The Patient Protection and Affordable Care Act
In 2012, over 47 million Americans were uninsured. Due to the rising costs of health care, decreases in employer sponsored health care, and ineligibility gaps for public programs, the number of insured people has steadily increased (KFF, 2013). In an effort to overhaul the broken, fragmented system, massive health care reform has been launched. The most far-reaching law affecting managed care since the creation of Medicare and Medicaid, the Patient Protection and Affordable Care Act “ACA” was signed into law on March 23, 2010 (Kongstvedt, 2013). This controversial and comprehensive piece of legislation focuses on provisions to expand coverage improves health care delivery systems, increase consumer protection, and control health care costs (KFF, 2013).
While no one can accurately predict what impact all the changes will have on future costs, undoubtedly we are entering a new health care landscape that will be very different from the health care system of the past. This paper will attempt to explore the impact of the Affordable Care Act on current and future practices of health insurance and managed care. Additionally, this paper will address the effects of reform felt by hospital administrators and how the ACA influences their decisions moving forward.
The Effect of the ACA on Health Insurance and Managed Care
The key provisions of the Affordable Care Act are designed to decrease obstacles for obtaining health care coverage as well as accessing care. After the legislation is fully implemented, all Americans will be required to have health insurance through an employer, or through a public program such as Medicare or Medicaid, or by purchasing through an insurance exchange (Bihari, 2013). Under the ACA, health plans are barred from denying coverage of pre-existing medical conditions, dropping coverage of people who become sick, and charging higher premiums because of health conditions (Bihari, 2013).
Moreover, the ACA requires large employers to provide health insurance for their employees or be subject to penalties. Small employers who provide health insurance coverage are given tax credits. Unless an individual qualifies for an exemption, they are required to obtain health insurance or pay a penalty (Bihari, 2013).
Managed care organizations and HMOs are largely affected by the ACA’s new requirements that are placed on health insurers that offer coverage in the individual and group markets. Additionally, employer sponsored group health plans are subject to the ACA provisions (Kongstvedt, 2013). The most major coverage provisions of the ACA are designed to take effect beginning in 2014. Provisions include the expansion of Medicaid; the providing of subsidies for private coverage; the establishment of state health insurance exchanges for individuals; and creation of new insurance cooperative arrangements and small business to purchase coverage; and rules eliminating restrictions on...