetime dollar limits on benefits, and are limited in their use of annual dollar limits (These provisions are being phased in);
May not deny enrollment in a plan on the basis of a preexisting condition;
May not use rescissions when an enrollee is sick as a way of avoiding plan responsibility for paying the medical bills; may not use “purges” to similarly exclude small business employees from coverage; (Unless policy holder or plan member commits intentional fraud.)
Must abide by yearly caps on the out-of-pocket expenditures they can require of enrollees. National standards are established, but at a very high level.
Make Preventive Services available with little or no cost for all insured individuals and families.
Must implement simple standard reporting formats for the plans they offer to enable potential enrollees to make reasoned comparisons and choices about health insurance plans;
Will issue rebates to enrollees if plan non-medical expenditures exceed certain thresholds in a given year.

Place your order
(550 words)

Approximate price: $22

Calculate the price of your order

550 words
We'll send you the first draft for approval by September 11, 2018 at 10:52 AM
Total price:
$26
The price is based on these factors:
Academic level
Number of pages
Urgency
Basic features
  • Free title page and bibliography
  • Unlimited revisions
  • Plagiarism-free guarantee
  • Money-back guarantee
  • 24/7 support
On-demand options
  • Writer’s samples
  • Part-by-part delivery
  • Overnight delivery
  • Copies of used sources
  • Expert Proofreading
Paper format
  • 275 words per page
  • 12 pt Arial/Times New Roman
  • Double line spacing
  • Any citation style (APA, MLA, Chicago/Turabian, Harvard)

Our guarantees

Delivering a high-quality product at a reasonable price is not enough anymore.
That’s why we have developed 5 beneficial guarantees that will make your experience with our service enjoyable, easy, and safe.

Money-back guarantee

You have to be 100% sure of the quality of your product to give a money-back guarantee. This describes us perfectly. Make sure that this guarantee is totally transparent.

Read more

Zero-plagiarism guarantee

Each paper is composed from scratch, according to your instructions. It is then checked by our plagiarism-detection software. There is no gap where plagiarism could squeeze in.

Read more

Free-revision policy

Thanks to our free revisions, there is no way for you to be unsatisfied. We will work on your paper until you are completely happy with the result.

Read more

Privacy policy

Your email is safe, as we store it according to international data protection rules. Your bank details are secure, as we use only reliable payment systems.

Read more

Fair-cooperation guarantee

By sending us your money, you buy the service we provide. Check out our terms and conditions if you prefer business talks to be laid out in official language.

Read more
Open chat
1
You can contact our live agent via WhatsApp! Via + 1 929 473-0077

Feel free to ask questions, clarifications, or discounts available when placing an order.

Order your essay today and save 20% with the discount code GURUH