Time to Act on the Affordable Care Act

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America’s leaders approved a sweeping healthcare system reform, the Affordable Care Act (ACA), signed March 2010. The National Conference of State Legislatures details ACA’s intentions: “expand access to insurance, increase consumer protections, emphasize prevention and wellness, improve quality and system performance, expand the health workforce, and curb rising health care costs.” The American Medical Association’s figure above emphasizes benefits and access to care for millions who cannot afford healthcare expenses or health insurance.

 The ACA’s current challenge is sustainable, efficient implementation. The American Public Health Association highlighted ACA’s provisions (Medicaid expansion, insurance exchanges, and minimum coverage provision (“individual mandate”)) scheduled to phase-in by 2014, though USA Today anticipates delays. Implementation requires careful and extensive local, state, national coordination. Healthcare providers need to manage resource more cost-effectively, and promote preventive care. The ACA permits co-pay free preventive care, including screening for blood pressure, obesity, cervical cancer, and chlamydia infection, and others, as detailed by the American College of Gynecologists memo on the ACA.

A vital factor to ACA’s sustainability is individual and employer participation. This will be challenging since individual-purchased insurance will increase 30-40% with possible $5,000 deductible, according to the Miami Herald. Many will choose the no-purchase penalty and remain uninsured instead. Numerous companies are shifting personnel from full-time to part-time to avoid 5-20% cost increases. Maximal participation will offer lower long-term individual, employer, and federal cost. Thus, efforts should promote participation to deliver the greatest good, for the greatest number, and most importantly–better health and well-being for millions.

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5 Responses to “Time to Act on the Affordable Care Act”

  1. jtrunce Says:

    I was curious if the reference to the delays regarding the requirement of businesses with more than 50 employees provide health insurance to their workers was in any way indicative of the country’s readiness for the now, more imminent deadline of October 1st. The article mentions that the “more complicated parts of the law, such as the exchanges and the individual mandates, are set to take effect Jan. 1.” My understanding was that the exchanges were expected to open October 1st and I was wondering if you had found any other materials that spoke to the preparedness of the country in sustainably and efficiently meeting that deadline.

    My other questions revolves around the incentive for the currently uninsured to buy-in. You noted that many will choose the no-purchase penalty, but what is the trade-off? Less than what it would cost to maintain health insurance for a year? Given this is such a vital factor to the success of the ACA, as unfortunate as it sounds, I feel as though there has to be an incentive beyond “better health and well-being for millions”?

  2. mpatg Says:

    You have identified one of the most critical determinants of success of the PPACA: individual participation. For political reasons, Congress watered the tax penalty for not carrying health insurance down to, at most, a one month premium for a “young invincible” purchasing a catastrophic health insurance plan on the exchange. For most people this tax penalty will be a fraction of one month’s insurance premium.

    This tax penalty for not carrying health insurance was placed so that insurance companies could reduce their risk when implementing other portions of PPACA, such as community rating of insurance plans. In a recent Washington Post article, one PPACA noted that “I will cancel my insurance the instant I can no longer be denied insurance for preexisting conditions….”

    Health delivery is a for-profit industry in the United States. Insurance coverage, and the benefits extended by PPACA, are carefully calculated and monitored by the third-party payors. Individuals like the one in the second paragraph who plan to take advantage of the system will be the downfall of PPACA and everyone who benefits from the extended coverage, not the grandstanding Congress that continues to vote to defund or repeal.

  3. nicolezilliox Says:

    While there has been an awful lot of discussion about how employers will downsize their employees from full time to part time to avoid ACA regulations, I wonder if that isn’t a lot of bluster to try and encourage the administration and congress to change the regulations. The reality is, that only effects companies with less than 50 employees.
    For the individual mandate you forgot to mention that for unsubsidized health insurance those making less than 400% of the federal poverty line will be eligible for complete subsidization of the cost.
    The reality is that the number of people who are not already eligible for health insurance through their jobs AND making more than 400% of the FPL is not a huge number. While providing health insurance and medical care to those without is not only important it is a basic human right, the debate on the economic implications to such an incredibly small percentage of the American population may be more about politics than about the actual effect these new regulations will have.

  4. ryleejen Says:

    As a family physician, we do have concerns about next year. Not only to do we see hiring of fulltime employees slowing down in our area, we also see our premiums increasing for our families and employees. Many of us that provide insurance to our employees may soon cannot not afford to. It is even affecting us personally, as we as a family may choose a health exchange or “catastrophic”insurance b/c we are healthy and have no medical problems but yet our premium is close to $800/month for a family of four. I think many patients in my area will purchase an exchange insurance that are working and do not have insurance now. I dont think many in my area will forego and accept the penalty if the health exchange is affordable. For many who work, it will be a relief that now they can get their shoulder looked at or their blood pressure addressed, etc. Even though in Texas, Obama is seen generally as the antichrist, I tell people to hope for the future. It will take a few years to get the bugs and kinks out, just like it did in the UK. But in the big scheme of things, it is to support the working family and bring medical treatment to those who previously could not afford it.

  5. nadinechase Says:

    I just wanted to add my personal experience to the discussion. Because of the ACA I currently have health care coverage which I desperately need due to several life-threatening illnesses. I do not have a job that provides health care because I am a full-time student (I work part-time as an “independent contractor” to pay the bills). As a full-time student over the age of 21, I would normally not be covered by my mother’s health insurance. Because of the ACA, I can now be covered by her insurance until the age of 26. People can complain about Obama and health care reform all they want, but I am an individual that really benefited from the ACA. Without my asthma medication I would not be able to work and probably become a bigger “burden” on society by going on welfare. Because of the ACA I can get my medication, work, and complete my Master’s degree.
    This was a very informative blog post, thanks for sharing your research.

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