The Patient Protection and Affordable Care Act Part One: What It Is and Isn't

[TexasTowelie]

By Dr. Brian Carr
President, Behavioral Health Associates, Lubbock, Texas, 1991-Present
Chairman, City of Lubbock Board of Health, 2013
Submitted on September 3, 2013 - 7:12am

The Patient Protection and Affordable Care Act (otherwise known as “Obamacare”) has been labeled the most important piece of health-related legislation in U.S. history. Nearly 500 provisions are contained in the ACA legislation. With this law America provides a means for all of our citizens to be able to access health care and not be afraid of becoming sick or disabled.

According to a survey conducted by the Kaiser Family Foundation, 53 percent of Americans said they were “confused” by the ACA provisions. Too often we only hear the anger of those who oppose the law while not offering any sense of exactly what they are opposed to or what the alternative might be.

I spent time over the holiday reviewing the ACA provisions and the changes that will result in our health care industry. My plan is to present the essential components of the ACA over the next few weeks in my lubbockonline blog. It is not my purpose here to debate the “good” or “bad” of the law but more to help the reader understand the basic components and what has already been implemented and what will be rolling out in the coming months and years.

The ACA targets major problems in the existing system

Four Principle Goals

1. Give Americans greater access to healthcare. With about 37 million American citizens without health insurance coverage it is essential that we change the model of service delivery so that care is improved. For many in this group they simply cannot afford to purchase health insurance coverage. For others they are not able to obtain coverage because of pre-existing conditions. The ACA provides a means to be included in the healthcare system, either by increasing access to Medicaid for those at the lower earning levels or through subsidized health insurance via exchanges operated by the state or federal government.

2. Control or reduce healthcare costs. The current fee-for-service delivery model tends to drive up costs as the quantity of care is the result over the quality of care.

3. Provide for greater consumer protection and benefits that maximize a healthy lifestyle. These new safeguards and benefits provide for better regulation of the health insurance industry and require more transparency of how these carriers manage the premiums they take in and where the money goes. It presents insurance companies from dropping your coverage after you get sick because you made a minor error when you filled out your application. The carrier can no longer refuse to extend you coverage because you have a pre-existing health condition or charge you a higher premium because you’re older or have a chronic disease. Coverage can no longer have annual or lifetime limits.

4. Providing for an emphasis on prevention and wellness programs that help to maximize healthy lifestyles and reduced utilization of healthcare services.





The ACA at the Individual Level

For a person who currently has health insurance through their employer the ACA is a “mixed bag”. The law adds new consumer benefits and protections. A potential negative is whether your employer will continue to offer health insurance to you and your family. A telling point for this possible action is whether your job exists in a competitive market where such benefits are used to attract productive employees.

For the person who is uninsured, the ACA is good news. If you have a low income, you will either be able to enroll in Medicaid or qualify for a subsidized insurance plan through your state’s healthcare exchange. If you have a high income, you will also be able to buy a plan through an exchange, and its price will probably be better than what you would have to pay on the private insurance market today.

For those who have a high income the ACA represents an increase in taxes. There is a 3.8 percent ACA surtax on capital gains above $250,000 (for married couples). Single Americans who earn above $200,000 per year (or $250,000 for couples) will see the amount they pay in taxes for Medicare increase from the current 1.45 percent level to 2.35 percent above those income thresholds. Medicare beneficiaries with higher income will also be required to pay higher Part D premiums. A 40% tax will also be imposed above a specific threshold level for premiums on so-called “Cadillac” health insurance plans with enhanced benefit packages that some big earners now enjoy.

For working families the consumer protections and benefits provided by the ACA will help.

The ACA is of great assistance to the poor in America. Under the new law the income requirement to get into Medicaid is raised to 133 percent of the federal poverty line. An estimated 15 million more people will be able to get coverage as a result of the ACA, and low-income earners will still can’t get into Medicaid will qualify for government subsidies offered on the new state exchanges.

If you are concerned about those who are residing in the United States without proper documentation proving they are here legally being able to access any of the new benefits that come with the ACA don’t worry. This group will not be able to buy health insurance nor will they be allowed into the Medicaid or Medicare program.

For those who work for a large business there is a legitimate fear that their employer may drop their insurance. The key issue is whether you work for a large business such as McDonald’s, which pays low wages and does not need a health insurance benefit to attract workers or are employed by a business that sees health insurance benefits as of vital importance to compete effectively in the work place for skilled employees.

Small businesses benefit more from the ACA because of significant tax breaks they will receive against the amount they pay in health insurance premiums for their workers. Small businesses have historically had to pay significantly more than large businesses to insure their workers, not only in premiums, but also in administrative costs. The new ACA health exchanges create more of a level playing field and small businesses could realize large financial benefits.

Next: Understanding the current Healthcare System

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We don't need no stinkin' health reform

http://lubbockonline.com/interact/blog-post/dr-brian-carr/2013-09-03/patient-protection-and-affordable-care-act-part-one-what

Cross-posted in Good Reads forum.

[font color=green]You might also want to read the comments at 10:31 a.m. by Jeff Ross who is an assistant professor of psychology at South Plains College and a prolific commenter for liberals at the Website. Apparently the moderator not only deletes his comments, but has been contacting his employer in order to suppress his views. The storyline of harassment is full of irony.[/font]

[northoftheborder]

1. Thank you so much for your efforts to spread the truth. I intend to print out your paper for ....

....my own information in case I come across misinformation amongst my acquaintances.