The success of PPACA, and its provisions for people who are currently or chronically uninsured, will depend on reform of public programs as well as private insurance practices to create "new pathways to coverage (Gulley) and address the problematic link between employment and insurance coverage. In other words, employment should not be the only viable option for securing affordable insurance, nor should there be "significant work disincentives for people with disabilities" (Gulley). The law should help "reduce disparities in [healthcare] access (Gorin, 2010).
A number of provisions of PPACA have already taken effect. Beginning January 1, the law provided for a 50% discount on covered brand-name drugs. This provision was designed to close the coverage gap in Medicare Part D coverage, the so-called "Donut Hole." There is a 7% discount on generic drugs. The coverage gap will be completely eradicated by 2020, according to PPACA, making it even easier for people with limited resources to get the medicines they need ("Understand the affordable care act," 2010).
PPACA allows young adults to stay on their parents' plans until they turn twenty-six, unless they are offered a plan at work. With unemployment are record highs and the job market tough on young workers who have not yet developed sufficient skills or amassed enough work experience, this provision takes care of young adults as they strive to independence from their parents. It provides a safety net while they establish themselves in the workplace and may allow them to put money in savings, towards large purchases such as cars or starter-homes, and toward student loans. All of these expenditures will help boost the economy.
PPACA makes up to 4 million small businesses eligible for tax credits to help them provide health insurance to workers. The first phase of the provision gives a credit worth up to thirty-five percent of the employer's contribution to health insurance. Small non-profits can earn up to a 25% credit. This provision is obviously good for insured individuals, but it also helps the bottom-line of the businesses. Better financial health of individuals and small businesses is good for the economy.
States can now cover more individuals with Medicaid, thanks to an increase in federal matching funds. Individuals benefit from increased access, while states and the local economies within them benefit when more services are federally subsidized. Ultimately, health care costs will go down for everyone when individuals can access primary care, for example, instead of relying on more costly emergency-room visits. More preventive care will reduce later needs for treatments and hospitalization.
PPACA also includes new laws designed to address rampant Medicare fraud. According to HealthCare.gov, current efforts to fight fraud have returned over $2.5 billion to the Medicare FY 2009 trust fund. Continued efforts are expected to recover even more funds that are wasted and obtained fraudulently through Medicare and Medicaid. Money saved in this way can provide more for legitimate care to the people who need it.
The new law also created a provision to cover early retirees, who in the past could see their savings erode when they had to purchase coverage to see them through to age sixty-five, when they would be eligible for Medicare. Funded with $5 billion, the Early Retiree Reinsurance Program provides money through employer-based programs not only for early retirees, but for their spouses and dependents.
A Pre-Existing Condition Insurance Plan (PCIP) provides new coverage options for individuals who have been uninsured for at least six months because of a pre-existing condition. States can choose whether or not to participate in the program; if they opt out, a plan will be established by the Department of Health and Human Services in that state. Before PPACA, individuals with pre-existing conditions...
Now they do. The law includes a specific provision addressing the issue of pre-existing conditions in children. New rules prevent insurance companies from denying coverage to children under the age of nineteen who have pre-existing conditions. It is no longer legal even to limit coverage in such cases.
In the past, insurance companies could rescind coverage on the basis of a technical error on an individual's application. For example, a woman identified as "Katy" neglected to mention two visits to a psychologist she had six years before completing her insurance application. It was an honest oversight on her part, but when she was later diagnosed with breast cancer and submitted claims to her insurance company, the insurer, under the old law, could have denied coverage, claiming she withheld information. Individuals are now protected against such insurance loopholes.
There are additional provisions that make it easier for consumers to be informed and proactive. For example, PPACA provides a way for individuals to appeal coverage determinations and has established an external review process. The government has also created an easy-to-navigate website, HealthCare.gov, that enables individuals to educate themselves with respect to their rights and entitlements under the new system.
The new law provides immediate and direct benefits for individuals. It also provides short-term and long-term benefits to society. When individuals benefit, there is an immediate effect on family and local economies. Over time, the ripple will extend to the nation as a whole. Healthcare coverage will help the country recover from its deep recession that has devastated so many people over the last few years.
The changes will not all happen quickly. It is impossible to completely eradicate fraud, waste, and the problems associated with poverty. However, PPACA takes huge and important steps towards addressing these issues. All Americans are beneficiaries, particularly those who have been forgotten in the past.
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Gorin, S.H., Gehlert, S.J., & Washington, T.A. (2010). Health care reform and health disparities: Implications for social workers. Health & Social Work 35(4), pp. 243-247.
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