How The Affordable Care Act Benefits You
Health System Dilemma And Reform Solutions
On March 23rd. 2010 President Obama signed The Affordable Care Act into law.
Two years later, on June 28th. 2012, the US Supreme Court upheld the key provisions of the law, further confirming its legitimacy, as the law of the land. The intent of the Affordable Care Act is to improve upon the existing health care system, by addressing major deficiencies, in terms of access, continuity of care, portability, and affordability.
While 60% -70% of Americans receive their health care coverage through their employer, an estimated 45 million of our fellow Americans, do not have health care coverage. Hence, they cannot access the health care system. These unfortunate Americans are either, unemployed, underemployed, or self-employed. Under the existing system, if you lose your job, you also lose your health coverage. If you are able to pay the full premium (employee + employer portions) under your employer coverage, then you may continue with your employer plan for another 18 months, under the COBRA Provisions. However, once that18 month separation period has elapsed, your COBRA coverage will end. If you have not found another job, that offers health care coverage, chances are, you will join the ranks of the uninsured. The typical part time job does not offer health care coverage. Most Americans who work part-time cannot afford the premiums for individual health insurance coverage. Small business owners, also find themselves in the same predicament. They too, cannot afford to buy health care coverage for their own families, let alone employees. That’s because, the cost of coverage is just too prohibitive.
This lack of access, and escalation in health cost, has only been exacerbated, by the 2008 recession, during which millions of Americans lost their jobs, and with it, their employer sponsored coverage. This has led to a steady rise in the ranks of the uninsured, since 2008.
In Figure 1, above, a bar chart compiled by the Center on Budget and Policy Priorities, using Census Bureau data, illustrates the growth in the number of uninsureds from 2007 through 2011. This chart also indicates that the number of uninsureds fell by 1.3 million, in 2011. This small, but encouraging reduction in the number of uninsured, between 2010 and 2011, is attributable to the early effects of the Affordable Care Act.
It is unconscionable, that under the current health care system, many hardworking American are forced to go without health insurance coverage, praying that they, or a family member,does not get sick. Many, with the understanding, that, they may be one serious illness away from bankruptcy, and or, total financial ruin. Sadly, that’s the enormous risk of self-insuring, under the existing system.
The Affordable Care Act -The Solution
Essentially, The Affordable Act seeks to address some of these deficiencies, by making sure all Americans will have access to affordable, high quality health care, that’s both reliable and portable. Below are some of the key features of the new health care system.
Improve Health Care Access Using Health Exchanges
Beginning October 1st. 2013, all Americans, including small businesses (under 50 employees) can purchase health care insurance online, through Health Care Insurance Exchanges/Marketplace. Each state will set up its own Exchange. If your state has not set up an Exchange, then you can easily purchase your coverage from the Federal Exchange/Marketplace. Health Insurance companies will compete for your business through these exchanges, helping to reduce premium costs.
Within each exchange, there will be many health insurers, hoping to get your business.
The Core Essential Services
Each insurer in the exchange will provide a variety of plans. You will be able to compare the plans and decide which is best for you and your family’s situation. These plans will cover a core range of health care benefits. And, you can choose additional services if you need them. These essential health benefits include at least the following items and services:
- Ambulatory patient services (outpatient care services)
- Emergency services
- Hospitalization (services while admitted to the hospital)
- Maternity and newborn care
- Mental health and substance use disorder services, including (includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive Care Services and chronic disease management
- Pediatric services
Depending on income, and other factors, some individuals may also qualify for discount credits, to help them afford the premium cost. All Americans will also have the option of selecting the plan with which your current doctor (if you have one) participates. This is important for continuity of care reasons, as well as, relieving the stress of having to change doctors.
Because of the Affordable Care Act, many Americans will for the first time, have the opportunity, to purchase health care coverage, at a reasonable cost. And, in so doing, protect their family from potential financial ruin, due to a catastrophic illness.
Lower Health Care Cost And Improve Quality
Many critics of existing health care system complain, that compared to many other developed nations, like France, Sweden and The United Kingdom, The United States is not getting enough ‘bang for the buck’ it spends on health care. US Health Care Expenditure in 2012 was a staggering $3 trillion dollars. Critics say, many of these countries spend far less, and enjoy better health care outcomes, than the US does.
They manage to cover nearly all their citizens, enjoy better access, and their infant mortality is much lower than ours.
One of The Act's main focus is to provides Americans with Free Preventive Care. This means that you do not have to wait until you are sick to seek care services. Visiting your primary care physician for a free check-up periodically, can be the difference between identifying symptoms of an illness in its early stages, where it can be treated more easily and effectively, and catching it later, when symptoms are likely to be more severe, and more difficult to treat.
By focusing on preventive care, hopefully, over time, we can improve our overall health status, leading to a healthy, more productive America.
Reducing fraud and abuse is another target of The Affordable Care Act. Some reports estimate that 3-10% of US health care expenditure can be attributed to fraud/abuse, and waste. This manifests itself in many ways, ranging from practicing defensive medicine, duplication of health services, delivery of unnecessary care, to the malfeasance, we often hear in the news, where the FBI raids ‘scam medical facilities’, set up for the sole purpose of ripping off Medicare & Medicaid and other reimbursement programs.
Strengthening Consumer Protections
The Affordable Act also enhances and strengthens health care protection for all Americans.
Under the existing law, many Americans were denied health care coverage because they had a pre-existing health condition, for example, diabetes, asthma, and hypertension.
Under The Affordable Car Act, an insurance company can no longer deny you insurance coverage, because you have a pre-existing condition. The Act also provides other key protection for Americans, for example, a health insurance company can no longer drop your coverage, when you get sick. Additionally, there is a guaranteed, clear and transparent review process, for appealing claims, denied by your health insurer.
The new law also requires that health Insurance companies must spend no less than 80% of your premiums for direct health care services. In other words, not more that 20% of your premium dollars can be spent on administrative overhead costs. If they spend more than 20% on administrative cost, the excess funds must be refunded to you. Previously, many insurers spent up to 40% of your premium dollar on administrative cost. Finally, your health insurer must publicly justify, any premium hike of 10% or more, before it can be implemented
Open Enrollment The Next Big Milestone
While many features and benefits of the Act, such as, free preventive care, removal of pre-existing conditions, children remaining on parents plan until age 26, are already in place, an important milestone for the system comes up on October 1st. 2014. That’s when open enrollment begins. American who do not currently, have health coverage, through an employer, will have the opportunity to compare and select an affordable health plan offered through the health care exchanges.
Open enrollment period under the plan closes on March 2014. Once enrolled, coverage takes effect on January 1st. 2014. So, get ready to enrol. This could be one of the best decisions you will ever make for you, and your family.