President Obama signed the Affordable Care Act (ACA) on March 23, 2010, and although that was 5 years ago, many people are still confused about what it all means. The ACA is a complex set of changes, but we’ve broken it down into simple key points of the Affordable Care Act you’ll want to know about below…
Affordable Healthcare Coverage For Everyone – Millions of Americans who couldn’t previously afford health insurance can now have access to affordable healthcare as a result of the health insurance marketplace, and through the expansion of Medicaid.
New Provider Incentives – There are more financial incentives for healthcare providers to deliver patient-centered care that is coordinated with other providers. This is in an effort to reduce costs and improve the quality of healthcare. Doctors are now incented to treat the patient, not the disease, and to look for and treat the causes instead of just the symptoms.
Value-Based Care – Value-based Medicare reimbursements are now offered for healthcare providers that meet certain criteria. Providers are finally being rewarded for providing the best care, not the biggest number of procedures.
Readmission Penalties – Hospitals are now being penalized if certain Medicare patients are readmitted within 30 days of discharge. Because of this, patients can expect improved follow up care. Instead of being left with vague instructions as to how to care for yourself after discharge, patients with certain medical conditions can expect homecare nurse visits, detailed instructions, or a tracking monitor.
Patient-Centered Care – Providers are incented to provide patient-centered care, which means they are encouraged to seek answers from the patient that better helps them prescribe the right treatment or solution for the individual, not for the disease or for the benefit of the provider.
Quality of Care – The healthcare system is now working to improve the health of the population, improve patient satisfaction and reduce healthcare costs at the same time. Instead of being paid for the quantity of procedures or office visits they deliver, providers are now being paid for the quality of healthcare they provide.
Coordination & Integration – The ACA encourages integration, whereas the system we know up until today has been extremely fragmented. As Prevention magazine puts it, “Our current system provides such uncoordinated services that if home building were like health care, carpenters, electricians, and plumbers would all work with different blueprints and wouldn’t cooperate with each other.” The ACA will change that.
Transparent Pricing – Pricing is much more transparent. Previously, costs were hidden and varied drastically so that you never really knew what a procedure would cost until after a procedure was completed. More and more, prices will start to be provided up front, especially as the bundled payment model is used more often.
Preventive Medicine – Certain preventive and screening services, such as mammograms and colonoscopies, are now available with no co-payments. Other preventive programs will be more readily available, such as smoking cessation and obesity programs, and free annual wellness visits are available for most individuals. In addition, insurers must provide all 50 of the preventive services recommended by the US Preventive Services Task Force for free.
Consumer Protections – There are no more annual limits, lifetime limits on coverage, and no more discrimination against pre-existing conditions (on a state-by-state basis) or against gender when pricing health insurance. There is now extended coverage for young adults (allowing them to stay on their parents’ plan until the age of 26) and early retirees (for people between the ages of 55 and 65). Insurance companies must also justify their rate hikes.
Employer Sponsored Coverage – By the year 2016, the ACA will require all employers who have over 50 full-time employees to offer health insurance to their full-time employees.
Primary Care Availability – There are new incentives in place to increase the number of primary care physicians, nurses and assistants, such as scholarship funding, loan repayments and tax breaks.
Reduced Costs – Numerous measures are being taken to help bring down the cost of healthcare. For example, efforts are being made to reduce waste and administrative costs, and standardized billing and electronic health records are being put in place, along with certain tax credits. Plus, because all Americans are required to have health insurance now, uninsured health events will be reduced. This will help to keep healthcare costs and taxes down since coverage and taxes had often been raised in the past to balance the cost of uninsured Americans.
Better Standards – Health insurance companies now have essential health benefits when selling to individuals and small groups, which are standards that all health plans must meet.
Prescription Drug Coverage – All individual and small group health plans must cover at least one drug in each category and class in the U.S. Pharmacopeia. In addition, prescriptions now count toward out-of-pocket medical expense caps.
Pediatric Care – Children under the age of 19 will be entitled to two teeth cleanings each year, as well as X-rays, fillings, orthodontic work that is medically necessary, annual eye exams, and one pair of glasses or contact lenses per year.
Maternity & Infant Care – Prenatal care will be considered a preventive service that must be provided at no cost, and that includes childbirth and infant care.
Essential Health Benefits – Every plan under the ACA must include outpatient hospital services, inpatient hospital services, emergency services, prenatal care, maternity care, newborn care, pediatric care, preventive care, wellness services, chronic disease management, mental health services, substance abuse treatment, prescription drug coverage, and certain laboratory tests.