Affordable Care Act

The Affordable Care Act, also abbreviated as ACA, PPACA, and Obamacare. It is centralized health reform. It was brought into force in the year 2010. The 900+ page act contains many provisions, with various effective dates.[1] In this article, we will be discussing and addressing specific topics in more detail that comes under the Act.

Since the Affordable Care Act (ACA) became law, more than 20 million people have gained health insurance coverage, with the U.S. uninsured rate reaching a record low by 2016.[2] This expansion in coverage has improved access to care and narrowed racial and ethnic coverage disparities.[3] “As with any complex legislation, however, the ACA’s success has been shaped by how federal officials have interpreted and implemented the law’s various requirements and programs. Federal officials generally have flexibility in implementing and administering the Affordable Care Act so long as they comply with the Administrative Procedure Act.”[4]

Key Features

The main purpose behind the Act is to increase greater access to insurance, strengthen consumer protection, lay emphasis on deterrence and well-being, better the quality and system operation, develop a beneficial workforce, and curtail increasing healthcare expenses.

The Act helps the citizen of the USA to be able to afford better health insurance and to make sure that the same is available to more people. “The law provides consumers with subsidies (“premium tax credits”) that lower costs for households with incomes between 100% and 400% of the federal poverty level(FPL).

- “If your income is above 400% FPL, you may still qualify for the premium tax credit in 2022.
- If your income is at or below 150% FPL, you may qualify to enroll in or change Marketplace coverage through a Special Enrollment Period.”[5]

The Act enlarges medical facilities to all those individuals whose salaries are below 138% of FPL.
The Act also precludes insurance enterprises from refusing any policies owing to pre-prevailing terms and conditions.
In addition to this, the Act also contains a list of important health benefits.
“The Affordable Care Act was designed to reduce the cost of health insurance coverage for people who qualify for it. The law includes premium tax credits and cost-sharing reductions to help lower expenses for lower-income individuals and families. Premium tax credits lower your health insurance bill each month.”[6] Cost-sharing reductions, meanwhile, reduce your out-of-pocket costs for deductibles, copays, and coinsurance, as well as lowering your out-of-pocket maximum: the total amount you pay in a year for covered health expenses.[7]

Consumer Insurance Protection[8]

Prohibit lifetime monetary caps on insurance coverage and limit the use of annual caps.
Prohibit insurance plans from excluding coverage for children with preexisting conditions.
Prohibit insurance plans from canceling (rescinding) coverage, except in cases of fraud.
Establish state-based rate reviews for “unreasonable” insurance premium increases.
Establish an office of health insurance consumer assistance or an ombudsman program.
Establish the share of premiums dedicated to medical services (minimum medical loss ratios).

Curb Rising Health Costs[9]

Key provisions of the Affordable Care Act that intend to address rising health costs include providing more oversight of health insurance premiums and practices,
Emphasizing prevention, primary care, and effective treatments,
Reducing health care fraud and abuse; reducing uncompensated care to prevent a shift onto insurance premium costs,
Fostering comparison shopping in insurance exchanges to increase competition and price transparency; implementing Medicare payment reforms; and
Testing new delivery and payment system models in Medicaid and Medicare.

Conclusion

Healthcare collaborators have contributed to approaches that offer comprehensive assistance for a variety of national governmental guidelines and policies. The idea is to increase and provide access to reasonably priced, inclusive health insurance, thereby boosting health equity. It also includes expanding funds for outreach and enrollment programs, reducing short-term policies, and affiliating them with health plans. Further to this, it is important to reassess and re-evaluate strategies, policies, and guidelines on any policies or legislation that come into being enforced. As such long-term overall benefits should be emphasized as well. There is a dire need to emphasize and promote policies that help people gain and maintain coverage. As well as increasing accessibility to these policies as we have continued to reiterate in the above article.

[1] The Affordable Care Act: A Brief Summary (ncsl.org)

[2] Susan L. Hayes et al., What’s at Stake: States’ Progress on Health Coverage and Access to Care, 2013–2016 (Commonwealth Fund, Dec. 2017); and Robin A. Cohen, Emily P. Zammitti, and Michael E. Martinez, Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, 2016 (National Center for Health Statistics, May 2017).

[3] Jesse C. Baumgartner et al., How the Affordable Care Act Has Narrowed Racial and Ethnic Disparities in Access to Health Care (Commonwealth Fund, Jan. 2020); and Sherry A. Glied, Stephanie Ma, and Anaïs Borja, Effect of the Affordable Care Act on Health Care Access (Commonwealth Fund, May 2017).

[4] Affordable Care Act in Biden Era: Identifying Federal Priorities | Commonwealth Fund

[5] Premium Tax Credit - HealthCare.gov Glossary | HealthCare.gov

[6] Affordable Care Act (ACA) Definition (investopedia.com)

[7] HealthCare.gov. "Premium Tax Credit." Accessed April 24^th, 2022.

[8] The below points have been retrieved from: HRACA.pdf (ncsl.org)

[9] Refer Footnote 8.