AFFORDABLE CARE ACT:
The Affordable Care Act was signed by President Obama on the 23rd of March 2010. It has broadened the policies and altered the pre-existing insurance laws, aiming to improve efficiency in the health care sector along with cost reductions.
The Summary Of The Laws Concerning Health Care
A revised version of the Patient’s Bill of Rights will be put into order, which will shield clients from being exploited by the insurance coverage companies. Many services are likely to be available free of charge for many of the individuals residing currently in the U.S.
Individuals who are members of Medicare will be able to acquire critical services without any charges and they will also be liable to get charged 50% less on various drugs.
Doctors and health workers will be able to work together to provide better care due to the Care Organizations and many other health programs.
The Affordable Care Act will result in previously un-insured Americans receiving health insurances. Low income people, or people residing under the poverty line, who previously were unable to obtain health insurances, will now get covered due to tax credits and low costs on health insurances in general.
Health Care Laws For Protecting The New Consumers
Availability Of Online Viewing Of Health Care Programs:
From July 1 2010, online viewing of health based insurance programs will be possible and consumers will be able to compare and select the best programs most suitable for them.
Children Below 19 To Be Provided Rights:
For health plans starting from the 23rd of September 2010 or after, children below the age of 19 will no longer be denied health insurances due to their previous devastative conditions.
Insurance Coverage Firms No Longer Allowed Discontinuing An Insurance Coverage Program:
These companies previously had the right to deny coverage to any sick patient on the premise of a mistake or error in the patient’sapplication. But from the 23rd of September, the new law will deny the companies these rights.
Insurance Coverage Programs To No Longer Set Lifelong Time Limits:
From the 23rd of September 2010, the law will make the imposition of life long dollar bans on important services illegal.
Insurance Coverage To Be Set And Revised On Annual Basis:
According to this law, the insurance coverage companies will no longer be liable to provide benefits such as stays at hospitals, etc. Instead, new policies will be set which would be different for both the group and individual markets. The law is to be fully implemented by the year of 2014.
Consumers Encouraged To Appeal To Their Insurance Coverage Companies:
The law will allow individuals to question their insurance companies and lay claims on them. It will also permit them to hold their companies accountable and ask for justifications on various practices. It aims to provide consumers with a way to appeal coverage determinations or claims to their insurance companies, and establish an external review process. The act is to come to implementation by the 23rd of September 2010.
Consumer Assistance Programs To Be Set Up In The United States:
Federal grants are given to states for the creation or expansion of self-governing offices so that consumers are helped in steering health insurance programs offered to them. These policies are aimed to educate individuals more about the insurance plans that are available. The program is aimed to allow people to understand how to complain, raise an appeal, or know the duties of the insurance companies. The program will identify the common problems faced by the majority, which are then to be reported to the U.S. Department of Health and Human Services.
TAKING OUT COST EFFECTIVE COVERAGE PROGRAMS
Allow Insurance Tax Credits To The SME’s
In effect now, the law enables SME’s in obtaining tax credits which is to help them pass on to their employees various benefits.
The “Donut Hole”, A Medicare Prescription Drug, To Be Provided Free Of Charge:
The Medicare drug will be taken by an estimated 4 million seniors. Every senior that fulfills the category will be given a $250 discount on his/her tax. In June 2010, the first checks were mailed, and the process will continue throughout the year as more seniors make use of the provided service.
Prevention Services To Be Provided Free Of Charge:
From the 23rd of September 2010, protective services should be provided for free without any deductible charges.
Invest In Mainstream Diseases:
$15 billion will be invested in a new program starting from 2010 which is to cover Americans from various diseases such as obesity to smoking cessation.
Investments In Anti-Fraud Programs:
In order to clamp down on fraud and prevent waste, investments will be made to acquire new resources that will result in updated screening methods.
INVEST IN HEALTH CARE SERVICES TO BE MADE MORE AFFORDABLE
Citizens Of The U.S Currently Uninsured To Be Provided Coverage:
From July 1, 2012, individuals residing in the US who were uninsured will now be able to get covered. Any state can choose to implement this plan and for states which fail to do so, the Department of Health and Human Services will take notice.
Insurance Coverage To Be Expanded For Growing Adults:
Starting from the 23rd of September 2010, those under the age of 26 and not covered by a program, provided at work, will be allowed to stay covered by their parent’s health insurance program.
Spread Insurance Coverage Among The Retirees:
Many a times, individuals who retire are not provided insurance coverage by their employers. They witness their life time savings fall apart by merely a few medical bills. To aid the retirees, a $5 billion dollar plan is being funded for the people who fall in the age group of 55-65, ensuring they receive the coverage they deserve. Not only the retirees, but also their spouses and dependents are to be given a desired share as well.
Investments On Reforming A Team For The Primary Sector:
By providing incentives such as scholarships to workers operating in the underserved areas, the law emphasizes on trying to boost the number of primary care workers.
Insurance Coverage Firms To Be Made Answerable For The Increased Rates:
Insurance firms will need to give reason for increasing rates and companies found increasing their rates unreasonably will not be allowed to play an active role in the Health Insurance Program determined to take place in 2014.
Medicaid To Be Provided To More Individuals Across The State:
From April 1st 2010, States that choose to implement this program will be provided national funding so they can deliver their service to as many individuals and families as possible, who are found to be underprivileged.
An Increase In Pay For The Individuals Working In The Rural Part Of The Economy:
Studies show that today 68% of the population who are not given the medical treatment they should be given reside in the rural areas. It is often observed that these individuals are unable to acquire help of professionals or renowned hospitals. The policy aims to amplify payments to workers in the rural sector so that they can keep on serving the economy.
Health Care Centers In Communities To Be Further Strengthened:
The policy aims to strengthen the health care sector of the economy by investing upon many buildings and infrastructures that are to be dedicated towards serving the community. It is aimed to provide health care facilities to 20 million new patients across America.
PROVIDE BETTER QUALITY AT REDUCED COSTS
Offering Discounts On Various Drugs:
Individuals and seniors who reach the gap known as the coverage gap would be given a flat discount of 50% when they purchase drugs which fall under the brand name of Medicare Part D. Seniors would further receive discounts on the prescribed drugs if it carries the above mentioned label till the year of 2020 (In effect from the 1st of January 2011).
Giving Seniors Free Care On Many Services:
The act allows individuals who reach a certain age to receive free medical services that are aimed to prevent illnesses. Such services include visits annually by professionals to ensure the wellness of the customers. The law makes the services available for free for only those who are members of the Medicare Plan (In effect from the 1st of January 2011).
Enhancing Quality In The Health Care Sector:
The plan aims to open up various medical centers that are to work on innovating and reducing health care costs for the end consumers. The Medicare and Medicaid center to be set up would aim to provide the consumer with better quality services at more affordable rates. It also seeks to establish an insurance program for the children, which is to be titled CHIP. The HSS will derive a complete new strategy to improve the services offered by the medical sector and also continuously work on providing cost effective drugs (In effect from the 1st of January 2011).
Provide Better Services To Seniors Who Depart The Hospital:
Through the transition program by the Community Care, seniors who are at great risk and are members of the Medicare Plan would receive personal and customized attention to ensure well being. They will be offered services within their own community as well (In Effect from the 1st of January 2011).
Innovations Encouraged To Cut Costs:
The Trust Fund of Medicare will seek to increase proposals sent to various officials including the Congress and the President. The proposals will be sent by the Advisory Board and will work towards increasing the life of the Trust fund. It has been anticipated that the board will likely work towards improving the current running inefficient systems, work on ways to reduce health care costs, improve the end services offered to customers, and enhance health care quality (In effect from the 1st of October 2011).
HEALTH CARE TO BE MADE MORE AFFORDABLE
Services To Be Made Available At A Greater Volume:
Individuals who are disabled will be provided health care services by Medicaid. The services could be both, community or home based. The States will be granted the right to offer the services to the disabled individuals of the society, and they are to be granted the right by the Community First Choice Option as well (In effect from the 1st of October 2011).
INSURANCE FIRMS TO BE HELD ACCOUNTABLE
Reduction In Health Care Costs:
In order to make sure that money is spent largely on health care, 85% of the revenue insurance companies gain by large clients will be well spent on improving health care services and encouraging innovations so that customers acquire better quality in the end. The law also has a provision that 80% of the revenue collected from the small individuals or companies would be spent on improving the health care quality and drugs. If however, companies fail to provide improved quality due to high operational costs or reduced profits, discounts and rebates should be offered to consumers (In effect from the 1st of January 2011).
Fortifying The Medicare Advantage Plan:
Medicare Advantage receives over $1000 more per individual by the Medicare in comparison to the traditional sector. This allows the members of the Advantage plan to receive benefits in different forms and also permits them to receive a certain premium amount. The 77% of the members enrolled in the Medicare Advantage plan are to further receive better quality at reduced costs. The law is aimed to pass on more bonuses to Medicare Advantage if it manages to provide care at better quality (In effect from the 1st of January 2011).
IMPROVE QUALITY & REDUCE COSTS
Monetary Incentives For Improving Performance:
Starting from the 1st of October 2012, A Value-Based Program (VBP) is to be established and that will provide monetary incentives to health institutions so that they improve the standard of their offerings. Health institutions will be bound by law to report their performances to the general public.
Emphasis On Coordinated Health Care:
Starting from 1st January 2012, benefits will be offered to doctors to work as a unit. The goal in mind is to improve the health care performance and efficiency. If this goal is achieved then these doctors working as a unit will beallowed to keep a part of the sum that they have helped contribute in savings.
Less Paperwork To Lead To Lower Operational Costs:.
With the goal of being more efficient in terms of saving time and reducing costs, health care institutions will be required to make use of technology with less reliance on paper work (In effect from 1st of October 2012).
Countering Health Diseases:
Diseases related to a particular race or ethnic group are to be reported so that they can be dealt with accordingly. This will allow individuals from different ethnic or race groups to receive the same health care services offered to the general mass and ensure no discrimination occur.
INEXPENSIVE CARE FOR ALL
Option Of Long Term Insurance Care:
There will be set a provision of money to the disabled adults so that they can afford long term health insurance coverage.
BOOST HEALTH CARE QUALITY & REDUCIE MEDICAL EXPENSES
Better Coverage of Care for the Prevention of Illnesses.
From January 1, 2013, States which give preventive care to their public will be solely funding it, with the individual experiencing little or no cost. To cover more broadly, the number of Americans receiving care for the prevention of diseases is to increase.
Encourage Authority to Make Receipts in the Bundle:
Starting from 1st January 2013, the plan enforces a campaign which is to be followed nationally in which individuals, or the end customers, will not be receiving medical bills for separate services. Instead, they are to be charged a flat rate for a bundle of services or tests and Medicare should then receive the receipts in bundles. For example, a surgical team is paid together rather than every member of it given a separate payment. This lends to the team working more efficiently as every member has a say in the final payment. Team work is emphasized.
IMPROVED ACCESS TO HEALH CARE
Increased Wages to Doctors Providing Medical Services to Children:
From January 1, 2013,,it will be mandatory for the states to disburse 100% of the rates of Medicare to primary care doctors for the complete year of 2013. This increase in wages will be subsidized completely federally.
More Investments In The CHIP:
From October 1st 2013, the government will provide funding to states for 2 years more so that they continue the provision of coverage to children who are ineligible for the Medicaid program. The law is aimed to increase health care among children at much more affordable rates.
GUARDING THE NEW CUSTOMERS
Assure Consumers Do Not Face Gender Or Pre-Condition Discrimination:
The plan aims to assure that no health care or institution encourages discrimination, whether it is gender discrimination or discrimination due to a patient’s pre-existing medical condition. Strong actions would be taken against companies that fail to renew plans of customers who face or hold a pre-existing diseases, or because they belong a specific gender. The law aims to discourage insurance companies from charging higher rates to a specific gender as well (In effect from the 1st of January 2014).
Getting Rid Of Yearly Limits On Insurance Policies:
The act aims to eliminate all insurance coverage plans, that are new or existing, which assign annual values to their plans. According to the law, money value should not be given to plans on annual basis (In effect from the 1st of January 2014).
Individuals, Part Of Clinical Trials, To Receive Coverage:
Individual who are participating in clinical trials must receive coverage. Companies will not be permitted to provide lesser coverage to the respective individuals (In effect from the 1st of January 2014).
BETTER QUALITY AT REDUCED COSTS
Care to be Made Inexpensive:
Credit on taxes is aimed to make health care services more affordable for individuals who fall in the middle class category. The facility will be granted to individuals who have an income of 100% to 400% above the poverty line. The service offers such individuals to avail discounts on payments every month. The person seeking to avail this service will not have to wait for the tax time and can even choose to refund the service, if he/she wishes (In effect from the 1st of January 2014).
Set up Insurance Exchange Program:
If a company or employer fails to provide its employees with insurance coverage, employees can choose to opt for low cost insurance coverage at the Insurance Exchange. Insurance Exchange will be a market place where insurance coverage will be offered to the employees or small businesses at highly economical rates. A standard will be set for the services that are to be offered and along with price caps (In effect from the 1st of January 2014).
Increase Credit Facilities on Taxes to the SMEs:
The act aims to provide small businesses with a greater credit opportunity so they can offer employees better health care facilities. The law is applicable for both the small businesses and nonprofit organizations. The percentage of the credit is to rise up to 50% for the small businesses and 35% for the nonprofit organizations (In effect from the 1st of January 2014).
GREATER ACCESS TO HEALTH CARE AT AFFORDABLE RATES
Medicaid To Be Made More Accessible:
Individuals who earn $14,000 (who reside 133% above the poverty line) are to be enrolled in the Medicaid program. A family comprising of four individuals, which earns up to $29,000, can also become a part of Medicaid. The funding is to be provided completely by the federal department for the starting 3 years.
Individuals To Seek Responsibility:
The law encourages individuals to seek responsibility and pay a fee for the health care service offered to them, if they can afford to do so. The respective individuals will be made to take responsibility and acquire basic health care services, at minimal costs, so that the uninsured citizens can benefit from the budget provided by the federal department. If people are encouraged, the federal department can help ensure many more uninsured citizens
PROVIDE BETTER QUALITY AT AFFORDABLE RATES
Physician’s Pay to Be Set According to The Value Provided:
The plan aims to encourage physicians to work towards providing better quality and reducing accidents. It seeks to abolish the price discrimination where all physicians receive standard payments. Hence, a physician that provides better health care service would receive higher pay compared to the physician who provides a lesser quality service (In effect from the 1st of January 2015).