Understanding the Patient Protection and Affordable Care Act(PPACA or ACA) can be difficult but it is not as confusing as it may seem. This paper will highlight some of the provisions that have already been implemented and will discuss how it affects me, healthcare workers, and the citizens of Arkansas. There are two provisions I will discuss that went into effect on January 1, 2011. One is known as the Medical-Loss Ratio(MLR) and the other is a policy focused on Bringing down healthcare premiums. The MLR policy will put an end to insurance companies being able to raise rates without explaining their actions, or justifying the reason for their high premiums.
The policy aims to bring transparency to the healthcare rate changes by requiring “that all insurers seeking rate increases of 10% or more in the individual or small group market publicly disclose the proposed increases and the justification for them”. (“Insurance Rate Increases,” Posted: December 21, 2010, para. 4) These proposed increases will be analyzed further by the affected state before approval to determine if they are in fact reasonable. The ACA provides funding to states in order to strengthen or create rate review processes and consumers will be provided with detailed information on proposed increases from their insurance provider. The other significant policy made effective at the same time is one that will bring down the cost of insurance premiums. Under this provision, insurers must spend 80% (for individual or small group insurers) or 85% (for large group insurers) of premium dollars on health costs and claims, leaving only 20% or 15% respectively for administrative costs and profits. If an insurer fails to meet this requirement, there is no penalty, but a rebate must be issued to the policy holder. (“Key Features of the ACA,” n.d.) This affects me by protecting me from unreasonable rate increases. As I get older, I make more frequent visits to a healthcare provider for both acute and chronic illness.
The costs add up quickly and with a limited source of income, anything that I can save helps greatly. A common feeling among insurance holders is that we are paying for something that we never use so the idea of a rebate for overpayment of premiums will be welcomed by all. There is one provision that became effective on September 23, 2010 that was a relief to my family in a time of despair. My mother underwent many procedures and surgeries in the
last few years of her life and we were concerned about limits on annual or lifetime coverage placed on her by the insurance company. Under the law, insurance companies are prohibited from imposing lifetime dollar limits on essential benefits, and their use of annual dollar limits on the amount of insurance coverage a patient may receive will be restricted. Her medical bills were significant, but we never had to worry about her coverage expiring. The American Nurses Association has fighting for health care reform for many years.
By doing so, the ANA is promoting our core value of patient advocacy. We have been taught that we should represent our patients’ best interests in regards to healthcare at all times. So supporting measures that will allow for more affordable healthcare, is what nurses should do. The ANA has been working to ensure that RNs are “fully included as leaders and eligible health care providers in new, patient-centered, team-based models of care, and accountable care organizations. ANA continues to urge federal agencies to include advanced practice registered nurses as primary care providers, and for nurse-managed clinics to qualify as essential community providers.” (“Still The Law,” August 2012, para. 7) Arkansas has put much effort into forming our Health Insurance Benefits Exchange, called the Arkansas Health Connector. It is a program through which our more than 500,000 uninsured Arkansas can shop for affordable health insurance. The plans are required to offer 10 essential services. Some of which include prescription drugs, emergency and hospital care, doctor visits, maternity and mental health services, rehabilitation and lab services.
“The Arkansas insurance Department(AID) has been awarded a one year, $1 million planning grant from the United States Department of Health and Human Services (DHHS) Center for Consumer Information and Insurance Oversight CCIIO) to assist with studying options for development of the best possible Insurance Exchange for Arkansans.” (“Planning for HBE,” n.d., para. 2) This Arkansas Health Connector makes it easier for uninsured individuals to shop for comparable and affordable health plans. The requirements placed on these plans are also greatly needed in order to provide complete healthcare and prevent future healthcare related costs. The only cons that I will mention are that not enough people know about the availability of this program and that if people do not already know, they will found out rather abruptly when they are assessed a $95 penalty on their filed income tax return. The ACA outlines plans to reduce episodic based care and increase population(community) based care. The idea is to provide a higher value of healthcare instead of volume, while reducing readmissions for nosocomial infections, preventable diseases, or complications from chronic conditions and illnesses.
By implementing community based programs to promote healthcare, we can reduce healthcare costs and help patients live healthier lives with reducing the risks of significant and recurring medical problems as well as their associated costs. Regardless of arguments against the ACA, the most important aspect is that it helps Americans to become and remain healthier people. It teaches our next generation to value healthcare, and to take an active role in being healthier adults. The ACA will affect me professionally as well as personally. Another provision of the ACA provides for the increase of payments for rural healthcare providers. The majority of communities who are most in need of higher quality and more affordable healthcare, are located in the rural areas of our country. These communities often have trouble attracting and retaining medical professionals. My wife is also a nursing student, and we live in a rural area, so we plan to take advantage of these incentives to provide a higher standard of healthcare to those in need.
A similar provision worth mentioning calls for the rebuilding of the primary care workforce. In order to strengthen the availability and quality of healthcare, there has been increased funding for scholarships and loan repayments for primary care physicians and nurses working in underserved areas, as well as tax free student loan payments for these health professionals. (“Key Features of the ACA,” n.d.) Again this affects my wife and I directly through scholarship opportunities and reduced financial burden after we graduate. Also affecting me is the increase in the number of patients seeking healthcare due to more people have health insurance. This will increase the demand for both registered and advanced practice nurses in episodic based care as well as in the community. Our role as an educator will be more important than ever when teaching patients who have never had affordable health care. There are many arguments against this legislation, but as an aspiring nurse, I have yet to find one that suggests ACA is not the best option we have for making a healthier future for America. References
Affordable care act is still the law. (August 2012). Retrieved from http://www.theamericannurse.org/index.php/2012/08/06/affordable-care-act-is-still-the-law/ Key features of the affordable care act by year. (n.d.). Retrieved from http://www.hhs.gov/healthcare/facts/timeline/timeline-text.html#2010 Planning for the arkansas health benefits exchange. (n.d.). Retrieved from http://hbe.arkansas.gov/Planning.pdf Shining a light on health insurance rate increases. (Posted: December 21, 2010). Retrieved from https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/ratereview.html