Affordable Care Act
NUR/571

Affordable Care Act: Description The Affordable Care Act (ACA) was enacted March 2010. The Act is to provide better health security for Americans by putting comprehensive health insurance reforms in place that will
•Expand coverage
•Hold Insurance companies accountable
•Lower health care costs
•Guarantee more choice
•Enhance the quality of care for all Americans (medicaid.gov)
“The Affordable Care Act expands Medicaid coverage and makes numerous improvements to both the Children's Health Insurance Program (CHIP) and Medicaid ” (medicaid.gov). The actual document is a 974 page compilation of the major provisions put together by the office of the legislature. The major provisions as related to Medicaid and CHIP focus on the following: 1. Eligibility requirements – will fill gaps in current coverage for lower income Americans by minimizing eligibility levels for Medicaid across all states (medicaid.gov). 2. Financing - Starting January 2014 adults newly eligible for Medicaid will be fully funded by the government for a period of three years, then gradually reducing funding to 90% by 2020 (Medicaid gov). 3. Information systems and data management – Government financing will be provided for investment in data technology systems needed to get Medicaid systems up and running in time for the projected start date of January 2014 and for expanding Medicaid eligibility (medicaid.gov). 4. Coordination with affordable insurance exchanges – This will assure all applicants applying for coverage will be able to use a single application to have their eligibility determined (medicaid.gov). 5. Benefits - Newly eligible Medicaid recipients will receive a package that includes benefits the Affordable Insurance Exchanges provides for (medicaid.gov). 6. Community-based long-term services and supports - Includes a number of funding improvements and programs providing coverage for long-term care or health services in their home or community (medicaid.gov). 7. Quality of care - Improvements will reduce costs while maintaining quality of care and the manner of care delivery (medicaid.gov). 8. Prevention, wellness, and public health - Promotes prevention, wellness, and public health, and supports health promotion efforts at all government levels (medicaid.gov). 9. Children’s insurance programs (CHIP) – Provides funding for CHIP through 2015 and establishes continued authority through 2019 (medicaid.gov). 10. Dual eligible - Coordinates Medicaid and Medicare programs for individuals who are eligible for both (medicaid.gov). 11. Provider payments - 100% federal matching funds will be provided to States to cover increased payments (medicaid.gov). 12. Program transparency - Promotes transparency about Medicaid policies and programs by urging public involvement in developing Medicaid waivers (medicaid.gov). 13. Program integrity - Medicaid programs will exhibit integrity by terminating providers that have been terminated in other programs, suspending Medicaid payments while fraud investigations are pending, and reducing or preventing inappropriate payments under Medicaid. (medicaid.gov)
Implications for Consumers Consumers can find themselves facing many changes in their choices concerning health care despite promises made by the President. The questions most asked according to a Fox News report were 1. Can I keep my own doctor? 2. Can I keep my current insurance? 3. Will the Affordable Care Act affect my job? 4. Will I really be able to afford insurance under the ACA?
To answer these questions in the affirmative is possible only if one includes the “unless” provisions. One may keep ones’ own doctor unless that doctor is one who chooses to shutter his doors or shed patients. One can keep one’s current insurance unless one works for a small company who lays off to stay in business. One’s job will not be affected unless as a direct result of ObamaCare one’s company becomes one of hundreds that have already either eliminated jobs or reduced full-time jobs to part-time jobs, or one works at one of the many hospitals across the country firing staff and reducing work hours. As to affording insurance under the ACA, that remains to be seen. The answer can depend upon income, the size of one’s family, and one’s job. It is simply too soon to expect promises.
Implications for Employers
“Taking into account the ACA’s effect on coverage, premiums, and, if applicable, penalties or tax credits, had the law been in effect in 2012, employer-sponsored coverage would have increased by 2.7% and employer spending by 2.2%. The largest relative coverage increase (6.3%) would have occurred among workers in small firms with 100 or fewer employees (Blumberg, Buettgens, Feder, & Holahan, 2012)”.
“For small businesses with fewer than 50 workers, which are exempt from penalties and may be eligible for premium tax credits, along with other employers with 100 or fewer workers, the law reduces the costs of coverage in aggregate (Blumberg et al, 2012)”.
“Only mid-size businesses (with 101 to 1,000 employees), as a group, would experience an increase in costs per person insured, reflecting penalties on as many as 5% of these employers not currently providing coverage. Expanded enrollment, however, is the primary factor contributing to an increase in overall spending of 9.5% for this group of employers (Blumberg, et al, 2012)”.
Affordable Care Act Funding The Patient Protection and Affordable Care Act (ACA) made large changes to the health care system and arranged for significant funding to help implement those changes. This funding is made available by direct financing of new programs, extending already existing grant programs, and providing new tax credits and rebates to consumers. Its intent is to provide state and local governments, providers, employers, consumers, and others with the money to implement provisions of the law (Kaiser Family Foundation, 2013). “The ACA appropriates an estimated $100 billion over a ten-year period (federal fiscal years 2010-2019) in mandatory funding, and authorizes another $100 billion over the same time period in discretionary funding, which will be subject to the annual appropriations process (Kaiser Family Foundation, 2013)”. The amount of funding provided for any year will depend on requests for increases from those eligible for funding, law and funding amount changes, and Congressional decisions regarding discretionary funding appropriations (Kaiser Family Foundation, 2013).
Potential Changes to Act Applying changes to the Affordable Care Act should start with putting this on the back burner until the country is more financially stable. We, as a country, are already attempting to borrow our way out of debt. The cost of funding this program will only increase the debt, along with affecting jobs adversely for many and putting an increased strain on those already struggling to get by. It is true that health care is in trouble but after all my reading I doubt this will fix it. We would be better served to find a way to deal with the national debt that does not involve printing billions of dollars a day that have no more real value than Monopoly money. Cut salaries to top government employees such as Senators and Congressmen and of course, the President to minimum wage. Make the term public servant mean someone who serves the public out of a real desire to serve, a real job with honor. Radical thinking, I know.

References
Blumberg L.J., Buettgens, M., Feder, J., and Holahan, J. (2012). Implications of the Affordable
Care Act for business , Urban Institute, October 2012. Retrieved from http://www.urban.org http://kaiserfamilyfoundation.files.wordpress.com/2013/01/pdf http://www.medicaid.gov/affordablecareact/affordable-care-act.html