Discussion Thread 3
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According to the U.S. Department of Health and Human Services (2023) the Affordable Care Act has
three primary goals: to make affordable health insurance available to more people, expand the
Medicaid program to cover all adults with income below 138% of the FPL, and to support
innovative medical care delivery methods designed to lower the costs of health care generally.
Timeline of ACA
Hirsch (2018) explains that the Affordable Care Act (also known as Obamacare) provides insurance
for millions of uninsured Americans through new state health insurance marketplaces, called
exchanges, that are run by the states or by the federal government on the state’s behalf while
simultaneously bending the cost curve down. According to The Wall Street Journal (2021), the ACA
has survived three challenges before the Supreme Court.
In March of 2010, President Obama signs the Affordable Care Act into law, which provides the
broadest changes to the U.S. healthcare system in decades (The Washington Post, 2014). Reisman
(2015) explains that the ACA is divided into 10 titles and contains many pages of provisions that
touch almost every aspect of the healthcare system. Some of these provisions became effective
immediately when the law was implemented in 2010, while others are phased in through 2020
(Reisman, 2015). According to The Wall Street Journal (2021), in 2010 the ACA bars insurers from
denying people coverage because of pre-existing health conditions, imposes new taxes, requires
large employers to provide coverage to workers and sets up a fund to give grants to states. In 2011,
young adults are able to stay on their parent’s insurance until 26 years of age, health plans have to
cover preventive care, Medicare payments for certain preventive services increases, and health
insurers have to give consumers rebates if they spend to little on health benefits and quality of care
instead of to advertising and marketing (The Wall Street Journal, 2021). In 2012, The Supreme
Court upholds the penalty on people who do not have health insurance (The Wall Street Journal,
2021). In 2013, Open enrollment under new ACA exchanges for the 2014 plan year begins in
October. More than 100,000 Americans enroll in plans in the first month but the rollout of the
website experiences major technical difficulties (The Wall Street Journal, 2021). In 2014, most of
the ACA law takes full effect, with the mandate on individual insurance and employer-provide
coverage requirement, eight million people select ACA marketplace plans, and The Department of
Health and Human Services’ Office of Inspector general puts the cost of building
HealthCare.gov
at
almost $2 billion (The Wall Street Journal, 2021). In 2015, roughly 10.8 million people are enrolled
in Medicaid since the ACA’s passage and the uninsured rate falls by more than 40% (The Wall Street
Journal, 2021). In 2016, 13 million people sign up for ACA coverage and small businesses get
healthcare tax credit to help afford coverage for employees (The Wall Street Journal, 2021). In 2017,
House republican leadership introduced ACA repeal and replacement budget reconciliation bills but
the repeal fails the first attempt. More than 12 million people select ACA plans on the marketplace,
the Congress reduces the penalty for not having health insurance to $0, and President Donald trump
ends cost sharing payments to insurers (The Wall Street Journal, 2021). In 2018, a federal judge in
Texas rules that congress’s reduction of the tax penalty for not having insurance to zero means the
ACA is invalid, Trump administration loosens restrictions on short-term health plans that don’t
comply with the law, approves Medicaid work requirements and cuts funding for outreach and
marketing of the ACA (The Wall Street Journal, 2021). In 2019, the Justice Department asks for U.S.
Court of Appeals for the Fifth Circuit to invalidate the ACA, rule finalized that raises premiums on
the ACA exchanges, and a new rule means employers can forgo offering coverage and contribute
money to a tax-free account for employees instead (The Wall Street Journal, 2021). In 2020, the
Trump administration narrows scope of ACA provision that provided protection against
discrimination of healthcare based on sexual orientation and gender identity (The Wall Street
Journal, 2021). In 2021, the Biden administration reopens a special enrollment period because of
the COVID pandemic and extends it because of changes made to the ACA in the COVID relief package
(The Wall Street Journal, 2021).
Quality of Care
According to Reisman (2015), the Affordable Care Act was shrouded in confusion and
misinformation from the very beginning prior to being signed into law due to politics and poor
communication about the law to the public. Early controversy entailed individuals being concerned
with losing their current health plans when the ACA law took effect and initially some people were
shocked when their insurers canceled policies that did no quality as minimum essential coverage
under the ACA (Reisman, 2015). Blumenthal et al. (2015) suggests that critics say the ACA
overlooked the need to reform the U.S. healthcare delivery system so as to constrain its costs and
improve its quality however, careful examination of the law has shown that it constitutes one of the
most aggressive efforts in the history of the nation to address the problems of the delivery system.
For example, nearly 2 million previously uninsured young Americans gained coverage under their
parent’s policies because the ACA required all private insurers and employers to offer dependent
coverage to cover children until they are 26 years of age (Blumenthal et al., 2015). In October of
2012, hospitals with higher-than-expected readmission rates of Medicare beneficiaries within 20
days were subject to financial penalties and since the initiation of the program, 30-day readmission
rates declined from 19% to 18% (Blumenthal et al., 2015). The ACA also expanded a CMS previous
program that penalized hospitals for avoidable threads to the safety of Medicare patients to help
reduce rates of hospital-acquired infections (Blumenthal et al., 2015). Hospitals that were in the
lowest quartile of hospital-acquire infections could lose 1% of their Medicare payments
(Blumenthal et al., 2015).
Delayed/Denied insurance claims
According to Espinosa (2012), “the ability to secure a timely, fair, and balanced review of the denial
of a claim for health insurance coverage is an essential element of any health insurance system (p.
460). Appeals of claim denials in both the employer and individual markets are challenging because
of the unbalanced nature of the relationship between insurers and claimants (Espinosa, 2012).
Espinosa (2012) explains the appeals process: “the appeals process begins after the insurer denies a
claim, either because (1) the treatment sought is simply not covered by the policy and (2) even if
covered, the treatment is not deemed necessary for the patient given the medical facts of the case”
(p.46). Patients may challenge the decision through an internal appeals process requesting
reconsideration of the decision by the insurer (Espinosa, 2012). Espinosa (2012) suggests that the
ACA strengthens internal appeals rights in both the employer and the individual plan markets to
create fairer systems when patients challenge claim denials and also the ACA extends these stronger
protections to cover individual and group health plans. “The ACA broadens the rights of patients to
appeal benefits denied by health plans, legally referred to as adverse benefit determinations”
(Espinosa, 2012, p. 461).
Biblical Integration
The ACA aims to provide healthcare access to more people, which can be seen as a way to promote
social justice. Micah 6:8 states “Do justice, love mercy, and walk humbly with God” (NIV, 2021, p.
230). The Lord requires this of us as individuals and encourages us to support and care for those
who are unable to care for themselves. The ACA fosters a sense of community and mutual support,
echoing the verse Galatians 6:2 which states “bear ye one another’s burdens, and so fulfil the law of
Christ” (NIV, 2021, p. 345). The primary goals of the ACA are well-intentioned and guided to help
individuals are not able to help themselves.
References
Assistant Secretary for Public Affairs (ASPA). (2022, March 15).
About the ACA
. HHS.gov.
https://www.hhs.gov/healthcare/about-the-aca/index.html
Blumenthal, D. B. (2015).
The Affordable Care Act at Five Years
.
https://doi.org/10.15868/socialsector.25102
Espinosa, J. F. (2012). Strengthening appeals rights for privately insured patients: The impact of
the Patient Protection and Affordable Care Act.
Public Health Reports
,
127
(4), 460–463.
https://doi.org/10.1177/003335491212700414
Hirsch, J. A., Rosenkrantz, A. B., Allen, B., Nicola, G. N., Klucznik, R. P., & Manchikanti, L.
(2017). AHCA meets BCRA; timeline, context, and future directions.
Journal of
NeuroInterventional Surgery
,
10
(2), 205–208. https://doi.org/10.1136/neurintsurg-2017-
013478
Press, J. S. A. (2021, June 17).
The Affordable Care Act: A brief history
. The Wall Street Journal.
https://www.wsj.com/articles/the-affordable-care-act-a-brief-history-11623961600
Reisman, M. (2015). The Affordable Care Act, Five Years Later: Policies, Progress, and Politics.
National Library of Medicine
,
40
(9), 575–578.
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