Question

What would be two policies that would be recommended for a health services organization and explain why these recommendations are important for PPACA implementation. What steps might be recommend as a healthcare administration leader to ensure that your health services organization will address the implications of PPACA.

Answer 1

?The PPACA came effective from January 2014. First, the law made national standards for private insurance sold to individuals and small groups. Insurers selling health plans can no longer set prices on the basis of health or exclude coverage of preexisting health conditions, and they are limited in what they can charge older adults as compared with younger adult, also the plans that are sold in these markets must meet comprehensive benefit standards. Cost sharing such as deductibles may vary across plans, but to aid consumer decision making, health plans must be sold at four distinct levels of actuarial value. For example, on average, bronze plans must cover at least 60% of medical costs, silver 70%, gold 80%, and platinum 90%.

Second, the law created new private insurance marketplaces to sell subsidized insurance to individuals and small groups. Many states and the District of Columbia chose to run these marketplaces themselves in 2014. The rest of the states left this wholly or partly to the federal government.

Third, substantially expanded eligibility for the Medicaid program. The 2012 Supreme Court decision made state participation in the law's expansion optional. Also pursuing customized approaches requiring federal approval.