The Patient Protection and Affordable Care Act (ACA) was signed by President Obama in 2010. There were three major goals of ACA: to expand health insurance coverage, to shift focus from treatment to prevention, and to reduce costs but improve the efficiency of health care in the USA. “The intent of the ACA is to reform how insurance and health systems work to ultimately improve health care access, quality, and individual and public cost” (Hellerstedt, 2014). Indeed, The ACA provides incentives for delivering preventive care and funds for primary prevention programs. Nevertheless, The ACA’s primary goal is to make all citizens of the US insurable by means of requiring the insurers to accept applicants regardless of their health status. Besides, the act also increases coverage by the wide expansion of Medicaid, the social healthcare program designed for individuals and families with extremely low income, and by subsidizing insurance for those who do not have a current workplace.
The Affordable Care Act puts individuals, not insurance companies, in charge of their health care. Prevention and Public Health Fund has invested in numerous prevention and public health programs that can keep people healthy, including combating obesity and smoking cessation. The act requires all new plans to cover various preventing services such as, for example, colonoscopies or mammograms without charging a copay. Moreover, insurance companies cannot deny or limit benefits to children under the age of nineteen due to their pre-existing health condition. Besides, the Affordable Care Act offers eligible seniors a wide range of services without cost-sharing and several discounts on drugs. In addition, it provides additional preventive services such as personalized prevention plans and annual visits.
The Affordable Care Act provides people to keep the costs down. “Most of the act’s core insurance provisions flow from these few fundamentals – guaranteed issue, subsidies, and individual and employer mandates” (Hall & Lord, 2014). Insurance companies are prohibited from imposing limits on essential benefits, including hospital stays. The new law makes small businesses eligible for tax credits so that they can provide insurance benefits to their employees. In general, the act gives each person numerous alternatives in the private insurance market. In the past, all insurance companies could try to search an error on a customer’s application and deny payment for services. However, such procedure is illegal now. The new law has created a new marketplace, an Affordable Insurance Exchange, where small businesses and individuals can buy various health benefit plans. It means that if the employer does not provide his worker with insurance, an employee will be able to buy it himself directly in an Exchange. Besides, if a person has low income and the employer does not offer coverage, he may get a specific tax credit to pay for insurance. In addition, State Medicaid programs offer affordable services to help people who need long-term care and people with disabilities. The act guarantees that existing Medicare-covered benefits of any individual will not be reduced or taken away. If a person has Medicare prescription drug coverage but has high prescription drug costs, the new health law provides a 50% discount on these drugs or a one-time 250$ rebate to pay for the prescriptions that can be a significant cost relief for an individual.
As a rule, women have unique and special health care needs, that is why the Affordable Care Act provides women with different insurance options, covers preventive services and lowers costs. In the past, insurance companies could deny coverage to women due to specific pre-existing conditions, including being pregnant or having cancer. Nowadays, it is illegal to discriminate against any individual with a pre-existing condition. Thanks to the act, women can have the freedom to choose a primary care provider, a pediatrician, or an OB/GYN. Besides, they can receive preventive services, including well-child visits, vaccinations, and new baby care without additional costs. Insurers also cannot charge women higher premiums because the law strictly controls health care costs. In general, under the new law, Americans do not have to worry about losing the insurance; vice versa insurance companies have become more responsible for each individual. Thus, it is important to know the new principles of the ACA because it will help to avoid additional fees and penalties. Nurses should also be informed about all changes and acts in the health care system because they help patients navigate the national healthcare system.
Despite passing the Affordable Care Act, The United States of America still fall behind in quality of the delivered health care compared to some other countries. In Canada, The Canada Health Act provides universal health insurance coverage for all residents, and there are no financial restrictions at the point of health care service. “For example, in Canada, costs are controlled because Canada pays ten percent of its gross domestic product for its health care system, covering everyone” (Dada, 2014). Besides, Canadian government makes drugs prices more affordable compared to the US, where pharmaceutical companies determine the price of drugs. In France, the government also negotiates drug prices and tries to keep it at a low level. As a rule, savings are put towards the complimentary health care insurance for individuals who cannot afford it. “The United Kingdom’s National Health System is funded through taxation and provides a wide variety of free health services for individuals who are legal residents in the UK” (Dada, 2014). Germany also has universal coverage for the entire population because its health care system is funded by co-payments, taxes, and workplace contributions.
Despite numerous oppositions, the Affordable Care Act is not a radical transformation of medical practice or health insurance. Most Americans still keep the same kind of insurance that they acquired before the act. Those individuals who were above the poverty line or did not have job-based insurance now have a possibility to buy standard private insurance, disregarding their current health condition because the majority of states have expanded Medicaid with the aim to cover all citizens. Government subsidies also make private insurance quite affordable for most people, but those who decline the affordable insurance must pay a penalty. Besides, the act contains several provisions that affect medical practice but they cannot be considered as fundamental changes because almost all innovations deal with Medicare. The Affordable Care Act does not change the way how private insurers pay physicians and hospitals but created narrower networks and increased patient cost sharing, the practice which positively affect medical practice. Although the insurance reforms still do not provide universal coverage and most innovations are being introduced only on a pilot basis, they really try to achieve universal insurability, which means that no one has to worry about being uninsurable.
References
Dada, S. (2014). The Affordable Care Act Compared to International Health Care Systems: Can Changes in Pharmaceutical Industry Impact the Health Care System in the United States of America? Annals of Health Law, Vol. 24, p. 136-146. Retrieved from http://www.luc.edu/media/lucedu/law/centers/healthlaw/pdfs/advancedirective/pdfs/issue13/11_Dada%20Formatted.pdf
Hall, M.A. & Lord, R. (2014). Obamacare: what the Affordable Care Act means for patients and physicians. The British Medical Journal, Vol. 22, p. 1-10. Retrieved from http://www.bmj.com/content/349/bmj.g5376
Hellerstedt, W. L. (2014).The Affordable Care Act: What Are Its Goals and Do We Need It? The Center for Leadership Education in Maternal & Child Public Health. Retrieved from http://www.epi.umn.edu/mch/wp-content/uploads/2013/09/ACA-Overview.pdf
