PPACA - The Affordable Care Act
PPACA | The Patient Protection and Affordable Care Act
The Patient Protection and Affordable Care Act (PPACA), also commonly known as the Affordable Care Act, was signed into law in 2010. The goal of the legislation is to provide quality, affordable health care for all Americans, in order to reduce the number of uninsured Americans and thereby reduce the overall costs related to health care.
PPACA uses a variety of methods to accomplish this goal, such as tax credits, subsidies, and mandates. For example, insurance companies are required to offer the same rates to both men and women, regardless of any pre-existing conditions, and must cover all applicants.
According to the Congressional Budget Office, the legislation is expected to reduce the number of uninsured by approximately 33 million.
Immediate Improvements and Immediate Actions
In order to produce immediate improvements in health care coverage for all Americans, PPACA includes amendments to the Public Health Service Act, including individual and group market reforms aimed at improving coverage. These include lifetime or annual limits, extension of dependent coverage, and prohibition of discrimination based on salary, among other reforms.
To accomplish individual and group market reforms, the law also includes immediate actions to pursue and expand coverage, such as reinsurance for early retirees and administrative simplification.
Quality Coverage, Affordable Choices
To help ensure quality health insurance coverage for all Americans, health insurance market reforms detailed within the legislation include general reform, such as the mandate for health care, health insurance premiums, and guaranteed availability of coverage.
Central to PPACA is ensuring that all Americans have available coverage choices, which is why PPACA calls for the establishment of qualified health plans (which entails defining essential health benefits requirements) and a focus on consumer choices and insurance industry competition through health benefit exchanges.
Affordable coverage choices for all Americans are promoted through premium tax credits, cost-sharing reductions, and a small business tax credit for employee health insurance expenses.
PPACA defines the responsibility for health care as being shared by individuals and employers, and provides an outline of these responsibilities.
In addition to its focus on quality, affordable health care for all Americans, PPACA defines the role of public programs such as improved access to Medicaid, enhanced support for the Children’s Health Insurance Program, simplification of the enrollment processes for Medicaid and CHIP, Medicaid service improvements, some new options for States to provide long-term services and supports, and Medicaid prescription drug coverage.
The law also includes provisions related to Medicaid payments and beneficiaries, quality improvements for patients and providers, improvements to the Medicaid and CHIP Payment and Access Commission (MACPAC), protections for American Indians and Alaska natives, and maternal and child health services.
Improvements in Health Care Quality and Efficiency
PPACA also aims at transforming the health care delivery system by linking payments to quality outcomes under the Medicare program, establishing a national strategy to improve health care quality, and encouraging development of new patient care models.
To help improve Medicare for patients and providers, PPACA addresses ensuring beneficiary access to physician care and other services, rural protections, and improving payment accuracy.
PPACA and Dental Care
Under PPACA, subsidized health insurance plans are required to address at least 10 health care service categories. These so called “essential health benefits” categories include pediatric oral and vision services. Dental insurance for adults is not mandated under the Affordable Care Act. Instead, each State has the option of including adult dental coverage within the State’s benchmark insurance plan.
States may include pediatric oral care benefits within health plans, or they may separate these benefits out as standalone products. Moreover, States may define oral care benefits for adults as part of the essential health benefits for their citizens, and they may roll those benefits into health plans or offer them as standalone components of the benefits package.