Analysis of the Healthcare Reform Act
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Published: Tue, 19 Dec 2017
According to the U.S. Department of Health and Human Services the Health policy broadly describes actions taken by governments national, state, and local to advance the public’s health. It is not a single action but requires a range of legislative and regulatory efforts ranging from ensuring air and water quality to supporting cancer research. Health care policy deals with the organization, financing and delivery of health care services. This includes training of health professionals, overseeing the safety of drugs and medical devices, administering public programs like Medicare and regulating private health insurance (U.S. Department of Health and Human Services 2010). This analysis covers the federal statute enacted in 2010: the Patient Protection and Affordable Care Act (PPACA), which was designed to help families across the states gain access to quality, affordable health care.
Many countries integrate a human rights viewpoint when creating their health care policies. The World Health Organization reports that every country in the world is party to at least one human rights treaty that addresses health-related rights, including the right to health as well as other rights that relate to conditions necessary for good health (World Health Organization, 2012). The United Nations’ Universal Declaration of Human Rights (UDHR) asserts that medical care is a right of all people (The United Nations, 2012).
UDHR Article 25: Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, and housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.
Health care reform in the United States has a long history. In 1900 the American Medical Association (AMA) became a powerful national force. By 1910 the American Association for Labor Legislation (AALL) organized the first national conference on “social insurance”. Liberal activists argued for health insurance. In the 1930’s the Depression changed priorities, placing more importance on unemployment insurance and “old age” benefits. The Social Security Act was passed, omitting health insurance. By the 1940’s prepaid group healthcare began and was seen as radical. During the 2nd World War, wage and price controls were placed on American employers. To compete for workers, companies began to offer health care benefits, this employer-based system in place today. President Roosevelt asked Congress for “economic bill of rights,” including the right to adequate medical care. President Truman offered national health program plan, recommending a single system that would include all of American society. Truman’s plan was criticized by the American Medical Association (AMA), and is called a “Communist plot” by a House subcommittee. In the 1950s, hospital care cost doubled. In the early 1960s, President Lyndon Johnson signed Medicare and Medicaid into law. President Richard Nixon renamed health care plans to health maintenance organizations (HMOs), with regulations that provided federal endorsement, certification, and assistance. American medicine was viewed as being in a state of emergency. President Nixon’s plan for national health insurance was rejected by liberals & labor unions. In the 80’s Corporations began to integrate the hospital system (previously a decentralized structure), consolidating control. Healthcare shifted toward privatization and corporatizations. In 1986 Congress passed and President Ronald Reagan signed into law COBRA, an option that former workers could stay on the company health care plan for 18 months after leaving a job, although the former employee would pay for the coverage. In 1988 prescription drug benefit and catastrophic care coverage was added to Medicare; Congress repealed the law the next year. Under President Reagan, Medicare moved to payments for diagnosis’s (DRG) rather than for treatment received. Health care costs increased at double the rate of inflation. Federal health care reform legislation failed passage for a second time in the U.S. Congress. By the end of the decade there were 44 million Americans, which was 16 % of the nation, with no health insurance at all. With a fresh era and Health care costs are on the upsurge again. Medicare is viewed by some as unmentionable under the current organization and must be “rescued” (Associated press, 2012).
After years of unsuccessful attempts by a series of Democratic presidents and a year of bitter partisan struggle, President Obama signed legislation on March 23, 2010, “to overhaul the nation’s health care system and guarantee access to medical insurance for tens of millions of Americans. The Affordable Care Act seeks to extend insurance to more than 30 million people, primarily by expanding Medicaid and providing federal subsidies to help lower- and middle-income Americans buy private coverage. It will create insurance exchanges for those buying individual policies and prohibit insurers from denying coverage on the basis of pre-existing conditions. To reduce the soaring cost of Medicare, it creates a panel of experts to limit government reimbursement to only those treatments shown to be effective, and creates incentives for providers to “bundle” services rather than charge by individual procedure”. (Henry J. Kaiser Foundation, 2010)
According to research done by the New York Times the law will cost the government about $938 billion over 10 years, according to the nonpartisan Congressional Budget Office, which has also estimated that it will reduce the federal deficit by $138 billion over a decade (Andrews, 2012).
One feature of the Affordable Health Care Act is that insurance companies including all exchange plans will provide adequate benefits to their enrollees. The essential health benefits package will define the minimum set of benefits that new health plans must offer for private market individual and small group plans as well as for Medicaid enrollees in benchmark coverage and those covered by state Basic Health Programs. Many expected the Department of Health and Human Services to outline the services to be included in essential health benefits package; instead it specified that each state would select the package that best meets the needs of children and families (Merles, M. 2005).
Essential health benefits (Ebbs) are the least amount benefits that the Affordable Care Act (ACA) requires to be offered by non-grandfathered health plans in the individual and small group markets. Section 1302 of the ACA identifies the requirements for the essential health benefits. This approach allows states have the discretion to choose a benchmark set of benefits from among the existing health plans. Section 1302 also establishes some specific guidelines in defining the Ebbs. Benefits may not be designed “in ways that discriminate against individuals because of their age, disability, or expected length of life” and are required to “take into account the health care needs of diverse segments of the population, including women, children, persons with disabilities, and other groups.”(Touschner, 2011)
EHB packages must include benefit protections established in other parts of the ACA, including parity for mental health services and preventive services offered at no cost to enrollees. For infants, children, and adolescents, the preventive services requirement incorporates the services recommended in the American Academy of Pediatrics’ Bright Futures initiative (Touschner, 2011).
The need for adequate Children’s benefits is critical due to their constant development and growth. Children have need of health services that are different than adults, which includes preventive screenings depending on their age and development stage. Children’s growing bodies may also require long-lasting medical equipment (like wheelchairs) on a more frequent schedule than adults. In its Scope of Health Care Benefits for Children policy statement, the American Academy of Pediatrics (AAP) outlines the services that are essential for children. (“Scope of health,” 2012)
For many years, Americans have paid the price for policies that have allowed insurance companies to place barriers between them and their doctors, dropping their coverage for sickness, and discriminating against anyone for pre-existing conditions. Mississippi has one of the nation’s highest percentages (63.2 percent) of uninsured people who would qualify for Medicaid under the expansion in the United States (Kaiser 2010). The Affordable Care Act gives middle-class and low income families in Mississippi the health insurance coverage they deserve. The new health care law dictates that insurance companies are to play by the rules, they can no longer drop coverage if you get sick, sending you into bankruptcy because you have met your annual or lifetime limit, but most importantly they cannot discriminate against anyone with a pre-existing condition (U.S. Department of Health and Human Service, 2010). It is now mandated that health plans allow parents to maintain coverage of their children who are under the age of 26 and without insurance on their jobs. Resulting from this provision, As of December 2011, 37,000 young adults in Mississippi now have insurance which is included in 3.1 million young people nationwide. The health care law includes Medicare prescription drug coverage benefits which have made prescriptions more affordable. In 2010, a $250 rebate was given to 34,604 people with Medicare in Mississippi who had hit the prescription drug donut hole. In 2011, they began receiving a 50 percent discount on covered brand-name drugs and a discount on generic drugs (U.S. Department of Health & Human Services, 2012). Since the law was enacted, residents with Medicare in Mississippi have saved a total of $41,809,338 on their prescription drugs. As a result of the discounts people are saving $591 per year and a total savings of $11,732,360 in Mississippi in 2012. It is projected by 2020; the law will close the donut hole.
Last year (2011) 330,017 people with Medicare in Mississippi received free preventive services or a free annual wellness visit with their doctor (U.S. Department of Health & Human Services, 2012). Approximately 47 million women, including 381,704 in Mississippi now have guaranteed access to additional preventive services without cost-sharing. Under the new health care law, insurance companies must provide consumers greater value by spending generally at least 80 percent of premium dollars on health care and quality improvements or they must provide consumers a rebate or reduce premiums. This means that 51,744 Mississippi residents with private insurance coverage will benefit from $10,122,532 in rebates from insurance companies this year which will average to $329 for the 30,800 families in Mississippi covered by a policy. Under the new law Mississippi has received $4,783,208 to help fight arbitrary premium increases. As of August 2012, 317 previously uninsured residents of Mississippi who were locked out of the coverage system because of a pre-existing condition are now insured through a new Pre-Existing Condition Insurance Plan that was created under the new health reform law (U.S. Department of Health & Human Services, 2012).
Mississippi has received $21,143,618 in grants for research, planning, information technology development, and implementation of Affordable Insurance Exchanges. Since 2010, Mississippi has received $5,200,000 in grants from the Prevention and Public Health Fund created by the Affordable Care Act. This new fund was created to support effective policies in Mississippi, its communities, and nationwide so that all Americans can lead longer, more productive lives (U.S. Department of Health & Human Services, 2012). In Mississippi, there are 21 health centers providing preventive and primary health care services to 324,046 people from183 different sites. These health centers have received $49,784,983 under the Affordable Care Act to support the operations and establishments of new health center sites. Mississippi was granted $4,100,000 for school-based health centers, to help clinics expand and provide more health care services such as screenings to students and $3,100,000 for Maternal, Infant, and Early Childhood Home Visiting Programs. These programs bring health professionals to meet with at-risk families in their homes and connect families to the kinds of help that can make a real difference in a child’s health, development, and ability to learn – such as health care, early education, parenting skills, child abuse prevention, and nutrition (U.S. Department of Health & Human Services, 2012).
The Patient Protection and affordable care Act (PPACA) will be implemented in a span of the next four years. The law includes an increase of the number of persons who are eligible to Medicaid; the government will reward discount of insurance premiums, for businesses providing health insurance. Insurance companies will no longer be able to deny coverage or claims because of the health history of any person. With the Patient Protection and affordable care Act all Americans will have the security of knowing that they don’t have to worry about losing coverage if they’re laid off or change jobs. Insurance companies now have to cover preventive care like mammograms and other cancer screenings. The new law also makes a momentous investment in State and community-based efforts that promote public health prevent disease and protect against public health emergencies.
Although this healthcare plan comes with its own costs, they will be covered by the taxes that will be imposed on the wealthy. Individuals who choose not to have insurance will be penalized with a tax fee as a way of encouraging every member in society to have insurance and this will be as a source of income to offset the plan’s cost. This was a great step towards ensuring a good healthcare for all the people of the US regardless of whether they are insured or not. There are several classes of people living in the US, who do not have access to insurance. These people range from illegal immigrants to others who see insurance as very expensive and can’t afford to pay for insurance. The number of uninsured Americans is estimated to be 32 million today but after the PPACA was signed in to law the number is expected to decline considerably to about 23 million. Most of the uninsured people are drawn from illegal immigrants because they are not eligible to obtain insurance while they are residing in the US. Poor and middle class persons and their families also tend to go without insurance. (Institute of Medicine of the National Academies 2010 available online)
The Affordable Care Act was specifically designed to give States the resources and flexibility they need to tailor their approach to their distinctive needs and to help families across the country gain access to quality, affordable health care. The Affordable Care Act ensures hard-working, middle class families will get the health care they deserve by keeping health care costs low, encouraging prevention, and making insurance companies accountable.
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