Patient Protection and Affordable Care Act - Assignment Example

s Introduction The Patient Protection and Affordable Care Act (PPACA) is also referred to as the Affordable Care Act (ACA), though more commonly known as the Obamacare. The act is a US federal statute which has been signed into law by the President of the United States Barrack Obama. The bill was signed on March 23, 2010 (Mason, Leavitt and Chaffee 2012). The bill holds quite a significance since it has changed the course of healthcare in the US following Medicare and the Medicaid bills. The Obamacare bill is aimed at enacting the goal of enhancing quality as well as affordability of the healthcare insurance by essentially lowering the rate of uninsured, which is achieved by expanding the coverage while reducing the cost of healthcare for both individuals and the government. The Obamacare incorporated various measures to achieve the goals, including mandates, insurance exchanges, along with subsidies to expand the affordability and the coverage. The law further states that the companies which deal with insurance must cover almost all applicants who meet the new minimum standards while offering similar rates irrespective of sex or other pre-existing factors. Other reforms were aiming at essentially reducing costs while improving healthcare objectives by transforming the system in such a way that it focuses towards quality rather than quantity. This, in turn, is achieved after regulation, competition and also other incentives in order to streamline the deliverance of healthcare. It was in 2011 when the Congressional Budget Office announced that as per their findings the Obamacare would tend to lower not only the deficits but also the Medicare spending, labeling it as a win-win. In this context, the case of National Federation of Independent Business V Sebelius, the ruling which was published on June 28, 2012, the Supreme Court of the US upheld the constitution of the Obamacare as an individual mandate since it was proclaimed to be under the jurisdiction of taxing power rested in the Congress. Yet, the Court was of the view that the it would be unlawful to also force the states to go by the bill if they are under the penalty after which they risk losing the Medicaid related funding. Thus, given the complexity of the ruling, certain challenges are being faced by Congress and the Federal Courts, also other lobbies, unions and advocacy groups. It was, however, on March 31, 2014 that the deadline for open enrollment ended for the very first year of Obamacare exchange marketplace, where response was phenomenal (Mason, Leavitt & Chaffee 2014). Around 7 million people were enrolled in the first round to the surprise of Obama Administration. Provisions of the Bill The Obamacare Bill included various provisions which were to be effective from 2010 to around 2010. Also, those policies released prior to 2010 were declared null and void by virtue of a grandfather clause which exempts many changes to the insurance standards yet other provisions effect a few policies. A summary of a few provisions which took effect on the January 1, 2014 are as follow; Guaranteed issues is the most significant one which clearly prohibits insurance companies from denying individuals of insurance on the basis of pre-existing conditions or other community rating patterns. In additions, the insurers are required to offer similar pricing for all potential applicant from same age groups or geographical locals, also disregarding differences in gender or other related patterns (Starr 2011). However, minimum standards for insurance policies have been established. Furthermore, the Obamacare assigns all individuals who aren’t covered by employee`s healthcare plans, Medicaid or even Medicare to get a privately insurance policy or else they will be required to pay a penalty. However, individuals would be exempted from penalty if there is a financial hardship or a religious reason defies the purchase of such policy. The law also allows those from low income groups to benefit from subsidies. Health Insurance Exchanges have taken the form of an avenue where people and even small business can acquire insurances by comparing pricing, and even benefitting from government subsidy if applicable. The open enrollment dates would be announced, as were earlier. Those individuals and also the families who come from low income groups and fall from around 100% to 400% of the federal poverty level will be subject to acquire federal subsidies when they purchase insurance via exchanges. Those wh fall from 133% to 150% would be subsidized to an extent where the cost incurred is around 3 or 4% of their income. The law aims at restructuring and enhancing efficiency which was being effected by the Medicare payment plans. For instance, under the new plan, one single payment would be made to the hospital or the entire group of medical practitioners involved rather than individual payment schedules to each of the service provider. Also, businesses are expected to employ 50 or more than 50 employees on the condition that healthcare would be offered, else they would be subject to a tax penalty if the government has subsidized the full time employee`s healthcare via tax deduction or even other similar means. Background As mentioned above, the PPACA offers a unique combination which is rather an extension and an improvement on the Medicaid to further subsidize private insure and cutting off costs with an added function of regulating the insurance business. The sole aim is to make universal healthcare dispensable via individual mandate. However, the concept isn`t entirely new and goes back to 1989 while the Conservative Heritage Foundation offered the individual mandate as a viable alternative to the single-payer healthcare. Also, during the time, the republicans and other conservative minded groups were hailing the concept on the basis that it would rid them of the free rider issue. Also, the Emergency Medical Treatment and Active Labor Act of 1986 also required the medical practitioners to treat emergency cases after which the costs were mostly being borne by the governments (Haugen 2008). Furthermore, President Bill Clinton also proposed a similar reform in 1993 where the employers would bear healthcare reforms, while the republicans offered an alternative where individuals would purchase the insurance instead of employer. Thus, amid conservative pressures, the Clinton plan was bound to fail (Blendon 2011). Also, in 1993, the republic alternative which was proposed by Seantor Chafee was proposed which offered Health Equity and Access Reforms Act which also included universal coverage where penalty would be imposed on non-compliance. Ironically, Republicans who were supporting the bill during the time are now strongly opposing Obamacare. Another similar reform was proposed by Republican Senator Don Nicles back in 1994 which also offered an individual mandate with penalty yet he later removed the provision on the basis that it was wrongful of the government to force people into buying insurance. However, constitutional issues regarding the bill weren’t raised during the time. Later in 2006, another insurance expansion bill was introduced at state level in the Massachusetts which was vetoed by Governor Mitt Romney however late his veto was over-ridden. Later in 2007, Senator Bob Bennet and Ron Wyden proposed the Healthy Americans Act which was also lobbying for individual mandate and state regulated insurance however it was killed in the committee. By 2008, many democrats were quite convinced using the approach for reforms in healthcare. Experts are now of the view that the emergence of Bills in 2009 and also in 2010 are rooted in the 2007 bill since the patterns are inter-related. Public Policy Impact The ACA law inherently contains two mechanisms aimed at enhancing insurance coverage. The Medicaid is expected to cover individuals falling around 138% of federal poverty level and also ensuring state regulated insurance exchanges where individuals as well as small businesses can purchase insurance plans. Also, during these exchanges individual falling between 100% to 400% will also be applicable to attainting subsidies. The Congressional Budget Office had estimated that the public policy would be as impactful as to cover around 32 million uninsured residents while the proportion of the elderly being insured increased to 83% in the next few years. In 2012 alone, around 3 million uninsured were covered which portrayed adequate results. Yet, those who remained uninsured were those who were illegal immigrants which have been estimated to around 8 million who fail to meet the criteria for insurance purchase. They will continue to be covered under Emergency Medical Treatment and Active Labor Act of 1986. In addition those who weren’t enrolled under Medicaid also remained uninsured. Those who are younger and serious who didn’t take the penalty seriously also make to the list of those uninsured. Also, people who`s insurance cost would take more than 8% of household income were also hesitant in availing the insurance. The public policy initiative behind the act wasn’t only to increase quantity of insurance; rather the focus was also towards maintaining quality. Also, the act was framed in such a way the healthcare providers would also easily agree to the payment system which also had to do with the fact that the hospitals would be required to do less of the charity work. Another objective achieved by this policy initiative was that the rare of un-insurance amongst 19-25 years dropped by 1.6% due to the fact that the children were now being covered under their parents` insurance plans. Also, those workers who would be eligible for employer`s coverage would rather not be eligible for subsidies being offered by the government. However, if the cost of insurance exceeds around 9.5% of the household income, subsidies would again be applicable. Yet, the cost of family plan went higher since child-only plans were abandoned (Altman 2014). Key Stakeholders A thorough analysis proclaims that the healthcare practitioners are the key stakeholders in the issue, especially those at the administrative ends, sine their lobbies are the most influential ones, also they would be administering and directly implementing the policy. Secondly, those at the left and right extremes in the House and the Senate are definitely critical stakeholders. Essentially, those who are uninsured and would now comply by the criteria to be eligible for policy, and also would be able to avail insurance are also stakeholders in the issue. Moreover, another neglected lot of stakeholders are the small companies are they would now have to hold penalties if their employees aren’t insured thus they are the ones being directly influenced as well. Adverse Effects of the policy Firstly, opponents of the Act turned to federal courts where the National Federation of Independent Business V Sebelius ruled 5-4 to acclaim individual mandate constitutional. However, court also clarified that the courts wouldn’t be expected to comply which made the states opt out of the act which decreased the impact of the public policy. However, there are still legal concerns over the law being a violation of First Amendment where the right to exercise religion is being questioned. Lawsuits regarding the issue are still pending. Also, in the aftermath of the NFIB V Sebellius ruling, many states are opting out of the act, while it is a known fact that around half of the uninsured population resides in those states, which again poses a public policy challenge, Supreme court ruling also raised another issue with relevance to coverage gap, since the states which choose to reject the Medicaid have many people who fall 133% below poverty line (Gray, Loweri & Benz 2013). Furthermore, in many states the official are non-cooperative where they opt to oppose certain parts of the ACA over which they may have certain discretions. For instance, Missouri defied on expansion of Medicaid engaged in an active program of non cooperation which aimed at enacting statutes forbidding aid required by federal law. In such a case, the conservatives are especially lobbying to derail the bill, while those in favor of the bill are indulged in advertising the benefits. Another huge aversion to the act was the 2013 federal government shutdown which was a strong case against the Obamacare. A strong bi-partisan divide in the Congress prevented adjustments to be made to the act. Only the provision of repeal on tax has achieved support from both the blocs. In 2013, certain republicans aimed at defunding the implementation of a bill, and some senators went as far as refusal to fund the government unless the ACA was delayed after which the President had to push the employer mandate to an year. Role of Healthcare Practitioners In this content, the healthcare practitioners, keeping in view the provisions of the bills, must assist and facilitate the implementers. The healthcare practitioners are the ones who have to directly deal with the emergency cases with no insurance, or who have to make the hard decision of choosing to deny treatment based on the insurance or not, thus they will make the most out of it. They should also play their role in educating the individuals of the benefits of the bill, also lobby for expansion of Medicare for as far as possible (Stark 2010). Also, the practitioners should take the penalty provision seriously and must report any such cases subject to penalty without hesitation as they also have a crucial role to play in context to the bill. The hospitals must comply by the provisions and rather ensure that maximum numbers of people are being insured. Also, they can assist the low-income groups in identifying their provisions to subsidies. Thus, conclusively, The Patient Protection and Affordable Care Act (PPACA) is also referred to as the Affordable Care Act (ACA), though more commonly known as the Obamacare. The act is a US federal statute which has been signed into law by the President of the United States Barrack Obama. The bill was signed on March 23, 2010 (Atlass 2010). The bill holds quite a significance since it has changed the course of healthcare in the US following Medicare and the Medicaid bills. The Obamacare bill is aimed at enacting the goal of enhancing quality as well as affordability of the healthcare insurance by essentially lowering the rate of uninsured, which is achieved by expanding the coverage while reducing the cost of healthcare for both individuals and the government. The Obamacare incorporated various measures to achieve the goals, including mandates, insurance exchanges, along with subsidies to expand the affordability and the coverage. The law further states that the companies which deal with insurance must cover almost all applicants who meet the new minimum standards while offering similar rates irrespective of sex or other pre-existing factors. Other reforms were aiming at essentially reducing costs while improving healthcare objectives by transforming the system in such a way that it focuses towards quality rather than quantity. This, in turn, is achieved after regulation, competition and also other incentives in order to streamline the deliverance of healthcare. It was in 2011 when the Congressional Budget Office announced that as per their findings the Obamacare would tend to lower not only the deficits but also the Medicare spending, labeling it as a win-win. Works Cited: Altman, S. (2014). Power, politics, and universal health care: The inside story of a century-long battle. Amherst, NY: Prometheus Books. Atlas, S. W. (2010). Reforming Americas health care system: The flawed vision of Obamacare. Stanford, Calif: Hoover Institution Press. Blendon, R. (2011). American public opinion and health care. Washington, D.C: CQ Press. Gray, V., Lowery, D., & Benz, J. K. (2013). Interest groups and health care reform across the United States. Washington, DC: Georgetown University Press. Haugen, D. M. (2008). Health care: Opposing viewpoints. Detroit: Greenhaven Press/Gale. Mason, D. J., Leavitt, J. K., & Chaffee, M. W. (2012). Policy & politics in nursing and health care. St. Louis, Mo: Elsevier/Saunders. Mason, D. J., Leavitt, J. K., & Chaffee, M. W. (2014). Policy & politics in nursing and health care. St. Louis, Mo: Elsevier/Saunders. Stark, A. (2010). Drawing the line: Public and private in America. Washington, D.C: Brookings Institution Press. Starr, P. (2011). Remedy and reaction: The peculiar American struggle over health care reform. New Haven: Yale University Press. Read More