...3 Western Governors University AMT 2 Task 3 New and/or Pending U.S. Legislation The Patient Protection and Affordable Care Act (PPACA) The purpose of the PPACA is to ensure more Americans have access to quality healthcare. According to the Congressional Budget Office (CBO), the PPACA is paid for and will provide quality healthcare to more than 94% of Americans. The PPACA will, or is supposed to, eliminate lifetime and unreasonable annual limits on healthcare benefits; prohibit health insurance policy recessions; extend dependent healthcare coverage up until the age of 26; provide assistance to uninsured due to pre-existing conditions; cap insurance administrative expenditures; require coverage for immunizations and preventative services; develop uniform coverage documents allowing consumers to juxtapose different insurance plans from different insurance providers; create temporary re-insurance programs to support coverage for early retirees; simplify healthcare administration as a means to lower health system costs; create an internet portal for consumers to identify insurance coverage options; and implement an appeals process to guarantee consumers and provide consumers assistance processing and accessing their insurance coverage ("PPACA Summary," n.d.) The PPACA does expand public programs, e.g. expanding the eligibility for Medicaid to lower income people; simplify Medicaid and enhance the Children’s Health Insurance Program; simplify enrollment; and expand resources...
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...Discussion Questions #1 Health insurance has become an ongoing issue in America, in regards to accessibility, quality, and cost for Americans. Since the Affordable Care Act (ACA) was passed in 2010 some of the issues have been alleviated. For example, a decrease in the amount of uninsured Americans. The percentage of uninsured Americans has fallen from 16% to 11%, concluding that the 10 million Americans who had no insurance prior to 2013 are now insured. A primary goal of the ACA was to reduce drastically the number of uninsured. To achieve this goal the act allows children to stay under their parents’ insurance plan until age 26, requires employers of 50 or more employees, as well as uninsured Americans to receive coverage or risk paying a penalty, and most importantly make health insurance more affordable for Americans. Having active roles as the payer, regulator, and healthcare provider I believe that government has always played a significant role in the funding of the uninsured, but with no control of prices and quality of goods, market forces should continue to steer this dimension of healthcare. Each of the three levels of government owns and operates large numbers of healthcare institutions. (Jonas & Kovners, 2011). Providing funds for the uninsured falls under the job responsibility of the local government which they own and operate acute care hospitals and public health clinics. Medical treatment for the uninsured is often more expensive than for the insured, because...
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...Analysis of Obamacare Health Policy Anthony E Davis POL201: American National Government Ginger Devine November 25, 2013 Analysis of Obamacare Health Policy One of the most crucial issues of today is the issue of health insurance and availability of quality health services to all residents of the U.S. This paper will analyze the Obamacare Healthcare Policy-highlighting its core elements, health care problem solution, and the policies history. Also it will evaluate the pros and cons using different perspectives in debate. Let’s begin with the elements of Obamacare. The Patient Protection and Affordable Care Act (PPACA), also called Obamacare or the Affordable Care Act, is a United States federal statute signed into law by President Barack Obama on March 23, 2010 (ObamaCare Summary: A Summary of Obama's Health Care Reform, 2013). Since the establishment of Medicaid and Medicare of 1965, Obamacare is one of the most significant expansions from the government and administrative overhaul of the U.S healthcare system. The purpose of the Patient Protection and Affordable Care Act is to raise the rate of health coverage of Americans, to modernize the delivery of health care services, and to reduce the overall costs of health care. This is to be done by restricting certain insurance company practices and providing tax credits and subsidies for individuals and businesses. Prior to the approval of the Obamacare Policy, the American health care industry was in deep...
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...the US Health Reform Bill The latest poll out today from the Kaiser Family Foundation, a nonpartisan health-care-policy research organization, says only 27 percent of the public has been following the 2010 health reform debate closely. Despite this, more than half (56 percent) of Americans think health reform is more important than ever. Very smart people are zoning out of the health care reform debate because they think it’s just too complicated. The complexities of US health reform are a problem, because American citizens and politicians cannot make good decisions about an issue they do not clearly understand or have been misinformed. Defining the goals of reform is relatively easy. Implementing them is tough and that’s where people are made to feel stupid - partly by special interest groups who intentionally or unintentionally confuse the debate. According to John Lapook in an article posted on CBS News.com, at least one senator admits he has no intention of reading it. "I don't expect to actually read the legislative language because . . . the legislative language is among the more confusing things I've ever read in my life," Sen. Thomas Carper (D-Del.) quotes to online news service in the article. Carper told CBSnews.com that the bill was "incomprehensible" and "hard stuff to understand. Carper stated he doubts his fellow members of the Senate Finance Committee will read their handiwork either. The article states that the committee is drafting a summary of the awkwardly...
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...Access to Insurance Versus Access to Care Access to Insurance Versus Access to Care and the Impact of the Affordable Care Act Tyanna Qualls Walden University Access to insurance differs from access to care because of cost. One example of my personal experience of insurance and access to care was when I had to assist my brother with his sickness battling sickle-cell anemia. My brother resided with me the last six months before he transitioned over so I witnessed firsthand the lack of quality care he received due to being underinsured. Medicaid was my brother’s only source of health insurance. His sickness prevented him from maintaining a full-time job. The full-time jobs he did hold did not offer him an affordable insurance plan due to his condition. One employer denied him coverage completely because it cost too much to insure a person who needs extensive long-term care. Pre-existing clauses prevented him from receiving necessary preventatives services. The pharmaceutical companies charged high copays for name brand medications that he needed. Medicaid drug formularies limited his access to many beneficial drugs. Lack of insurance coverage prevented him from having a primary care physician to see consistently so he frequented the ER departments at the community hospitals. Whenever he was admitted into the hospital, he had a certain amount of days they would keep him, a lot of medical services were not provided to him because of his level of benefits with Medicaid, and he was...
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...Risk and Quality Management Assessment Summary Xxxxxxx Xxxx HCS451 September 24, 2012 Instructor Executive Summary Resolve, The National Infertility Association has been assisting and helping out individuals with infertility issues since 1974. Risk and quality management improvements in the organization have rallied behind the patient’s safety, while finding new ways in working as a team that is more effective and efficient when ensuring that the organization can deliver high quality and safe patient care. There have been issues regarding cost of visits and procedures with no insurance coverage while having to pay out of pocket for services that can cost hundreds or even thousands of dollars. The organization offers assistance in providing financial assistance for those in need and assist in finding the health care coverage that would best suit them. Infertility coverage is not a mandated health issue in many states that needs insurance coverage. Out of all the states only 15 are mandated to cover some sort of infertility. 1.1 Key Concepts The main problem was to determine what insurance provider would have some sort of infertility coverage that could assist their patients and avoid out of pocket expenses. The risk analysis will provide information that will help the risk manager realign the activities when dealing with quality care and improvement with the main focus on patient needs. * Review of the current functions of quality improvement and risk...
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...Healthful Small Business and Health Insurance Eugenia H. Snead Southern New Hampshire University A common issue facing midsize to small employers today is health insurance coverage. John and his wife, Liza are small business owners of a boat repair business, who are quite busy since the recession with the upkeep and repairing of older boats in the area. Business is so good Liza hired a young woman to assist her with paperwork. John and Liza are wondering if they can afford to hire an additional mechanic (Robert), who happens to be the best applicant for the open boat mechanic job. (Spencer, C.S. 2014) The purpose of this paper is to analyze the options for John and Liza from all angles. There are many issues in this case such as legal implications, ethical, and addressing it from a pure business standpoint. To illustrate the choices that John and Liza have let’s consider a hypothetical scenario that John and Liza employs 6 employees full time and Robert would be the 7th. Currently the company offers health care benefits paying 100% of premiums at an average cost of $5,000 per employee. OPTION 1 The company could continue to absorb the costs of the health insurance premium and do nothing. * At an estimated cost of $7,000 per employee, the company would have to absorb the full $49,000 cost or pass along part of the cost to its employees or customers. OPTION 2 The company could encourage the men to quit smoking and provide incentives for them to quit. ...
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...Health Insurance Portability and Accountability Act Changing Lives Heather Cuthbert COM 102 June 22, 2014 CollegeAmerica Health Insurance Portability and Accountability Act Changing Lives The acronym HIPAA stands for the Health Insurance Portability and Accountability Act. HIPAA was enacted by congress August 21, 1996 and signed by President Bill Clinton the same year. It had required the Secretary of Health and Human Services (HSS) to propose standards protecting the privacy of individually identifiable health information within a year by August 21, 1997 (Summary of the HIPAA Privacy Rule, n.d.). The overall purpose of HIPAA is to improve the portability and continuity of health insurance coverage in group and individual markets. HIPAA has changed lives in many ways for patients, doctors and medical offices. As a patient it has helped to make them feel more secure with not only their health insurance, but also their personal information. Doctors have had to adjust their offices in many ways in order to comply with HIPAA. Medical offices have had to make changes in how they perform everyday tasks, including the medical offices use of electronic records (Summary of the HIPAA Privacy Rule, n.d.). Effect on Patients HIPAA has made a great impact on the privacy of patient’s personal information. As patient’s it is important to know our rights. Patient’s now have a specific place to file a complaint and there is recourse if a medical practice violates the patient’s...
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...Medicare Summary Medicare, America’s biggest health protection plan currently covers more than 50 million people nationwide. Medicare can be summaries into 2 major categories, Traditional and Advantage. Both of them have 4 subcategories known as Part A, B, C, and D. Each of them represents a specialty insurance plan; Hospital, Medical/Health, Advantage Plans, and Prescriptions. The Centers for Medicare and Medicaid are responsible for the program operations. Medicare has changed over the years including the legislation law of reform H.R. 3590, Patient Long Protection and Affordable Care Act signed into law in 2010. And then there was H.R. 4872, the Health Care and Education Reconciliation Act. This legislation brings changes and impacts for how the Part D Medicare plans are to enroll and advertise beneficiaries. The legislation protect and strengthen all recipients of Medicare while expanding provisions for low income recipient groups by increasing original Part D provisions. These changes have powerful impact on Part D of the Medicare operations and dynamics that include specialty prescription coverage and benefit design (American Health and Drug Benefits, 2012). There is a plethora of obstacles ahead for the Medicare program; even though the U. S. government’s plan for modification has brought benefits to many, especially for (Over 65) seniors and physically disabled Americans covered by the plan. Revenues are decreasing and the cost of health care is steadily climbing,...
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...child(ren) * The portion of health insurance that is New Seasons Market pays on behalf of your domestic partner and/or their children is considered income. This obviously isn’t income and should NOT be seen as cash, but rather it comes to you in the form of a benefit. When Can I Enroll in Benefits? * Now * During Open Enrollment * Anytime there is a change in family status a.k.a. Qualifying Event -Marriage -Divorce -Birth -Death ****TAKE NOTE THAT WHEN THERE IS ANY CHANGE TO YOUR BENEFIT COVERAGE DUE TO A QUALIFYING EVENT, THEY MUST INFORM US WITH 30 DAYS OF THE EVENT HAPPENING**** * When there is a change in work status; like from part-time to full-time or full-time to part-time * Special Enrollment -If you are covered under another plan and lost that coverage you have the right to come onto our place as long as you so within 30 days of losing coverage Pre-Existing Conditions * Definition: A pre-existing condition is one for which medical advice, treatment, and/or diagnosis was given within the last three months prior to coming onto our health care plan * The plan does not pay for benefits for a pre-existing condition during the exclusionary period, which last up to 12 months. * If you had coverage before coming onto our plan you may acquire a “certificate of credible coverage” from your previous insurance that can be used to offset the pre-existing condition exclusionary period. Cigna Summary Preface this section with talking...
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...approaching. The bill aimed at reforming the health care industry was signed in to law on March 23, 2010. The primary focus of the law is to make healthcare services more affordable for all American Citizens. The Obama Care health insurance market place is set to open October 1, 2013. However, the U.S. Department of Health and Human Services has delayed the signing of final agreements originally set for the first of September to mid-month. With the Health Insurance Marketplace opening October 1st, insurance companies will compete as providers for individuals’ business via the Affordable Health Insurance Exchange, an online marketplace. Many health care provisions are already in affect saving on the cost of coverage, such as the rate review provision and the Medical Loss Ratio policy. The rate review provision was passed on May 19, 2011, as part of the new reform to combat insurance companies from “rate hikes”. From 2003 to 2009, reports from the Commonwealth Fund found that employers had faced an average 41% increase in premium costs, while individuals faced and average increase of 10%. 43 out of 50 states currently have a rate review process, but vary greatly in how they are performed. The U.S. Department of Health and Human Services performs reviews on those states which lack resources for adequate reviews. Another reform already in action is the Medical Loss Ratio Policy. The Medical Loss Ratio Policy requires all health insurance providers to invest a minimum percentage...
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...Timeline: History of Health Reform in the U.S. VIEW: Early 1900's 1930 – 1934 1935 – 1939 1940 - 1945 1945 - 1949 1950 - 1954 1955 - 1959 1960 – 1964 1965 – 1969 1970 - 1974 1975 – 1979 1980 - 1984 1985 - 1989 1990 – 1994 1995 - 1999 2000 – 2004 2005 – 2009 2010 1912 Teddy Roosevelt and his Progressive party endorse social insurance as part of their platform, including health insurance. 1912 National Convention of Insurance Commissioners develops first model of state law for regulating health insurance. 1915 The American Association for Labor Legislation 1912 Teddy Roosevelt and his Progressive party endorse social insurance as part of their platform, including health insurance. 1912 National Convention of Insurance Commissioners develops first model of state law for regulating health insurance. 1915 The American Association for Labor Legislation Early 1900's 1921 Women reformers persuade Congress to pass the Sheppard-Towner Act, which provided matching funds to states for prenatal and child health centers. Act expires in 1929 and is not reauthorized. (AALL) publishes a draft bill for compulsory health insurance and promotes campaigns in several states. A few states show interest, but fail to enact as U.S. enters into World War I. The idea draws initial support from the AMA, but by 1920 AMA reverses their position. 1927 Committee on the Costs of Medical Care forms to study the economic organization of medical care. Group is comprised of economists...
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...need big changes, and we need them soon. Healthcare has a long and detailed history in the United States. Since the beginning of the 20th century, it has been a major source of political debate. Both federal and state governments have made efforts in trying to take steps toward a universal health care system. Early reform poured the foundation for today’s government healthcare programs. The United States witnessed social movements that demanded access to the American dream. People who were viewed as second-class citizens banded together and demanded reform on their behalves. The largest of these movements was a demand for universal healthcare. American’s greatest issue was sickness and missing work. When working individuals missed work due to “sickness” they lost their wages. The loss of income made sickness the leading cause of poverty. Reformists saw a need for national healthcare and the campaign began. Health insurance that would protect the worker against wage loss and expenses incurred from medical treatment. In 1906, the American Association of Labor Legislation (AALL) became active in the push for national health care. They created a committee that concentrated on healthcare insurance, and in 1915 drafted a bill that gave limited coverage to the working class and to anyone that earned less than $1200 a year. This draft included sick pay, death, and maternity benefits. The proposal was meet by opposition. Although the American Medical Association offered its support of...
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...Your Business Fair? (The Impact of Affordable Care Act on Small Business) On March 23, 2010 President Obama signed into law the comprehensive health reform known as the Patient Protection and Affordable Care Act informally known as Affordable Care Act. According to the Executive Office of the President, Council of Economic Advisors (EOP/CEA), “the key goals of health care reform is to reduce the growth rate of costs while maintaining choice of doctors and health plans and assuring quality, affordable health care for all Americans.” (The Economic Case for Health Care Reform, June 2009) The ACA is created to improve the overall quality of health care delivery and its’ systems while adding new consumer protections. In the ACA there is a clause known as the individual mandate. This mandate requires most U.S. citizens and legal residents to obtain qualifying health care insurance coverage, and if not will be required to pay a tax penalty. Effective January 1, 2014 employers with fifty or more employees that do not provide affordable health coverage will receive an assessment where for those businesses with less than fifty employees are exempt. States have created health benefit exchanges for individuals and small businesses through which health coverage can be purchased at affordable prices. The Department of Health and Human Services (HHS) published several fact sheets and brochures highlighting what the ACA means for large and small businesses, individuals, families...
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...Process The Affordable Care Act ensures your right to appeal health insurance plan decisions which is when you ask that your plan to reconsider its decision to deny payment for a service or treatment. New rules that apply to health plans created after March 23, 2010 spell out how your plan must handle your appeal (usually called an “internal appeal”). If your plan still denies payment after considering your appeal, the law permits you to have an independent review organization decide whether to uphold or overturn the plan’s decision. This final check is often referred to as an “external review.” Many states offer help to consumers with health insurance problems. The Affordable Care Act improves these services with grants that help states start or strengthen Consumer Assistance Programs (CAPs). The states and territories that applied for these grants have received funds provide residents direct help with problems or questions about health coverage. Whether or not your state has a Consumer Assistance Program, you have rights under the health care law, including the right to appeal decisions made by your health insurance provider. If your state does not have a Consumer Assistance Program, some state and federal government offices may still be able to help you determine your rights and solve problems. Florida does not operate a Consumer Assistance Program under the Affordable Care Act. The new consumer protections and benefits of the law still apply to Joe. ...
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