Running head: THE AFFORDABLE CARE ACT

The Affordable Care Act

Samira Ali
FQ7753
Professor Dr. Keys
SW 4710
October 13, 2015

Running head: THE AFFORDABLE CARE ACT

Current Policy
The Affordable Care Act was signed by President Obama in 2010. This act is to
help Medicare and Medicaid recipients have better healthcare benefits. It reduces private
payments to providers as well as private insurance plans. Medicare seems to be sound
and stronger than ever before. Fraud, waste and abuse of its services is coming to an end.
The Obama administration has recovered over $4 billion in Medicare fraud. The tools
they are using are going to allow more crack downs according to the National Committee
to preserve social security and Medicare.
History of Policy
Healthcare reform in the United States has been a matter of substantial debate in
presidential elections since the early 1900s (Adkinson, 2014). In1965 Medicare
provided coverage to all people the age of sixty-five and older regardless of their income
and health. It covered the cost of hospital and doctor visits. Within the first week of
Medicare one million people had enrolled. Prior to Medicare, half of all seniors lacked
affordable coverage. Today, many seniors have health coverage. Medicaid provides help
for low-income seniors and is the single largest payer for long-term care services in the
nation (Schakowsky,2012). In 1970 approximately 96% of the elderly had hospital
insurance. Healthcare was expensive due to the inflation of the economy.
However , in 1972 Medicare coverage did expand. It now included younger adults that
have disabilities as well as kidney disease. It also offered coverage through a HMO
which is a Health Maintenance Organization. A person chooses a plan with a primary

Running head: THE AFFORDABLE CARE ACT

care physician from a certain network of healthcare and in turn their provider refers then
to specialists if need. All of their care is coordinated through their primary care
physicians. In 1988 President Regan claimed he would free the elderly from their fear of
catastrophic illness by having the (MCAA) Medicare Catastrophic Coverage Act. The act
did pass but was repealed shortly after. Many elderly thought the plan was costly and did
not have much benefit . Fear was amongst many in 1995 due to congress stating that
Medicare will not have enough funds to pay all hospital bills in 2001.
The Medicare shifts to payment according to diagnosis instead of treatment. Hospice
services were added to Medicare. Hospice aides and assists with personal care, which
includes bathing, dressing, homemaker services inpatient center or at a senior facility.
Policymakers should view with a degree of skepticism most hospital and insurance
industry claims of inevitable, large-scale cost shifting. Although some cost shifting may
result from changes in public payment policy, it is just one of many possible effects.
Moreover, changes in the balance of market power between hospitals and health care
plans also significantly affect private prices. (Frakt, 2011)
In 2003, drug benefits includes the Catastrophic Coverage Act and the infamous
doughnut hole was introduced and placed caps on the out of pocket limit and drug
coverage. Once a senior citizen drug cost exceeds the cost of $2250.00 they fall in to the
doughnut hole. The Medicare Modernization Act also expands the role of private health
plans in Medicare. The Affordable Care Act is the policy that is in place currently
throughout the United States. It was signed in 2010 by President Obama.

Running head: THE AFFORDABLE CARE ACT

Policy Problems and Goals

The (ACA) offers free preventive Services such as varies screenings, vaccinations,
mammograms, and colorectal screenings. The new health benefits are assisting seniors
because they are not having to pay co-pays for these preventive services. Moreover, free
wellness exams which are conducted ever year with their doctor to discuss their very own
personal prevention plan in order to better their health. The American Society of
Consultant Pharmacies claims that seniors between the ages of 65-69 take anywhere from
six to fourteen prescriptions yearly. When a person must take various medications they
can be confused which can allow adverse drug reactions. Over nine million seniors as
well as people who have disabilities are covered by both Medicare and Medicaid. (ACA)
eliminates Part D Prescription Drug cost-sharing for seniors. Many seniors have multiple
chronic conditions new help is available called health homes. It designed to help them
stay in their homes and still receive long-term care. Lower health care costs are exactly
what senior citizens are looking for. They are searching for lower prescription drug costs.
According to (ACA) A senior with a standard benefit would have been responsible for a
$310 deductible, 25% of the next $2520 in drug costs, 100% of the next $3570 in drug
costs, and then 5% of any additional costs. In 2010, about 4 million seniors and people
with disabilities had large enough drug costs to fall into the donut hole (Schakowsky,
2012).
Seniors that have Medicaid live on incomes less than $22,000. Seniors who live
on a fixed income are paying more than the amount a non-senior pays for the same
medical care. So the important question to ask is, are Medicaid and Medicare better than

Running head: THE AFFORDABLE CARE ACT

a private insurance company? The last decade Medicare spending grew at a rate of
5.1% and Medicaids grew at a 4.6% rate, while private insurance per capita spending
grew at a rate of 7.7%. Over the next decade, Medicare per capita spending is projected
to increase by 3.1% and Medicaid by 3.6%, compared to 5% for private
insurance(Schakowsky, 2012).

Seniors struggle to pay for healthcare, and medication. Because they need the essential
resources in order to survive. An issue that is occurring is high copays from their current
insurances or lack of.
Policy Problems

Often times the elderly have high copays; since they are no longer employed they
may not have enough funds for rent, utility bills, groceries, and transportation. Medicare
Part D has been widely criticized for the gap in coveragethe so-called doughnut
holeaffecting a large fraction of enrollees. Under the governments 2012 standard
benefit design, beneficiaries not receiving subsidies face a deductible, followed by a 25%
co-insurance rate. If the cost of prescription drugs exceeds $2,930 in a year the patient
will then have to pay full cost of all their medications. Among the many who are
chronically ill it seems that they are facing the most out -of pocket costs (Joyce,2013).
Seniors have many issues therefore when they have high premiums is something they
dont want to worry about. Quality of live and living comfortably is what needs to take
place at this time in their lives. Constant stress and lack of funds for medical and

Running head: THE AFFORDABLE CARE ACT

pharmasuedical coverage can only harm them and keep them on edge which can cause
them to become sicker.

Today in the U.S nearly 1 in 6 Americans that are between the ages of 45 and 64 which
makes up (16.3%) are uninsured; 20 often because theyvealready exceeded lifetime caps
on benefits, have pre-existing aliments, or they face higher premiums because of age.
Obama care takes steps to provide the near-elderly improve their health and lowering
Medicare costs( Shakshuki, 2015).

Policy Analysis
On March 23, 2010, President Barack Obama signed into law the Patient Protection and
Affordable Care Act (more commonly known as the Affordable Care Act, or ACA)
Although the assurance of healthcare coverage for every American is the prime directive,
numerous provisions within the bill aim to control costs and improve healthcare quality
in the United States(Adkinson,2014).
This healthcare reform is helping many seniors with better coverage. Allowing
seniors be involved in the Medicare program. The Medicare program consist of two
options which consist if Parts A,B and D as well as Medicare Advantage or Part C, in
which beneficiaries have the choice to enroll themselves in a private plan to obtain their
Medicare benefits.. There is a threat which has come about by the new leadership of the
House of Representatives is to repeal the Affordable Care Act. The cuts would include
increased out-of-pocket costs. It would raise the age of eligibility to sixty-nine. This

Running head: THE AFFORDABLE CARE ACT

plan would be devastating both to current beneficiaries and to todays working families
who are counting on the Medicare program they pay into to protect them from
unaffordable health care costs when they retire (Kennelly, 2015)
It is unfortunate if the House agrees with Paul Ryans roadmap. His roadmap leads us
backwards to a period when our most vulnerable were forced to choose between health
care costs and other necessities like food and shelter. Many seniors reject this vision, and
they hope Congress does too.
Under the Ryan Republican proposal, private insurance companies could limit choice of
doctors and manipulate benefits, meaning they would be able to cherry pick the youngest and
healthiest people. That would leave traditional Medicare with a smaller, older and sicker pool
and raise Medicare Part B premiums not just for seniors who enroll in Medicare for the first
time after 2023 but for seniors who are currently in Medicare( Schakowsky, 2012 p.13).

The threat to Medicare is present while the Republicans have a say in the vote for
healthcare. The question is will they be able to have an impact vote of Congress and the
American citizens who need the best possible coverage out there.
"Democrats attempted to allay seniors concerns by emphasizing that the bill was no
threat to Medicare, frequently pointing out that it would close the donut hole in
prescription drug benefits and that changes in Medicare financing would increase the
programs sustainability(Bradley, 2014 p.265 )
Preventative services are important when dealing with senior citizens. Often times you
hear of elder abuse, neglect, and even exploitation. Obama care is working on ways to
prevent abuse and how it can be prevented, work with healthcare providers, social

Running head: THE AFFORDABLE CARE ACT

workers, and law enforcement. The grants that have been created are guided to help with
long-term care facilities in order to train the staff, provide protective services, and even
aid with long-term care. Required Dementia and Abuse Prevention Training 1 in 8
older Americans 5.4 million people are living with Alzheimers, a number expected
to triple by 2050. Obama care requires dementia and abuse prevention training in skilled
nursing facilities and nursing homes before they are hired(Schakowsky,2012).
Nursing homes are becoming a huge concern among the elderly and their families.
Fragile seniors being cared for by providers who are not always capable. The (ACA) is
requiring that staff have background checks to insure the safety and well being of their
clients. Nursing homes are required to provide disclosure of their ownership making them
responsible for any wrong doing. The long term option seem to be a better idea with
cutting costs. The cost of nursing home care is averaging approximately $80,000 a year.
Nearly all states have an abundant supply of nursing facilities. However, many states
have a shortage of home and community-based alternatives, such as assisted living and
small group homes, or do not provide public financing for care in those settings.
Sometimes placement in a nursing home, although not the individuals preference, may
be the only way to obtain needed assistance(Reinhard,2011, p.5)
If seniors stay in their own homes it is less expensive and is much more preferred.
Families of the elderly want only the best services provided to their loved ones therefore,
if they stay in their homes and allow professionals to assist them in their daily activates it
is advantage for them. One can only qualify for health home beneficiaries if they suffer
from at least two chronic conditions; one condition or becoming at risk of developing

Running head: THE AFFORDABLE CARE ACT

another; also if one may have a mental health condition.

If you have Medicare you may also become eligible for Medicaid. A persons
eligibility depends on their income. Medicare does not cover long term care. The wrap
around coverage ultimately relies on services that are provided by the state Medicaid
program. It seems that many are poorer in health. Many require higher levels of
healthcare that others. The diversity in the dual eligible population is important to the
development of effective strategies to finance their care and control costs. Importantly,
the factors that make dual eligible more expensive than other Medicare beneficiaries are
not the same factors that make them expensive relative to other Medicaid beneficiaries(
Coughlin, 2009, p 9). I work at a pharmacy and most of our patients are on Medicare. I
would say many have the dual coverage primary because of disabilities. They are so
thankful for the coverage they have. Often times people do not realize the difficulties that
many seniors are going through as they get older. I see it everyday and I feel that more
needs to be done. Policymakers are exploring strategies to better coordinate and
integrate care for dual eligible and align financing for this population. Medicare and
Medicaid are two different, very large public health insurance programs that operate
separately and sometimes work at cross purposes(Coughlin, 2009, p.1).
The Policy has hope in my opinion. Many seniors need guidance when deciding
what plan is best for them. I hope they can all benefit from the (ACA) and thrive with
better health and happiness at this point in their lives.

Running head: THE AFFORDABLE CARE ACT

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My Interview
I interviewed Mr. Arric who is a former teacher at the High School I attended. He
is currently sixty-five years of age and recently was eligible for Medicare through the
Affordable Care Act. He had insurance through the American Federation of Teachers and
did have high deductibles which were difficult for him to pay. Arric states that since he
has become a Medicare beneficiary he has more money for other necessities. It is a
struggle because I am retired English teacher and I did not have a lot of money saved
because a teachers income is not much. (Arric, personal communication, October
5,2015) I asked him if he experienced himself in the doughnut hole. He did say yes. He
claimed after Medicare paid almost three thousand dollars for his prescription drugs, he
then in turn had to pay outrageous out of-pocket co-pays (Arric, personal
communication, October 5,2015). Mr. Arric said, I recently read an article that claimed
the doughnut hole would be closed possibly in 2020. Arric continued to say he thinks he
will have to file for bankruptcy before then due to costly medication he has to take daily
(Arric, personal communication, October 5,2015). He went over his costs of prescriptions
drugs with me and I was almost in tears. It is sad to think that a person has to make a
choice between eating or paying for medicine in order to survive. He hopes that all these
issues with the (ACA) get ironed out sooner than later. In closing he hopes more people
get involved and help the aging population of the United States of America.

Running head: THE AFFORDABLE CARE ACT

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References

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Bradley, K. W., & Chen, J. (2014). Participation without Representation? Senior
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