Affiliated Institution
Appendix:
Introduction
Objective P. 3
Program Details & Classification P. 3-4
Obstacles Facing Stakeholders.
Citizens. P. 4-10
Immigrants. P. 10
Employers & Workforce. P. 10-12
Options for Individuals without Affordable Coverage. P. 12-13
Conclusion. P.13
References. P. 14
Introduction
The purpose of this report is to analyze the Affordable Care Act (ACA) that was passed by the Congress in March 2010. In this document, we are going to discuss the program’s objective, how it affects the different stakeholders within the American Society, what are the pros and cons and what are the barriers for its implementation (or consequences); we will analyze what is the ACA affordability to individuals, how it affected the job landscape in the US and changed the context. Interviews have been conducted with different entities in order to retrieve an insight about the program and its affect. Also, multiple researches and references are mentioned to back up arguments and results present in this report. So let`s take a closer look about the core value and objective for this program as a start.
Objective.
The objective of this program is to provide health insurance for most of the American citizens, by creating a new marketplace for health insurance that serves the citizens effectively and through providing government subsidies to the people who can`t afford one. Regardless the fact that the program sounds very beneficial to the American people, yet statistics illustrated that nearly 51.4% of the people are against it, while 43.6% are favoring it. In this report, we are going to demonstrate the reason behind this statistics in details, by explaining the real effect of the program on the people.
Program Details & Classification.
The ACA states that eligible tax payers will receive a refundable tax credit according to a certain criteria that is primarily based on their level of income; if the citizen has a level of income that lies between 100 to 400 percent of the Federal Poverty Level (FPL) then this person is considered to be eligible for the program. The program also states 80% of the premium dollars paid for the insurance should be provided in the form of health care and improving the quality of health services, while the remaining 20% should cover the costs and the profit as an act to serve the citizen`s need and raise their standards of living.
Obstacles Facing Stakeholders.
Citizens.
As it was previously mentioned, although the ACA is supposed to serve the public in the health insurance field, yet it didn`t receive the support that was expected from the majority of the citizens. Only 20% of the eligible tax payers whose income fall between the 251% and the 300% of the FPL purchased Obama Care. One of the main reasons is that insured individuals will have to pay 8.18% of their income for insurance (Norris, 2015). As a result, more citizens decided to pay their health cost out of their own income.
The Interviewer:
“What is the purpose of the ACA?”
Charlotte:
“The purpose of the ACA is to serve individuals with low income to have access to health care system as individuals with 100 % to 400% of poverty line can receive tax credits and a 138% of FPL can get Medicaid.”
The Interviewer:
“What are the requirements in Florida State to receive health care assistance?”
Charlotte:
“Florida has strict requirements to receive health care assistance; those requirements are disability, pregnant women and dependent children leaving more individuals uninsured medically.”
The Interviewer:
“What is your estimate of the poverty level in Flordia and what is the range of medical premium amount in your State?”
Charlotte:
“35% of poverty level in Florida don`t have access to medical care and the medical premium amount to be paid is $300-$400 per month.”
The Interviewer:
“From your own point of view, what is the main reason behind the opposition of this program in your State?”
Charlotte:
“The main reason behind the opposition of this program, is that people are afraid that the federal government won`t fund the program continuously. In other words, they don`t trust it.”
The Interviewer:
“Where do the immigrants stand from this program?”
Charlotte:
“Well, poverty health lawyers are working to make immigrants who didn`t spend the whole 5 years in the state to become eligible to tax credit and buy insurance from the market place.”
Another interview was conducted with Health Planning Council that is basically responsible for developing health programs according to our interview with the navigator and the following results were revealed:
The Interviewer:
“Can you please tell me more about the role of the Council and its job description?”
The Navigator:
“The Health Planning Council is working with community partners to improve access to health care and enroll more individuals in the insurance marketplace. It is also focusing on educating citizens about the importance of the ACA and increases their awareness about it and guides them about how to find the right coverage that suits their needs.
The Interviewer:
“How is the council helping with the coverage gap?”
The Navigator:
“The health Council is involved in explaining the coverage gap to the citizens of Florida and refers them to other community help centers. Also, we educate people about how to get out of the coverage gap by increasing their level of income to get enrolled in health insurance plans. Moreover, the Council gets exemption from penalties to people who fall in the coverage gap due to low income level.
The Interviewer:
“How do you see your job at the council as a navigator?”
The Navigator:
“Being a navigator at the council is a very rewarding position from my own point of view; we change the negative mindset of people about the health care system to a positive one, especially for those who fall in the gap.
The Interviewer:
“ How do you see the ACA affordability to individuals?”
The Navigator:
“The plans are affordable due to the various packages; Platinum, Silver and Gold where the premium paid is based according to the level of income & household.”
The interviewer:
“How do you see the ACA affected the work landscape in the US?”
The Navigator:
“We don`t see any direct relation between the ACA and overcoming the Job-Lock phenomenon according to our readings. It is kind of out of our scope and it is more political.”
The interviewer:
“Is there a specific benchmark or goal to achieve for the council?”
The Navigator:
“There is no specific benchmark for our work, we are doing their best to educate as many as we can about the health care system.”
The Interviewer:
“Coming to an end, what are the main reasons behind rejection from individuals for getting enrolled in the health care system?”
The Navigator:
“They are individual cases when it comes to unexplained rejection, there is no unified explanation for the reasons of rejection”
The council also is giving a close attention to resolving Florida`s health problem; it is vigorously promoting for heath care in nearly every possible location such as campuses, bus stops and health fairs, saying that progress has been made as a lot of individuals have changed their mindset about medical insurance, when they were enrolled in the right one for them. The council works with different organizations such as SIU in order to achieve their goals.
Another major setback for the ACA act is the coverage gap that occurred, leaving hundreds of citizens uninsured in some states (for example Florida as it was previously mentioned). Those states decided not to expand the Medicaid care in their territories, creating a coverage gap; one of the main purposes of the ACA was to enroll people below the 138% of FPL in the Medicaid program, allowing low income individuals to be enrolled in medical care system. Yet, the Supreme Court made the Medicaid expansion optional for states in June 2012. In January 2016, 19 states didn`t expand their Medicaid. This left a large segment of people with an income that is above the Medicaid eligibility limits and below the premium tax credit uninsured, in other words, they found themselves located in the “Coverage Gap”. Individuals who earn 100% to 400% in Florida can receive tax credits, while others who are below the 100% are in the gap (Dapena 2015, Chang 2015). Nationally it is estimated to have 3 million individuals are in the Coverage Gap with 850,000 ones located only in Florida (Miami Herald, 2015)
On the other hand, states that expanded their Medicaid program have most of their citizens covered sue to implementing the ACA; the tax credits are eligible to individuals who earn 138% to 400% of the FPL, while the Medicaid covers others who earn below the 138%, allowing most of the segments to be covered.
Immigrants & Health Care.
Moving on to another important stakeholder in the community; the immigrants sector has their controversial aspects too. Undocumented immigrants are not eligible for buying market place health coverage. Yet, they can apply on the behalf on documented ones (HealthCare). According to the existing laws of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, immigrants who have been present for 5 years or less are not eligible for the Medicaid, even of their level of income is 138% of the FPL. On the other hand, refugees have the right for immediate Medicaid enrollment upon their arrival under the 1980 law. Also, 14 states decided not to strictly apply the 1996 rule, allowing qualified immigrants to enjoy Medicaid benefits. Moreover, Twenty-nine states, have chosen to provide Medicaid coverage to lawfully residing children and/or pregnant women without a 5-year waiting period.
Employers & Workforce.
The ACA is encouraging employers to provide health coverage for their employees by providing tax credits for small businesses and applying financial penalties to large ones, that don`t provide the minimum essential coverage. The Congressional Budget Office is stating that statistics show a reduction in the number of working hours by about 2% throughout the period from 2017 to 2024. This drop is due to shifting full-time employees into part-time ones, especially in small businesses. It is expected that the APA will help in eliminating the “Job-Lock” phenomenon where the medical coverage acts as a major factor in employee retention rate. The American Action Forum found that the small businesses pay $22.6 billion annually and the rising premiums have lowered the employment by 350,000 jobs nationally with 20,000 in 5 states only. However, Dr. Olveen Carrasquillo saw things from another perspective as we are about to see in his interview about how the APA will affect the economy. Below are the main highlights for the interview:
Dr Olveen:
“Effect of ACA on the job landscape is anecdotal evidence. Economy is doing well compared to traditional measures and employment rates as well. Fear from decrease employment rate are all speculations. There is no hard objective evidence. The refusal to ACA expansion made us miss out on the federal funding because a lot of republican refuse the government helping people.”
Interviewer:
“Is the ACA the future?”
Dr Olveen:
“No we should move to a Medicare or a single payer system like a lot of the developed countries. It needs a lot of improvement and it needs to cover the whole population.”
Interviewer:
“Did it change the context of the health care system?”
Dr Olveen:
“No it did not, tt did some experimentation that might have a little effect but we will not change it until we we cover the whole population. The hospital health expenditure is very high. The government needs to make a global hospital budget and use the rest of the money to cover every body. Preventive services are much cheaper than actual treatment.”
The final thoughts by Dr. Olveen:
“ACA is a compromise. ACA is what we get with our political system but it is very far from what we deserve”
One of the main focuses of the APA regarding the workforce and employers is highlighting on increasing the attractiveness of primary care and improving its availability to Medicaid users. This comes with full federal funding as a single ACA provision made it mandatory for all the states having Medicaid programs to pay primary care physicians at Medicare rates.
The ACA has a list of recommendations to the employers too; it will provide the option of insurance purchase for small businesses through a new market, called the Small Business Health Options Program (SHOP Exchange) that is more convenient for individuals and small employers, as it is easier to compare and purchase plans through it. Also, employers may remain to purchase insurance from outside the exchange and the reforms will be applied to both markets. The States are required to create an exchange by 2014, otherwise the federal government will run one in the states that didn`t create it. In addition, tax credits are available for small businesses that have less than 25 full time employees to support the business in the cost of the health insurance. However, penalties are applied in case the small business didn`t provide affordable coverage for their employees. The business is exempted from the penalty on their first 30 employees in case the company had over 50 full-time employed ones. Also, tax breaks are offered which is a huge benefit for small businesses as it significantly impacts its costs.
Options for Individuals without Affordable Coverage.
Well there are multiple alternatives which may not be very pleasant, yet they are options; the individual may shop for a private plan in the market without cost assistance or go without insurance and use their exemption. On the other hand, Florida has Healthcare.org which is the market place serving the state, that offers a special enrollment period for individuals who lost or left their jobs. This will provide you with 60 days of coverage until you find a new health plan. The Consolidated Omnibus Budget Reconciliation Act (COBRA) allows you to keep your employer sponsored package up to 18 months although this option is really expensive as you have to pay the full premium plus the administration fees. Another option the Children`s Health Insurance Program (CHIP) which is considered to be one of the many government programs that provide millions of Americans with coverage, especially low-income ones. Last but not least, there is always the option of directly purchasing a private health insurance plan directly from the insurance company or through a broker; this may also be an expensive option so you better check all of the other alternatives before choosing.
Conclusion.
All in all, the ACA has its pros and cons as it was illustrated in the report. It affected the American society`s stakeholders in various ways. We talked to different entities and specialists to come up with a precise report that demonstrates the features for the ACA and its benefits, as well as its area of developments. As any other program to be implemented, there are loops that needs to be fixed, so it can function the society the way it`s supposed to and achieve its objective.
References
Dapena, K., Chang, D. How 5.2 million people fell into the health insurance coverage gap.Miami Herald. Retrieved from http://pubsys.miamiherald.com/static/media/projects/2015/gap-explainer/index.html
How Will the Affordable Care Act Affect the Use of Health Care Services? (n.d.). Retrieved from http://www.commonwealthfund.org/publications/issue-briefs/2015/feb/how-will-aca-affect-use-health-services
Health Coverage for Immigrants. HealthCare. (n.d). Retrieved from https://www.healthcare.gov/immigrants/coverage/
Health Insurance Coverage and the Affordable Care Act. (2015). Retrieved from https://aspe.hhs.gov/basic-report/health-insurance-coverage-and-affordable-care-act-september-2015
Norris, L. (2015). Will you receive an Obamacare premium subsidy?. Health Insurance. Retrieved from https://www.healthinsurance.org/obamacare/will-you-receive-an-obamacare-premium-subsidy/
Obamacare Pros and Cons: What You Need to Know - NerdWallet. (2014). Retrieved from http://www.nerdwallet.com/blog/health/finding-health-insurance/obamacare-pros-and-cons/
The Price of Responsibility: The Impact of Health Reform on Non-Poor Uninsureds. (n.d.). Retrieved from http://www.nber.org/papers/w21565
