February 3, 2010

PPACA – The Affordable Care Act

The Patient Protection and Affordable Care Act (PPACA) was made a law in 2010. This law is also known as the Affordable Care Act (ACA). The goal of the law is to make sure all Americans can get quality health care at a price that is within their means. It is hoped this will help to bring down the number of people who do not have insurance. This should also help to bring down the total costs of health care in the US.

The ACA makes use of mixed means to reach its goals. Some of these means are tax credits, subsidies, and mandates. For instance, under the ACA, insurance firms must charge the same rates to both men and women. They may not bar you from their plans due to health problems that you may have had before you applied for the plan. And they must cover all who apply.

The Congressional Budget Office says the law should help to reduce the number of people who have no insurance by nearly 33 million.

Immediate Improvements and Actions

In order to move forward fast to meet the goal of health care coverage for all, the ACA includes changes to the Public Health Service Act. Some of these are individual and group market reforms, lifetime or annual limits, extension of coverage for dependents, and a ban on discrimination that is based on salary.

To achieve the ACA’s individual and group market reforms, the law also calls for immediate actions to pursue and expand coverage. Examples are reinsurance for people who retire early and some ways to help make it simpler to administer health plans.

Quality Coverage, Affordable Choices

To help make sure all are able to get quality health plans, the law includes a number of more general reforms. Some of these are the mandate for health care, health plan premiums, and guaranteed availability of coverage.

Helping to make sure that all Americans have available coverage choices is central to the goals of the ACA. This is why the ACA calls for creating qualified health plans, a focus on consumer choice, and more competition through health benefit exchanges.

The ACA promotes affordable choices for all through premium tax credits, reductions in cost sharing, and a small business tax credit for the cost of workers’ health plans.

Shared Responsibility

The ACA defines the responsibility for health care as one that is shared by both workers and employers. It also gives an outline of what these responsibilities are.

As well as a focus on quality health care for all, the ACA defines the role of public programs such as improved access to Medicaid and enhanced support for the Children’s Health Insurance Program. It also calls for making the process to enroll for Medicaid and CHIP simpler, and it calls for Medicaid service improvements. Some new options for States to provide long-term services and supports are also called for by the ACA, as is Medicaid prescription drug coverage.

The law also includes provisions that are related to Medicaid payments and beneficiaries and quality improvements for both patients and health care providers. Improvements to the Medicaid and CHIP Payment and Access Commission (MACPAC) are also called for by the ACA. Also, the ACA helps to protect American Indians and Alaska natives. It also helps with maternal and child health services.

Improvements in Health Care Quality and Efficiency

The ACA also aims to change the health care delivery system. It does this by linking payments to quality outcomes under the Medicare program. It also works to meet this goal by setting up a national strategy to help improve health care quality and by encouraging the development of new patient care models.

To help improve Medicare for patients and health care providers, the ACA addresses access to physician care and other services, rural protections, and better ways to make payments more accurate.

The ACA and Dental Care

Under the ACA, health plans that are subsidized must address at least 10 types of health care. These so called “essential health benefit” (EHB) categories include oral and vision services for kids. Dental insurance for adults is not required under the ACA. Instead, each State has the choice of including adult dental within the State’s benchmark insurance plan.

States may include kids’ oral care benefits within health plans, or they may separate these out as standalone products. Also, States may define oral care benefits for adults as part of the EHBs for their citizens. They may roll those benefits into the health plans they offer, or they may offer them as detached components of the benefits package.