AFFORDABLE CARE ACT

Healthcare in the United States

WHAT IS HEALTH CARE REFORM

Health care Reform was established when the Affordable Care Act was signed into law in 2010. Insurers have to provide coverage for preventive care, including immunization, wellness checkups for women, babies and children. There are several changes that will take place in January 2014. The most important change is the individual mandate which requires everyone to have health insurance. ACA allows the expansion of the healthcare system in the United States in order to make coverage available for more Americans. A misconception that people have about the ACA is that it creates a government-ran healthcare system. Which is false. The ACA was established from public and private insurance companies to get for more people.

AFFORDABLE CARE ACT REGULATION PROCESS

Government shut down Presidential & congressional politics and pressure heavily influenced the ACA regulatory process. Interim final rule making (expedite process which rules are created without normal notice & comment period). The secretary of health and human services (HHS) is chiefly responsible for developing the ACAs body of regulation. The process used to analyze the ACA regulations, and detail major deficiencies in that process, compared with other regulatory initiatives. Congress may impose tight deadlines to ensure that a law and its enacting regulations are in place before an election or before new members take office.

ACA FLAWS
The early and relatively minor provisions of the affordable care act that members of congress believed would be a popular tool effect more quickly, but shorter deadlines undermined the quality of the process. ACA provisions suffered from the inadequate consideration of regulatory alternatives. Thus these analysis failed to properly inform the regulatory decision making process. The ACA regulatory process fell below the normal standards of HHS and other agencies in writing regulations. ACA rules were produced under abbreviated procedures to comply with tight legislative deadlines and to satisfy presidential priorities.

 Under the ACA, after 2015 most employers will be required to provide coverage or pay a fine that they dont (small business with fewer than 50 employees wont have to pay a fine). This may make employers sponsor health coverage more widely available. In general, you will be able to keep your employer-based coverage as long as your employer chooses to keep offering it. Just like before health care reform, most Americans will get their health care coverage through an employer after 2014. However decides to stop offering coverage, there are many other options not based on your job, such as the health insurance marketplaces.

ACA FLAWS CONT.

In developing the proposed regulations agency products exhibited health coverage, which can have a substantial effect according to the authors. The regulators assumption that early retires may have difficult time obtaining insurance due to age and medical condition implies an equity problem. An equity problem is suggested by the assumption that insured people had been paying what the regulators call a hidden tax to cove the uninsured, although the analysis does not clearly indicate how making this tax explicit solves the equity problem.

Ex. If you odder unnecessary medical equipment such as a wheelchair. A Doctor might order one of these for a person who is in need of one. They will then look to bill Medicare for that wheelchair at a seriously inflated cost

that equates to often 4 or 4 times the amount it would normally coast. The organization would then pocket the profit.
Health Care Identity Fraud: the main sector of health care fraud may be identity theft. According to Louis Saccochio who is the executive director of the NHCAA (national Health Care Anti-Fraud Association), a government

watchdog in which members include law enforcement personnel, regulatory agencies and insurance carriers, he
maintain that after closely investigating the main reasons why fraud abuse in health care exist, findings show that this type of health fraud accounts for around 60 percent of the totals.

ACA CRITERIA
The ACA restricts health plans from imposing a waiting period of more than 90 days before coverage is available to newly hired and newly eligible employees. This period encompasses time before coverage is actually effective. Plans may continue to impose other eligibility conditions as long as they are not designed to avoid compliance with 90-day waiting period requirement.

THE HEALTH CARE LAW AND MEDICARE

The ACA improves Medicare practices and solvency and continues to enhance current Medicare coverage. It lowers out of pocket cost for Medicare Part D recipients The coverage gap or doughnut hole as some call it, will gradually be reduced. Recipients will get discounts on brand name as well as generic brand scripts. The donut hole is set to disappear by the year 2020 until then discounts will continue cost sharing will remain for Part D. Percentage discounts for brand names currently are at 52.5% but by 2019 it will be at 70%. Percentage discounts for generic drugs currently is at 21% by 2019 it will be at 63%. For more information you can call 1800 -633 -4227.

MEDICARE ADVANTAGE and MEDICAID EXPANSION

Medicare Advantage is an alternative to original Medicare and is offered by private insurance companies. The law rewards Medicare Advantage plans that provide high quality care. Plans must now limit how much they spend each year on administrative costs. Each dollar paid in premiums. Medicare Advantage plans must spend at least 85 cents on care. If the plan is changed or dropped, you can switch to a different Medicare Advantage plan or to Original Medicare Open enrollment is Oct 15 Dec. 7. The ACA encourages states to expand Medicaid. Democrats from the state of Michigan Senate have been calling for an expansion of Medicaid as part of the ACA since 2012. In Michigan the expansion will extend health care coverage to residents who are 133% under poverty level. In the first year of expansion 320,000 Michiganders would be covered. By 2021 470,000 would be covered. The expansion has the support of democratic senators of the Michigan State Senate. They include: Sen. Jim Ananich, Sen. Steve Bieda and Sen. Bert Johnson. The expansion is set to began March/ April 2014 The income limits include : $15,000-individual, $21,000

THE HEALTH INSURANCE MARKET PLACE AND ENROLLMENT

Market places opened up in Michigan on Oct. 1, 2013 Applications will be accepted through December 15, 2013 Coverage begins January 1st The market place will continue to accept applications January 1st March 31st coverage begins 15-45 days following enrollment Offers online access, assistance by phone and face to face assistance from a navigator. Downloadable applications are available

FRAUD AND SCAMS

ACA provides resources to fight fraud more tools to catch those who frequently bill Medicare members should be cautious of fraudulent attempts from criminals to obtain information through clever sales pitches. Ex. Scammers claiming they are with the government going door to door trying to sell fake insurance Telemarketers seeking personal information so they could send a new Medicare card or national health care insurance card required by law. Imposters telling consumers they need to turn over personal or financial information or they would lose benefits or go to jail. All are not true, these scams are designed to trick individuals into losing money or steal identity. All are not true, these scams are designed to trick individuals into losing money or steal identity.

FRAUD AND SCAMS CONT.

Criminals who fraud the government commit health care fraud. on the contrary, hospitals, doctors and even pharmaceutical companies will also try to cheat the system. there are many examples of hospitals that are billing for services of doctors who are not even alive! The types of people who commit these crimes are varied, form the highest levels of hospitals administrators to one man doctors offices. These people can be very clever I the way that they operate. In fact to avoid arousing any kind of suspicion, they may set up complicated billing structures and try to cover their tracks. This can make it very difficult for health care fraud investigators to pursue a line of inquiry. False billing: False billing is one of t he most egregious area of health care fraud. Hospitals and physicians may bill Medicare for treatment, drugs or equipment that was never prescribed in the first place.

HEALTH CARE BILL PROVISION

Since the House of Representatives voted to pass health reform legislation, the legislative process and its political impact have been the focus of all the newspaper and cable TV pundits However, many Americans are trying to cut through the chatter and get to the substance of reform with a simple question: What does health insurance reform actually mean for us? To help, weve put together a list of some key benefits every American should know.

HEALTH CARE BILL PROVISION

In the next fiscal year, the bill will increase funding for community health centers, so they can treat nearly double the number of patients over the next five years. This year, an independent commission will be established to advise how best to build the health care workforce and increase the number of nurses, doctors and other professionals to meet our countrys needs. Going forward, $1.5 billion in funding and support will be provided to the next generation of doctors, nurses and other primary care practitioners on top of a $500 million investment from the American recovery and Reinvestment Act.

HOW HEALTH INSURANCE REFORM WILL EXPAND AND STRENGTHEN COVERAGE

This year, children with pre-existing conditions can no longer be denied health insurance coverage. Once the health insurance exchanges begin in the coming years, pre-existing condition discrimination will become a thing of the past for everyone. Health care plans will allow young people to remain on their parents insurance policy up until their 26th birthday. Insurance companies will be banned from dropping people from coverage when they get sick, and they will be banned from implementing lifetime caps on coverage. Restrictive annual limits on coverage will be banned for certain plans. Under health insurance reform, Americans will be ensured access to the care they need. Adults who are uninsured because of pre-existing conditions will have access to affordable insurance through a temporary subsidized high-risk pool.

CONCLUSION
Health coverage for every individual in the United States has been long over due. Millions of people have been suffering from various diseases and illnesses for too long. Some have even died because they could not get the care that they needed due to lack of health insurance. Others such as ; senior citizens go with out medication due to the high cost of their prescriptions. The Affordable Care Act will alleviate these burdens by providing affordable insurance to all individuals regardless of race, gender etc. and any pre-existing illnesses and any other ailments.