Based on your readings this week; if you were given the opportunity, what changes would you make to the ACA, and why?
Few policies have had dramatic effects on the US healthcare landscape compared to the ACA. Enacted in 2010 and signed into law by President Barack Obama, the ACA served as a milestone in the quest for universal healthcare. By making health coverage more affordable and expanding access to care services, the ACA significantly reduced the number of uninsured (Berkman, Aries, & Caress, 2014). The ACA success was business like in strategy that expanded eligibility to federal Medicaid and created new markets where individuals without formal employment could access health insurance policies directly from providers. However, despite the successes of the ACA, the policy generated controversy and dissent in equal measure. Supporters and critics of the ACA agree that the policy could benefit from some crucial changes.
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The most debate on ACA centralizes on defining eligibility, which according to Sommers and Rosenbaum (2011) is subject to income and liable to changes under fluctuating market conditions that alter income and family composition. While the ACA does not have a limit period of enrolment, the changes in the economy and market conditions are likely to influence subsidy levels due to changes in income. The proposed change, under the circumstances, targets to reduce the frequency of disruptions to care access due to transitions between health coverage plans. There is need for a minimum guarantee eligibility period and certification of some health insurance plans with the duality to serve individuals enrolled in ether Medicaid and exchange programs. Such a change to the ACA would ensure individuals are cushioned from the transitions from Medicaid and exchange programs and vice versa due to fluctuations in income.
The process is not limited to minimizing transitions from Medicaid to exchange, but extends to reduction of individual and employers mandates. There is need to relax regulations to account for the dynamics of a free market economy while ensuring focus of the originally intended goal of increasing healthcare insurance coverage remains on course. The change would also require relaxation of regulations on insurers, rolling back of funding, and abolishment of ACA’s taxes and charges. However, implementation of the changes that seeks to increase individual mandate, such as elimination of non-compliance penalties, needs to be done with care because it increase defaulting among payers whose only motivation was avoidance of the penalties.
Describe a National Health Insurance that is in place today other than the ACA. What are the similarities and differences between the two?
Health insurance refers to any programs design to assist patients pay for their medical expenses through privately purchased or government funded insurance or social welfare programs. One national health insurance in place at the moment in the US is the Federal Employees Health Benefits Program. Under the program, individuals and their families can access medical cover from among the variety of options including:
Fee for service plans (FFS) or preferred provider organizations (PPOs), or health maintenance organizations (HMO) depending on availability of the plan in one’s area of residence.
Consumer driven and high deductible plans are also available to cater for risk protection against catastrophes through high deductibles, savings, and lower premiums (US Office of Personnel Management, n.d.).
The Federal Employees Health Benefits Program is designed specifically for government employees and operates using a system of managed competition in the provision of health benefits.
The Federal Employees Health Benefits Program and the ACA are integrated in their dealing in the health insurance market place. While the ACA stipulates that employers must notify employees of the available insurance plans in the marketplace, the law does not affect holders of FEHB program. On the other hand, an individual who has FEHB cover satisfies the requirements for enrolment in ACA. However, FEHB and ACA have different police governing eligibility to specific programs, failure to enroll due to financial constraints, of having enrolled for FEHB but experiencing affordability problems. The FEHB and ACA also vary in individual responsibility when it comes to contributions. While an individual is required to meet a certain threshold in contributions under the ACA, the government is the main contributor under FEHB, meeting up to 75% of the premium calculated based on individual and family coverage.
References
Berkman, E., Aries, N., & Caress, B. (2014). The Affordable Care Act: The Current Driver of Healthcare Reform. Policy and Politics for Nurses and Other Health Professionals , 65.
Sommers, B. D., & Rosenbaum, S. (2011). Issues in health reform: how changes in eligibility may move millions back and forth between Medicaid and insurance exchanges. Health affairs , 30 (2), 228-236.
US Office of Personnel Management. (n.d). The Federal Employees Health Benefits (FEHB) Program. Retrieved from https://www.opm.gov/healthcare-insurance/healthcare/
