Question

Write a 2 page report that describes the Who, What, When, Where, and Why about the Affordable Care Act.

Answer 1

What is the Affordable Care Act (ACA)?

The Affordable Care Act (ACA) is the comprehensive healthcare reform signed into law by President Barack Obama in March 2010. Formally known as the Patient Protection and Affordable Care Act—and simply Obamacare—the law includes a list of health-related provisions intended to extend health-insurance coverage to millions of uninsured Americans.

The Act expanded Medicaid eligibility, created health insurance exchanges, and prevents insurance companies from denying coverage (or charging more) due to pre-existing conditions. It also allows children to remain on their parents' insurance plan until age 26.

The ACA is for anyone not covered by their employers, young adults, children, and individuals who make less than 138% of the poverty line.

Under the ACA, health insurance carriers are required to grant the following provisions for all policyholders.

• Young adult coverage: All men and women under the age of 26 are eligible to receive health insurance under their parents’ individual or employer-sponsored coverage plan. This rule applies to persons living in all states, regardless of whether the child is married, attending a higher-learning institution, eligible for employer-based insurance, or otherwise able to obtain coverage beyond their parents’ plans.
• Medicaid/CHIP Expansion: One specific goal of the ACA is expansion of Medicaid and Children’s Health Insurance Program (CHIP) in order to provide coverage for millions of uninsured, low-income American families. The original intention of the ACA was to cover any individual under the age of 65 who earns at or below 138% of the Federal Poverty Level (FPL) through an expansion of state-sponsored Medicaid programs. For the first time, low-income individuals who do not have children were to also qualify for Medicaid.
• Consumer Protection: Policy-holders and health insurance companies have fought a long-standing battle regarding health conditions that prompt providers to drop coverage to beneficiaries. Now, under the ACA:
  • Policy-holders cannot be denied coverage due to a pre-existing condition, such as a permanent disability or chronic illness. In fact, insurance fraud is the onlycase in which an individual may be denied coverage. Additionally, providers cannot charge higher premiums for women or individuals facing chronic health issues.
  • Plans must include free preventive services, and insurance providers cannot impose limitations on ‘Essential Health Benefits,’ such as screenings and preventive treatments that reduce the risk of cancer and other diseases.
  • Insurance providers that spend less than 80% of premium revenue on medical services mustrebate the overage to their policyholders. This is known as the ’80-20 Rule.’
  • Group health insurance plans must kick in for all employees within a period of 90 days or less from the time he or she becomes eligible for this coverage.
• Essential Benefits: Under the ACA, the following benefits are considered essential and must be included in all individual and group coverage plans:
  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance abuse disorder services (including behavioral health treatment)
  • Prescription drugs
  • Rehabilitative and habilitative services (including certain devices)
  • Laboratory services
  • Preventive services and chronic disease management
  • Pediatric services (including dental and vision)
• A Note on Grandfathered plans:Although the ACA is designed to regulate all health insurance plans in the United States (regardless of the structure or coverage provider), there is one notable exception to the federal ruling: grandfathered insurance plans.

Regardless of whether a consumer uses the nationwide marketplace or a state-specific exchange, he/she is able to choose one of four individual plans, which are categorized by the rough percentage of medical costscovered by the insurer:

• Bronze: The insurer pays 60% of medical costs, and the plan-holder pays 40%.
• Silver: The insurer pays 70% of medical costs, and the plan-holder pays 30%.
• Gold: The insurer pays 80% of medical costs, and the plan-holder pays 20%.
• Platinum: The insurer pays 90% of medical costs, and the plan-holder pays 10%.

BENEFITS:

A set of 10 categories of services health insurance plans must cover under the Affordable Care Act. These include doctors’ services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more. Some plans cover more services.

Plans must offer dental coverage for children. Dental benefits for adults are optional.

Specific services may vary based on your state’s requirements. You’ll see exactly what each plan offers when you compare plans.

The ACA set out to ensure more Americans were insured regardless of their income or the state of their health. The number of Americans lacking health insurance has dropped by nearly 50% since its inception. The mandate on coverage for preexisting conditions remains in place.

Another goal of the ACA was to make health insurance more affordable for more people. According to data from the New York Times, 85% of the 7.3 million Americans who signed up for insurance during the first enrollment period received subsidies to decrease their costs. Premiums differ based on the number of insurance providers in each state. States with more options typically have lower premiums as insurance companies fight for their share of the market. The ACA has also been beneficial to the health insurance industry, which has seen significant growth in new clients since its introduction.

The number of people on Obamacare has grown significantly since the legislation first passed. Prior to the ACA being enacted, 48 million Americans were without health insurance. As of 2016, that number had shrunk to 28.6 million, or 9% of the American public. Nearly 11.8 millionAmericans signed up for Obamacare for 2018, despite a shorter sign-up window.