Question

Identify three components of the Patient Protection and Affordable Care Act that went into effect in 2014 and discuss their impact or potential impact on the practice of nursing and medicine. Be specific as to what the provision states, who it affects, and the impact that it may have.

Answer 1

The Patient Protection and Affordable Care Act, which was enacted by the US Congress in 2010, marks the greatest change in US health policy since the 1960s. The law is intended to address fundamental problems within the US health system, including the high and rising cost of care, inadequate access to health insurance and health services for many Americans, and low health-care efficiency and quality. By 2019, the law will bring health coverage--and the health benefits of insurance--to an estimated 25 million more Americans. It has already restrained discriminatory insurance practices, made coverage more affordable, and realised new provisions to curb costs (including tests of new health-care delivery models). The new law establishes the first National Prevention Strategy, adds substantial new funding for prevention and public health programmes, and promotes the use of recommended clinical preventive services and other measures, and thus represents a major opportunity for prevention and public health. The law also provides impetus for greater collaboration between the US health-care and public health systems, which have traditionally operated separately with little interaction. Taken together, the various effects of the Patient Protection and Affordable Care Act can advance the health of the US population.

Affordable Care Act (ACA) The comprehensive health care reform law enacted in March 2010 (sometimes known as ACA, PPACA, or “Obamacare”). The law provides consumers with subsidies (“premium tax credits”) that lower costs for households with incomes between 100% and 400% of the federal poverty level

ObamaCare's main goals are to Increase the number of Americans covered by health insurance. Streamline the delivery of health care services. Reduce the overall costs of health care for everyone by restricting certain insurance company practices and providing tax credits and subsidies for individuals and businesses

The PPACA intends to make coverage more accessible and in order to do this it does the following:

Creates an Individual Mandate. Imposes an individual mandate requiring most U.S. citizens and legal residents to have health insurance coverage or pay a penalty.
Establishes American Health Benefit Exchanges. In order to make coverage more accessible and affordable, PPACA creates new entities called American Health Benefit Exchanges through which individuals who generally do not have access to affordable employer coverage, as well as small businesses, can purchase coverage.
Changes Private Health Insurance Coverage. The PPACA establishes new requirements for health plans and insurers designed to expand access to affordable coverage, and prevent individuals from losing coverage.
Expands Medicaid. The PPACA significantly expands the Medicaid program (known as Medi–Cal in California) primarily by mandating coverage of certain population groups not previously required—such as low–income, childless adults.
Establishes New High–Risk Insurance Pool. The PPACA establishes a federal high–risk health insurance coverage pool program to provide coverage to individuals who are unable to purchase coverage and who are commonly referred to as hard–to–insure or medically uninsurable.

Health Insurance Exchanges

Simplifying the Purchase of Coverage. The primary function of the exchange is to make coverage accessible and to simplify the process of obtaining it. United States citizens and legal immigrants who generally do not have access to affordable employer coverage can use the exchange to obtain coverage. Additionally, small businesses with fewer than 100 employees can use the exchange to obtain coverage for their employees. Prior to 2016, states can limit exchanges to businesses with up to 50 employees. Beginning in 2017, states can allow any business to purchase coverage from the exchange. One recent study estimates that by 2016 up to 8.4 million individuals in California would be eligible to participate in the exchange, even if employers with over 100 employees are not included.

The major functions of the exchanges are to:

Certify Health Plans. The exchanges will certify the “qualified health plans” that will be offered through the exchange. Certification will be based upon the plan’s ability to meet federal requirements regarding: (1) benefit design; (2) marketing practices; (3) provider networks, including community providers; (4) plan activities related to quality improvement; and (5) the use of standardized formats for consumer information.
Maintain Consumer Access to Information. Each exchange is to maintain an Internet website through which individual consumers may obtain comparative information on participating health plans. They will also operate a toll–free telephone hotline to respond to requests for assistance.
Perform Premium Reviews. The exchanges will review the premiums that are being charged by health plans to determine whether the plan should be made available through the exchange.
Outreach and Exemption Functions. Individuals who contact the exchange will be provided information on various public health coverage programs as well as the plans available through the exchange. The exchanges will also establish a “navigator program” to conduct outreach and facilitate enrollment in qualified health plans. They will certify whether certain individuals qualify for an exemption from the individual mandate and determine when employers are subject to penalties for failing to provide coverage to their employees.