Obamacare

ObamaCare

Nick Farrell, Frank Caterina, Hui Cao

ObamaCare

Whether the creation of the Affordable Care Act is seen as beneficial for American health insurance or not, the steps that the act takes helps us understand why the system needs change at this time. Analyzing the characteristics that Obamacare changes in the system, it’s important to note the main functions that the act intends to change altogether. What objectively drives the popularity of Obamacare is the intent to continually renovate the private insurance market specifically targeting individual care and small business options, expand the Medicaid to the working poor, and create a list of essential benefits that every policyholder should have (Silvers, 2013, p.402).

Looking at the transformation of insurance company policies, one of the main characteristics of change is the shift from a large variation of policies to simpler, more comparable policies. Additionally, these policies are required to include pre-existing conditions and limits the rate that the policies can increase (Centre For Public Impact, 2017). The new method where Americans search and purchase health insurance creates an interesting situation for the insurance companies in that they have to take on more risk when assessing policies or clients. This makes the companies more of a stakeholder as a key partner to become more immersed in customer experience and overall coverage. However, to try and keep the playing field even, Obamacare requires all citizens to acquire “minimum coverage” which states unless your income is below an extreme level, you have to purchase health insurance (Centre For Public Impact, 2017). This is a key activity that ends up helping out the insurance companies to decrease risk in that they won’t have people getting insurance just because they are sick. Another factor Obamacare changes is the channel that citizens use to obtain their health insurance, especially ones without a corporate employer. Instead of using employers that have the money and resources to evaluate and offer plans, Obamacare makes obtaining insurance easier by using a website to pick your insurance plan. Additionally, Obamacare gives tax credits to small businesses that choose to offer insurance. This gives the consumer the ability to choose between insurance from their employment and individually.

With millions of uninsured families and individuals that don’t have the income to purchase insurance, Obamacare aims to expand Medicaid to these people. The act “covers any individual under the age of 65 who earns at or below 138% of the Federal Poverty Level (FPL) through an expansion of state-sponsored Medicaid programs. (Medical Billing and Coding, 2018)” This means that many working-class people who can’t obtain affordable insurance have the ability to choose between plans that fit for them. However, there is a drawback that each state gets to choose if they want to adopt the Medicaid expansion. While the majority of states agreed to adopt this, only about 18 chose not to (Medical Billing and Coding 2018). This enactment changes some of the key resources that go into healthcare due to how citizens now obtain their insurance. Since people are browsing and choosing insurance plans online, Healthcare.gov’s website is now crucial for obtaining coverage. This website is simple to understand for the most part and gives individuals a coverage tab on a web page to select which they can choose their insurance on.

Since one of the main ideas of Obamacare is to make coverage simpler and have more general coverage, a list of essential benefits were created and now apply to every policy holder. By setting in place basic care that must be given to every individual, it creates a new customer segment that is Americans making less than $36,000 per year. These general benefits include emergency, lab, and maternity services along with prescription drugs. To be able to pay for these newer benefits that every policyholder receives, we must notice that a new addition to the cost structure is created. With the expansion of Medicaid, new costs that cover the stated benefits have to be paid for in some way. In turn, we can notice the value proposition that is providing cost effective health insurance. To predict the actual cost associated with this, having these essential benefits helps Obamacare forecast how much low-income policies have to pay.

Obamacare intends to provide goodness. Before the ACA, there were still 400 million Americans failed to own insurances and one of the goal of Obamacare is to help those who do not have the insurance to get insurance and provide subsidy. The republic party was the main blocker. The Republicans demanded that the ACA hold for a year, and the tax on medical equipment and other related taxes should be abolished. However, Obama hoped the house of representatives would not ,insist on cutting the budget of health insurance law and relate it to government budget. The republican did not veto the Obamacare but want to delay it to ensure the Obamacare would not destroy the insurance market. (international center, 2013)

 The democratic party support the Obamacare. It considers the good healthcare in the United States as a necessity, which means accessible, affordable and high-quality health care for all Americans. The democratic party thinks no American should face financial loss when they are ill or have disease and no one should make payment decisions between house renting and health care cost. They prohibit the insurer from not providing insurance for Americans and support continuous care for seniors. The democratic party firmly believes that it is the senior’s diligence and responsibility that earned the Medicare and social security. Also, the democratic party fully support part D in the Obamacare, which guarantees better coverage of prescription drugs for the elders. (Republican Views, 2014)

First, its mandatory for everyone to buy Obamacare or they will get a financial penalty. The penalty was small but it had increased to 695 dollars per adult, 347.5 per child and even higher penalties applied to upper-income groups since 2016. Besides, the ACA demands plans through the health-insurance marketplace to cover the pre-existing diseases or health conditions. No insurer could charge you more when there is a pre-existing condition. This is different from previous insurance system, which would charge more insurance fees based on personal health condition. Third, the Affordable Care Act covers a greater number of people, there are 14 to 20 million people who receive Obamacare. A large number of uninsured Americans get Obamacare while they are not the main objective gains. Fourth, ACA provides Medicaid coverage for 50 states though the qualifications are different from state to state. Fifth, the ACA broadens the preventive services including annual physicals, various screening, appropriate immunizations and vaccines for adults. Women are qualified to get contraception services and health tests like mammograms provided by in-network professionals. Sixth, before ACA, young adults who between 18 to 25 years old are least likely to have insurance when their parents’ insurance is not allowed to maintain coverage. In ACA, adult children are eligible to remain on their parents’ health care insurance coverage until 26 years. Seventh, there is no lifetime limits on essential health benefit in ACA in case people lose coverage when they are in injury or illness. Eighth, the ACA demands 80% ~ 85% insurance fees are used in health care service so that limit the profit for administrative service and investors. The insurer will theoretically send back the rebates to holder if the healthcare expense is less projected. Before the ACA, it is limited to have the rights to reject the insurer’s appeal of deny payments or end coverage. Typically, patients only own internal appeal with insurer itself while legal remedies might be arduous after that. However, under the ACA, patients are able to have the third party to make an external review and if the reviewer rules in your favor, the insurer should comply. Last, the patients would not get any coverage if the insurer finds some faults in the insurance appliance, which leads to financial loss on patients. On the contrast, it is illegal for the insurer to revoke the coverage just because of a fault in the appliance. The insurer should prove that the patient cheats the insurer by providing incomplete or false information, or the patients did not pay for the insurance. (Caplinger, 2017)