Free «Affordable Care Act» Essay
Key features of the Affordable Care Act
The Affordable Care Act (ACA) aims at creating a robust consumer rights protection, and making health more affordable. The ACA is intended to enhance access to care besides making Medicare stronger. The key features of the ACA are:
Handling of pre-existing diseases
ACA stipulates that pre-existing diseases should qualify for health insurance benefits (Ohio State Bar Association, 2014).
The ACA assures Medicare benefits with many preventive free screenings. For example, immunizations, colonoscopy, and mammograms services (Ohio State Bar Association, 2014).
Cost of Prescription Drugs
The affordable care law will result in prescription medications costing less due to the gap in payment for the drugs under Medicare segment D. It is targeted that by 2020, the cost will be eventually eliminated (Ohio State Bar Association, 2014).
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Health Insurance Transparency
ACA greatly simplifies the complex health insurance information by requiring all participating health programs to avail a uniform and jargon-free summary of their services and limitations (Ohio State Bar Association, 2014).
Option on Employer Health Insurance Coverage
If satisfied by the employer’s insurance coverage, an employee is not required to do anything. In a case that the employee is uncomfortable with the provided insurance coverage, they are given the option to purchase coverage through their state’s health insurance exchange. Alternatively, the discontented employees can do so via the federal program where no state exchange exists (Ohio State Bar Association, 2014).
Increased Access to Health Insurance
The ACA makes it possible to purchase coverage via state health insurance exchanges. Health insurance exchanges refer to online marketplaces where firms compete for consumers. Alternatively, potential consumers of insurances covers can buy them via the federal website (Davidson, 2013).
Mandatory Health Insurance Purchase
Since April 2014, taxpayers are not enrolled to an health insurance cover and have to pay a special tax imposed on their annual tax return. However, individuals under employer insurance, Medicaid, or Medicare are exempted from this penalty (Davidson, 2013).
Incentives for states with expanded Medicaid programs
The ACA provides for eligibility to a subsidy to low-middle income individuals and family members under 65 years of age in an effort to aid them meet their insurance cost. Now, individuals with income below $44, 680 qualify for a tax credit refund for buying their health insurance (Davidson, 2013).
Describe the Implications to Consumers
Consumers with pre-existing conditions will enjoy coverage. In addition, health plans will no longer limit benefits to children 19 years of age due to a pre-existing illness. Furthermore, individuals under 26 years of age but adults qualify to be insured under their parents’ health plan. The ACA ends lifetime bounds on insurance coverage on most benefits. Notably, the ACA ends arbitrary withdrawals of insurance coverage because of errors on insurance applications. Insurance firms under the Affordable Care law are required to defend any unreasonable increase in premiums publicly (Ohio State Bar Association, 2014).
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The most-striking aspect of the ACA is that individuals are mandated to buy a prescribed level of insurance or stand to pay a standard levy on submission of their annual tax returns. Therefore, consumers areset to experience reduced gap in insurance coverage.
Describe the Implications to Employers
Employers have to initiate reasonable adjustments to their group health plans. Employers have to adjust benefits provisions, alter the eligibility criteria, and adjust the premium paid figures in a bid to comply with the ACA (Davidson, 2013). All the above-mentioned alterations result in tax implications. Normally, employers find it feasible to pay partly and partly play. As such, employers offer group health insurance coverage and subsidize the coverage by meeting part of the contribution to the premiums of some workers.
Describe the Implications for Healthcare Providers
Drawing from the provisions of Medicare Part B, healthcare providers in community health are now presented with enhanced opportunities to handle prevention. The increased opportunities exist since the yearly visit to the patient’s primary care is comprehensively covered under the provisions of Medicare Part B. There is a shift to value-based health care frameworks, in which healthcare providers have to show that their services have led to improved health for their patients. Under the ACA, failure to demonstrate so will yield decreased payments for their Medicare and Medicaid payments (Davidson, 2013).
Describe the Funding Sources for the New Legislation
The ACA law requires that an individual purchases and sustains insurance. In violation of the above-stringent requirement, individuals will be penalized. The ACA law is financed partially by the above-prescribed penalty. Additionally, increased taxes on other health items and non-health related items or services are the sources of funding for the ACA. For example, there is 0.9% increment on Medicare Tax Rate and 3.8% fresh tax levied on unearned income for large amount taxpayers (Davidson, 2013).
What Changes Would You Make To The ACA?
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I would strive to incorporate access to wheelchairs and related medical equipment, including assistive technologies. In addition to the above-mentioned observation, I would review what rehab visits are provided under each plan, including prescription drugs and medical supplies.
I would ensure there is amendment and adoption of a doctor-friendly Medicare Sustainable Growth Rate. Medicare SGR has long been a source of frustrations for both doctors and politicians. Medicare SGR is the instrument, in which doctors are reimbursed. The law stipulated continual reduction of payments by 4-5% to physicians every year.
There exists a loophole in the ACA. The ACA law mandates that people buy insurance via a spouse’s employer if the employer is offering it. The law stipulates that the employer charges the insurance cover below 9.5% of the household income but fails to extend the same affordability percentage to the rest of the family. In essence, if the percentage of the cumulative family members’ percentage goes up, the subsidy is rendered irrelevant. Lastly, I would completely alter the fee-for-service payment systems. Fraudulent healthcare providers are likely to ensure patients have as many as surgeries and X-ray examinations since they are paid for separately and per each item.
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