Affordable Care Act Reforms Healthcare Insurance

¶ … Patient Protection Affordable Care Act (PPACA) legislation is patently an improvement to the health care delivery system. The mere fact that thousands upon thousands of people are receiving healthcare and medical service through the Affordable Care Act is testimony to the scope of the improvement in healthcare services. But there is much more to the equation than absolute numbers of people now receiving medical and health care services through a healthcare insurance plan, many for the first time ("ObamaCare," 2015). The following sections discuss the healthcare insurance reforms that are integral to the Affordable Care Act.

Rescissions

The Affordable Care Act prohibits health insurance plans from rescinding coverage unless fraud or misrepresentation has occurred. Indeed, the reforms include prohibitions on rescissions and an extension that requires the provision of coverage of existing health insurance plans for non-dependent children up to age 26. This reform strengthens an area that insurance companies have substantively abused, as they have dropped coverage on people with chronic and severe health care issues, and refused to provide coverage for people who have pre-existing medical conditions.

Extended Dependent Adult Child Coverage

Insurance plans are required to allow unmarried children to stay on their parents' health insurance until age 26, and excludes gross income for employer provided health coverage for adult children until age 26. Many adult children have gone without health insurance when entering the workplace after high school graduation, or have relied on student health coverage, which is not sufficiently comprehensive, if they can afford the premiums when they enter higher education. Health insurance costs are often prohibitive for young people just starting out, and they are unlikely to have savings or a safety net beyond their parents if they extensive or costly treatments or care ("NCSL," 2011). Moreover, since the ACA is designed to provide coverage primarily for people of limited income, expecting parents of adult children to function as safety nets is neither rational nor feasible ("NCSL," 2011).

Preventative Care & Immunizations for Children

All insurance plans written under the ACA are required to provide preventative services and immunizations as recommended by the CDC, and child preventative services recommended by the Health Resources and Services Administration -- all without any cost sharing.

Uniform Explanation of Coverage Documents and Standardized Definitions

The ACA has vastly improved the accessibility of health insurance documents by ensuring that standards represent an accurate summary of benefits and explanations of coverage that are written in language easily understood by the average enrollee, are provided in a uniform format. The explanations provided by insurance providers must explicitly describe coverage features such as exceptions, cost sharing, limitations, and reductions, along with example scenarios that illustrate the application of these features. This aspect of the ACA contributes to informed decision-making by enrollees and acts to propel people toward making a choice about an insurance plan. Research on making choices has shown that when people are offered too many choices or descriptions that are complex and not easy to interpret, they tend to just freeze, stall, and not make a selection.

Provision of Health Education

One provision of the ACA requires the Secretary of Health to develop guidelines for health insurers to conduct outreach that provides information on programs and initiatives that improve health outcomes. Examples of these types of information and programs include care coordination, chronic disease management, improvement of patient safety, prevention of hospital readmissions, and promotion of wellness and health.

Reducing the Cost of Health Care Coverage