The Affordable Care Act | A Path to Health Equity

As we know, healthcare costs are continuously rising. In such cases, insurance plans and policies like the Affordable Care Act (ACA) can help people to cover their expensive medical bills. Hikes in healthcare expenses are major concerns in most developed countries. Yet, some political measures to reduce expenses have so far damaged the best interests of citizens and patients. The ACA may protect people from high medical bills. This blog will help you know about the Affordable Care Act (ACA) and how it works.

The Affordable Care Act

The Affordable Care Act (ACA), previously called, Obamacare and the Patient Protection and Affordable Care Act (PPACA) is a landmark U.S. federal statute enacted by the 111th United States Congress. It was signed by acting President Barack Obama on March 23, 2010. ACA is a comprehensive law introduced in the year 2010. It provides health insurance for uninsured people and implements some changes to the health insurance market. The ACA represents an essential step ahead on the path toward an affordable health system. Under the Affordable Care Act insurance, patients who are uninsured because of some pre-existing circumstances such as preexisting disease or limited finances can have affordable health plans via the insurance marketplace in the state.

Main Goals of Affordable Care Act Insurance

ACA expands access to health insurance, enhances consumer protections, forces wellness and prevention, enhances system performance and quality, increases the health workforce, and helps to fight the rising costs of healthcare. The ACA has three main goals:

To provide affordable healthcare services to more individuals.
Expand Medicaid to provide coverage to adults with income lower than 138% FPL.
Support modern methods of delivery of medical care which are designed to help lower healthcare costs.

Key Features of Affordable Act Care Insurance

The important features of ACA are:

To Provide Healthcare Coverage to More People

The ACA tells employers to provide coverage to employees and gives tax credits to some businesses. This was for those who cover health insurance expenses for their workers. It also provides coverage for people with less income. It permits adults to stay on their parent’s policies until 26 years. This law gives people subsidies that bring down household costs. This is provided to people with income between 100% to 400% federal poverty level. People can pass for premium tax credits even if their income exceeds 400% FPL. You may qualify and enroll in or change coverage during open enrollment if your income is below or equal to 150% FPL.

Improve Quality of Health

The ACA guides to lower medical errors and introduces easy payment methods to enhance work efficiency. This improves care coordination among different healthcare providers. This law helps to reduce healthcare fraud.

Enhance Consumer Insurance Protections

The ACA stops lifetime limits on healthcare coverage. It limits the annual caps usage. It prohibits insurance policies from excluding coverage for children having pre-existing diseases.

Prevention and Wellness

The Prevention and Public Health Fund, which is established under the ACA, gives money for prevention acts, such as immunizations and screenings, Health Promotion, and the National Prevention, and Public Health Council which addresses physical inactivity, poor nutrition, and use of tobacco. The ACA coverage plans cover preventive care for children, immunizations, screening of diseases for conditions like high cholesterol, hypertension, cancer, and diabetes, and awareness campaigns for oral wellness.

Patient Protection and Affordable Care Act

Under the ACA, a person has special patient protection.

Insurers are not allowed to refuse coverage for healthcare based on pre-existing conditions or gender.
Young people up to 26 years old can stay on their family’s insurance plan.
There are no annual or lifetime limits on coverage for required health benefits.

The ACA allows health insurance companies to approve all applications for coverage. Before Obamacare, health insurance companies had a right to reject you for health insurance coverage or charge high rates in case of pre-existing conditions. It made it difficult for people with health problems to find affordable health insurance for themselves. The ACA costs depend on age. For example, a 30-year-old pays less monthly on average for an ACA plan as compared to a 40-year-old and 50 or 60-year-old person. This law lets parents keep their children on their plans until their children turn 26.

What Does the Affordable Care Act Cover?

ACA insurance plans must cover these ten important health benefits, such as,
- Ambulatory patient and outpatient services
- Hospitalization
- Emergency services
- Laboratory services
- Newborn and maternity care
- Pediatric services (Vision and oral care for children)
- Mental health and services for substance use disorder.
- Habilitative and rehabilitative services
- Chronic disease management and preventive and wellness services
- Prescribed drugs

Eligibility Criteria for Affordable Care Act Insurance Plans

The eligibility criteria to enroll in healthcare plans are as follows:

A person must be a resident of the United States.
Present in US citizen or national.
Should not be incarcerated.
A person whom Medicare does not cover.

If anyone is not a US national but is lawfully present in the US, he or she may qualify for ACA if their status of immigration is one of the following:

Asylum-seeker
Cuban or Haitian entrant
Green-card holder
Refugee
Immigrant paroled into the U.S.
Battered spouse, parent, or child.
Trafficking victim.
Immigrants who are granted conditional entrance before 1980.
Nonimmigrants, including those with student visas and worker visas.
Deferred enforced departure (DED).
Those with an administrative order issued by the U.S. Department of Homeland Security.
Deferred action status, except Deferred Action for Childhood Arrivals (DACA).
Temporary resident (lawful).
Temporary protected status (TPS).
American Indian born in Canada or a member of a federally recognized Indian tribe.

The Affordable Care Act open enrollment

It is the annual period during which individuals can compare different available healthcare plans and choose the one that will fit their requirements. The Affordable Care Act open enrollment period runs from 1 November through 15 January. The dates may vary in different states. You can only sign up for ACA-compliant family and individual health insurance or switch to a different health plan if you get a chance to qualify for a life event that fits into the criteria of a special enrollment period.

Affordable Care Act Pros and Cons

ACA is beneficial as it is more affordable health insurance for preexisting health states. It also has some cons including individuals having to pay high premiums. Millions of Americans have benefited from ACA insurance plans. Many individuals had low incomes or were unemployed. Some people could not find decent healthcare insurance due to preexisting medical conditions like chronic diseases. Despite the positive facts, ACA has some downsides too like high taxes and higher insurance premiums are required to pay for ACA.

Pros of ACA

There are several benefits of getting ACA insurance plans.

Affordable for People

ACA is more affordable than other insurance plans. Insurance companies should spend about 80% of insurance premiums on enhancements in medical care. The Affordable Care Act prevents insurers from implementing unreasonable rate hikes. Insurance coverage is not free, but policyholders have more options to choose from now.

Accessible to More People

Within the ACA’s five years, about 16 million people in America have gotten health insurance coverage. Among these newly insured Americans young adults make up a huge percentage.

No Time Limits

Some insurance companies set time limits on the expenses they would pay for a person due to which some people with chronic health issues ran out of coverage. Now insurance companies are not allowed to set coverage limits.

No Denied Coverage for Preexisting Health Conditions

Before the ACA, it was difficult for people with preexisting health issues like cancer to get healthcare insurance. Many insurance companies did not cover the medical care for these problems. The reason for their rejection was the illness occurred before getting their policy. But the Affordable Care Act made it easy. Now your coverage cannot be denied because of preexisting health issues.

Affordable Prescription Drugs

Prescription drugs are more affordable with Affordable Care Act insurance plans. People, especially seniors, may be unable to afford costly medications. So, the ACA covers drugs. The number of prescription drugs covered by the ACA is expanding each year.

Coverage for More Screenings

The ACA covers many preventive services and screenings. They usually have deductibles or copays. Healthy policyholders will pay less costs with time. For example, early screening and treatment of diabetes may help to cut down on expensive treatment later.

Cons of ACA

High Taxes as a Result of the ACA

To pay for the ACA taxes such as pharmaceutical sales and medical devices were passed. People with high incomes must pay more taxes. The wealthy people are helping to cover insurance for the poor ones. Some economists predict that the ACA may positively influence the budget.

Higher Premiums

The premium has risen for people who already have insurance. This is because of providing a wide range of benefits and coverage for people with preexisting conditions.

Employee hours are Being Cut by Businesses to Avoid Covering Employees

In recent years, the number of jobs has increased, but there are some reports of businesses cutting hours from employees’ schedules. Businesses with 50 or more full-time employees must pay insurance for employees. So, by cutting time, they save on paying insurance for employees.

Affordable Care Act Healthcare Insurance Plans

Affordable Care Act insurance plans in the Marketplace are divided into four health plan categories:

Bronze
Silver
Gold
Platinum

Bronze

Less monthly premium.
Highest expenses for care.
Deductibles maybe thousands of dollars per year.

Silver

Moderate monthly premium.
Moderate costs when you require care.
Silver deductibles are less than those of bronze plans.

Gold

High monthly premium
Low expenses of care.
Deductibles are low.

Platinum

Highest monthly premium
Lowest costs of care.
Very low deductibles.

It does not matter which category of health plan you choose; you can save money based on your income on the monthly premium. The ACA can have a change in its policies every year. Decisions like budget decisions can affect its implementation. Amendments in the healthcare sector with changes to the future political makeup show that the ACA will continue to change in the coming years. Well, it is always a good idea to secure your future when you have a chance to get better coverage for your healthcare needs.