Tuesday, October 14, 2014

Affordable Care Act 101

The Affordable Care Act (ACA), as we are all well aware, has been rolled out and operational. There has been over 8 million people that signed up for the coverage through the different Marketplaces throughout the country. The end result, or the plan, is to provide affordable care to individuals and to reduce the overall count of uninsured that some say is over 40 million people currently in the United States. Moreover, the ACA is also trying to bring high quality, affordable coverage to all individuals, regardless of their gender or pre-existing conditions that may be present in an individual’s health history.

CMS provides individuals and businesses with tools to educate everyone that is purchasing healthcare and is making sure that 80 cents out of every dollar generated in premiums goes to the healthcare that you receive. There are checks and balances here, in that, if health insurance companies do not spend 80 cents for every premium dollar, you get a refund. In 2012 the average refund was around $100.00 per family.

When we look at health insurance rates we sometimes wonder why they are so high or where do we find posted rates that one can compare. Now the ACA has provided the consumers with a layer of protection when it comes to rate increases. Insurance companies in every state must follow the rule that if they increase any rate over 10% they must publicly justify this change in premium.

There are also administrative measures being taken to protect the individuals who may get ill or make a mistake on their application. Also, there are no more denials for pre-existing conditions. But one of the more appealing things that came out of the ACA, at least in my opinion, was that young adults can stay on their parent’s plans until the age of 26.

All of this sounds good, but there also needs to be an administrative change, and this has been addressed as well. The Donut Hole has been shrunk for individuals and this will save the average beneficiary money with regards to their pharmacy spending. Maybe our elderly will someday not have to worry about the decision, do I buy my medicine or do I buy food. Some other items of interest, and maybe of great interest, is that CMS is fighting fraud at a much higher level and they are trying to strengthen the Medicare Trust Fund. This fund supports so many programs, and without it, there will be many people impacted throughout the country.

Overall, the goal of our health system is access, cost and quality. This is a step in the right direction and with everyone’s help maybe we can continue to make positive changes in our healthcare system.

Contributed by Kevin Harrington, Faculty Member

No comments: