The Affordable Care Act (ACA), aka ObamaCare, was signed into law on March 23, 2010. It is the most significant overhaul in the U.S. healthcare system in almost 50 years.
Healthcare costs in the U.S. have recently increased by over 9% a year. Affordable insurance is defined as costing no more than 8% of a person’s annual income, if purchased through the federal government website, or 9.5% of family income when purchased through an employer.
The majority of the ACA takes effect by January 1, 2014. The law encourages medical insurance coverage for all Americans and calls for reform in many areas of the U.S. healthcare system.
About 15% of Americans are uninsured. The ACA makes health insurance affordable and reduces the overall cost of healthcare. It caps out-of-pocket costs and fully covers all preventive care.
The ACA contains ten titles, each of which addresses a different area of the healthcare system. Highlights of the law include:
- Americans must have health insurance coverage or pay a fee
- Pre-existing illnesses will not exclude a person from coverage
- Insurance companies will no longer pay a fee-for-service; payment is based on the quality of care delivered
- Preventive medicine including yearly physicals, maternity care, mental health care, mammograms and colonoscopies will be provided at no out-of-pocket cost
- Elimination of co-payments for preventive care and better access to generic drugs for seniors
- Scholarships and loan repayment programs to help students entering healthcare fields will save billions of dollars
- Improved nursing home regulations and standards
The Impact of ACA
Most Americans must have health coverage in 2014 or pay and Individual Mandate or fee on their federal income tax return. The fee is: $95 per adult, $47.50 per child or 1% of the individual’s income, whichever is higher.
Exemptions from participation in the federal program include those on Medicare, Medicaid, COBRA, VA health coverage and job-based, personally purchased or retiree insurance. No coverage change needs to be made for any of these plans.
October 1, 2013 through March 31, 2014 is open enrollment on the federal Health Insurance Marketplace. Individual Americans making $45,960 or $94,200 for a family of four can shop for coverage options on the Marketplace. Young adults can stay on their parent’s health insurance until they are 26 years old.
The cost for medical insurance from the Marketplace averages under $100 for about half of the population. Smokers will pay up to 50% higher premiums than non-smokers.
Healthcare institutions and medical professionals are paid incentives by health insurance companies if they improve the quality of care. Keeping patients healthier through preventive care is an important component of the law.
On the Job Scene
The ACA changes insurance payments, especially Medicare, to hospitals and other healthcare institutions from a fee-for-service to an incentive for the delivery of quality medical care. This is a major step towards controlling healthcare costs.
Medicaid payments will be increased to match the fees that Medicare pays out to doctors. This represents an average 73% pay increase for primary care physicians. This change will help Medicaid patients more easily find a doctor who accepts their insurance.
More financial support for advanced practice and general nursing education will be available for nurses. There is a grant program to fund nurse-managed, specifically nurse practitioners, health clinics that will help alleviate the shortage of primary care physicians in the country.
Nurses working in hospitals will witness a higher census. Adequate nursing staff levels are needed to prevent patient complications. The ACA bases fiscal reimbursement to healthcare institutions on improved patient care and a lowered number of readmissions.
The End Result
The ACA provides all Americans with health insurance. It is the law or a tax is incurred.