The Affordable Care Act: Beyond the sound bites

The Affordable Care Act (ACA) is aimed at improving the quality of the health care system.   People seem to be familiar with only one component of the law. They equate the ACA, often called “Obamacare,” with a way to get health insurance for previously uninsured individuals.

But the ACA is so much more.  Consider the images of a pie; Access to Healthcare (the Health Insurance Marketplace) represents about 1/5 of the pie chart that shows an overview of the ACA. The other 4/5 of the pie includes consumer protections, lowering healthcare costs, and improving quality. 

Detailed pie allocations [Click to enlarge]

Lowering cost and improving quality

When you think about how Medicare, other insurance companies, and you have paid for health care, you probably imagine it like this: a visit to the doctor is equivalent to a payment to the doctor.  That’s called “fee-for-service.”  Each time care is given, a payment is made.  In other words, the frequency, or quantity of visits determine the amounts paid.  More visits, more bills to pay.

ACA health care reform is shifting payment for care to be based on quality, not quantity.

One example of this shift is related to the Hospital Readmissions Reduction Program.  In the past, if you had a heart attack, were discharged from the hospital, and were back in the hospital ten days later, Medicare paid for the second hospital admission.  As of 2013 and 2014, there are 30-day readmission measures that define whether Medicare will pay when a person is readmitted. The focus is the quality of care given and incentive to give care in a way that prevents readmissions.

Consumer Protections

Having a  lifetime health insurance coverage limit was the norm before the ACA.  In the past, if you had a serious illness, but your lifetime coverage limit was one or two million dollars, your health insurance stopped paying bills when you reached the limit.  Imagine going through cancer treatment, (which is not only difficult, but expensive) and finding that the remainder of the bill was had become your responsibility.  The ACA ends lifetime limits on coverage.

Until 2014, it was acceptable to charge women a higher premium rate for health insurance The ACA ended charging more for women’s health insurance premiums.

Before the ACA, insurance companies would deny health coverage to people with pre-existing conditions.  Chronic conditions such as asthma or diabetes could prevent you from getting health insurance.  Imagine being pregnant and being told that your pregnancy is a pre-existing condition.  The ACA includes protections against that experience.

There are many more examples of pieces of the ACA pie, and you can learn more here:https://www.hhs.gov/healthcare/about-the-law/index.html

Written by Denise Woodworth on behalf of the EPDC Education Committee

 

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