Now that the dust of the 2016 election has settled, we can expect the health care landscape to change, probably dramatically. In the first part of this series, I'll cover the main components of the Patient Protection and Affordable Care Act (PPACA):
1. Expansion of coverage to more citizens
2. Increasing the quality of that coverage
3. Increasing the quality and reducing the cost of care
I. Expansion of Insurance Coverage
A. Insurance companies can't deny coverage based on pre-existing conditions
B. Expanded Medicaid eligibility to 133% of Federal Poverty Line
C. Simplified enrollment in CHIP (Children's Health Insurance Program)
D. Children could remain on parent's insurance until age 26
E. Individual Mandate - all citizens must have health insurance
• E1. Government run health care exchanges were setup to allow people not covered through other means to purchase health care.
F. Employer Mandate - businesses with over 50 employees must offer health insurance or pay a fine
II. Increasing Quality of Insurance Coverage
A. Essential Health Benefits - all health insurance must provide essential health benefits to its covered members. https://en.wikipedia.org/wiki/Essential_health_benefits
B. Contraceptives & Women's Reproductive Health must be covered
C. Risk management for insurance companies - temporary reinsurance, temporary risk corridors and permanent risk adjustment.
D. Elimination of lifetime coverage caps on essential health benefits
E. Can't drop policy holders when they get sick
F. Out of pocket expenses must be capped
G. Same premium to members based on age, not gender or pre-existing conditions
H. Preventive care, vaccinations and medical screenings cannot be subject to co-payments, co-insurance or deductibles.
I. 4 tiers of insurance coverage: bronze, silver, gold, and platinum.
J. 80-85% of premium costs must go to health care coverage. Rebates must be issue if this is violated.
III. Increasing the Quality and Reducing the Cost of Care
A. Creation of ACOs (Accountable Care Organizations). ACOs are groups of health care providers that come together to provide high quality, cost effective care to Medicare patients. If successful, the ACO will share in the savings it has generated.
The PPACA is one of the most complex and sweeping pieces of legislation that has been passed by the US government. In the next series, we'll cover how this legislation is being funded.
1. Expansion of coverage to more citizens
2. Increasing the quality of that coverage
3. Increasing the quality and reducing the cost of care
I. Expansion of Insurance Coverage
A. Insurance companies can't deny coverage based on pre-existing conditions
B. Expanded Medicaid eligibility to 133% of Federal Poverty Line
C. Simplified enrollment in CHIP (Children's Health Insurance Program)
D. Children could remain on parent's insurance until age 26
E. Individual Mandate - all citizens must have health insurance
• E1. Government run health care exchanges were setup to allow people not covered through other means to purchase health care.
F. Employer Mandate - businesses with over 50 employees must offer health insurance or pay a fine
II. Increasing Quality of Insurance Coverage
A. Essential Health Benefits - all health insurance must provide essential health benefits to its covered members. https://en.wikipedia.org/wiki/Essential_health_benefits
B. Contraceptives & Women's Reproductive Health must be covered
C. Risk management for insurance companies - temporary reinsurance, temporary risk corridors and permanent risk adjustment.
D. Elimination of lifetime coverage caps on essential health benefits
E. Can't drop policy holders when they get sick
F. Out of pocket expenses must be capped
G. Same premium to members based on age, not gender or pre-existing conditions
H. Preventive care, vaccinations and medical screenings cannot be subject to co-payments, co-insurance or deductibles.
I. 4 tiers of insurance coverage: bronze, silver, gold, and platinum.
J. 80-85% of premium costs must go to health care coverage. Rebates must be issue if this is violated.
III. Increasing the Quality and Reducing the Cost of Care
A. Creation of ACOs (Accountable Care Organizations). ACOs are groups of health care providers that come together to provide high quality, cost effective care to Medicare patients. If successful, the ACO will share in the savings it has generated.
The PPACA is one of the most complex and sweeping pieces of legislation that has been passed by the US government. In the next series, we'll cover how this legislation is being funded.
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