|Affordable Care Act|
While much of the media noise has died down recently, the Affordable Care Act has had more than its share of challenges lately.
No one can forget the initial implementation nightmares, and how websites created so people could register for government healthcare often crashed.
While it’s easy to focus on the problems, it’s more important to acknowledge the monumental changes that have already taken place since the Bill was signed into law in 2010.
While the Bill is often called Obamacare, its real name is the Patient Portability and Affordable Care Act. That alone says a great deal about its intention — it is focused on people who need healthcare.
The portability part addresses the system in the United States that ties healthcare to an employer; changing jobs has most often resulted in a need to secure new health insurance coverage. In the presence of pre-existing medical conditions, this frequently resulted in people being denied coverage. This meant many American’s went bankrupt paying their medical costs. Under the Affordable Care Act you can no longer be denied coverage for preexisting conditions.
The affordable part relates to the fact that the United States has the costliest healthcare system of any country in the industrialized world and not always the best results. (According to the World Health Organization (WHO), the United States annually spends a higher portion of its gross domestic product on healthcare than any other country. Yet, the United States ranks 37th out of 191 countries in the WHO's ranking of healthcare systems.)
While the underlying intention is to make affordable healthcare accessible to more people, in my opinion, the changes that have already taken place also have made health insurance coverage better for all Americans.
Some of the huge changes that have already taken place include:
- Removing lifetime limits or the monetary value of coverage. Previously, most benefits were capped at $1 million and many plans were capped well below that limit.
- Removing the insurance company’s practice of denying children insurance coverage based on pre-existing conditions
- Providing dependent coverage up to age 26. This change affords health insurance for millions of Americans.
- Providing minimum coverage with no cost-sharing for preventative services (screening colonoscopies, mammograms, Initial Preventative Physical Examination)
- Closing the Medicare D coverage gap (the “donut hole”). Copayments required for brand-name and generic drugs are being phased down to the standard 25 percent by 2020.
- Reducing payment (beginning with Medicare) for medical interventions that did not reflect evidence-based quality measures
- Reducing payment for hospital readmissions that were considered to be excessive and preventable
- Reducing payment for hospital-acquired infections
- Requiring that health insurance policies be simplified
The changes that are taking place in healthcare in the United States are HUGE; they are complex and sometimes confusing; and they involve many governmental agencies, all hospitals, clinics, long- term care facilities, physicians, nurses and other providers. Since 2010, significant benefits have already been realized. There will be more in 2014 — STAY TUNED!!!
Carole Bergeron, Ph.D., is the academic program manager for the Healthcare MBA at Post University offered through the Malcolm Baldrige School of Business, and a registered nurse with four decades of healthcare experience.