File Name: patient protection and affordable care act .zip
- Affordable Care: Harnessing the Power of Nurses
- The Patient Protection and Affordable Care Act
- Affordable Care Act Tax Provisions
- What Does the Affordable Care Act Say about Hospital Bills?
Original Medicare produced an increased index of suspicion regarding health costs in As services expanded, costs escalated. Policy makers moved to control upward spending trends in an attempt to leverage resources across the population.
Affordable Care: Harnessing the Power of Nurses
PLoS Med 16 2 : e This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The law is persistently contentious as a matter of public opinion, but represents a historic achievement in United States healthcare reform. While it was incremental in many respects—health insurance plans for the vast majority of Americans were relatively unchanged—the ACA left an indelible mark on the healthcare system through its expansion of insurance coverage and efforts to improve the healthcare delivery system.
In the past decade, the country has witnessed a substantial decline in the number of uninsured individuals, while other elements of the law have sought to make inroads into affecting the cost and quality of care [ 1 ]. Yet looking forward, the ACA continues to face challenges that make its abiding impact and legacy uncertain. The ACA expanded insurance coverage in two principal ways. First, it created health insurance marketplaces at the state level on the premise of competition and choice; individuals could compare similar coverage options and choose among competing plans.
The ACA reshaped private insurance in other important ways. It established new minimum federal consumer protections; of note, insurers were prohibited from discriminating on the basis of health status—they could not turn people away or charge higher premiums due to pre-existing medical conditions.
Annual and lifetime limits on covered health benefits were abolished. Expansions in health insurance were aided by complementary policies that encouraged people to enroll in coverage. Federal tax credits that reduced the financial burden of monthly premiums—and, in some cases, reduced cost-sharing—made plans on the marketplaces more appealing to low-income consumers.
When it launched in , this type of regulated individual market was new terrain for most insurers. They were responsible for projecting the likely healthcare costs of people who would elect to take up coverage, with limited experience to guide these estimates. The first two were temporary; they expired after three years but gave insurers an opportunity to find their footing and price their products accurately.
Risk adjustment is a permanent program, intended to mitigate against insurers selecting healthier enrollees and avoiding sicker populations.
The law has endured numerous legislative challenges following its passage. The House of Representatives advanced over 50 bills to repeal the ACA in whole or in part, with the Senate voting on a subset of them [ 4 ]. These started out as largely symbolic—a presidential veto was virtually guaranteed while President Obama was in office—but began to pose an existential threat to the ACA under a unified Republican government that held power during the first two years of the Trump administration.
The narrow to vote defeat of the last prominent repeal effort in the summer of illustrated the tenuous grounds upon which the law sat in the previous Congress. However, its survival was also a testament to its legislative durability; the political challenge of withdrawing health benefits shared across different constituencies has thus far been insurmountable, despite lukewarm public opinion on the law. Proponents of the ACA have identified some regulatory actions by the Trump administration as unilateral efforts to undermine the law.
For example, terminating funding for cost-sharing reductions, which are supplemental subsidies available to some low-income enrollees, led to fears about destabilizing the markets and increasing the ranks of the uninsured. Cutting resources allocated to enrollment outreach and education have raised similar concerns. Moreover, the administration has made it easier for states to modify their Medicaid programs in ways that could lower enrollment by requiring nondisabled beneficiaries to work in order to qualify for benefits, for example.
Its proponents have championed these changes as efforts to promote consumer choice and state innovation. A landmark Supreme Court decision scaled back the Medicaid expansion from a nationwide mandate to a state option. To date, 14 states have declined to expand their Medicaid programs although this number has gradually decreased in recent years. Another challenge sought to roll back subsidies on the ACA marketplaces. Still other litigation concerning regulations related to contraceptive coverage is ongoing.
The judge in this case ruled that the zeroed-out mandate is unconstitutional—and, moreover, that the mandate is not severable from the rest of the ACA, meaning that the rest of the law would need to fall with it. The case is now within the appeals process and could end up before the Supreme Court. The prospects for near-term repeal have diminished with Democrats taking control of the House of Representatives, but the ACA has not receded from the public debate.
The administration and new Congress will need to decide whether to leave the law alone or modify it. Additionally, attempts to weaken the law through regulatory channels will be subject to increased scrutiny now that Democrats have more congressional oversight.
Opportunities for bipartisan legislation to stabilize the law appear slim. The leading Republican and Democrat of the Senate Health, Education, Labor, and Pensions Committee coauthored a modest marketplace stabilization bill in that would have provided funding for cost-sharing reductions, increased funding for enrollment outreach and assistance, and made other minor tweaks to the law.
However, Democrats may be reticent to revive that bill, as insurers in many states addressed the cost-sharing reductions issue in a way that made insurance more affordable for subsidized enrollees. The prospects of this bill are dim without support from across the political aisle.
Perhaps more fundamental for the future direction of health policy, public opinion on the role of government in healthcare is evolving. These public opinion trends suggest that a growing share of Americans may be receptive to proposals that move the ACA in a more progressive direction. Provenance: Commissioned, not externally peer reviewed. Challenges to the ACA The law has endured numerous legislative challenges following its passage. Looking forward: and beyond The prospects for near-term repeal have diminished with Democrats taking control of the House of Representatives, but the ACA has not receded from the public debate.
References 1. Blumenthal D. N Engl J Med. Martinez M. Uberoi N. O'Keefe E. The House has voted 54 times in four years on Obamacare. The Washington Post. View Article Google Scholar 5.
The Patient Protection and Affordable Care Act
Affordable Care Act Tax Provisions
PLoS Med 16 2 : e This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
The 0. For more information see Tax Topic No. More specifically, the EHCCA provides that the requirements of the ACA do not apply to expatriate health plans, expatriate health insurance issuers for coverage under expatriate health plans, and employers in their capacity as plan sponsors of expatriate health plans, except that:.
What Does the Affordable Care Act Say about Hospital Bills?
Data are derived from the National Health Interview Survey and, for years prior to , supplementary information from other survey sources and administrative records. The methods used to construct a comparable series spanning the entire period build on those in Cohen et al 8 and Cohen 9 and are described in detail in Council of Economic Advisers For prior years, data are generally but not always biannual. Data are derived from the Gallup-Healthways Well-Being Index as reported by Witters 23 and reflect uninsured rates for individuals 18 years or older. Dashed lines reflect the result of an ordinary least squares regression relating the change in the uninsured rate from to to the level of the uninsured rate in , run separately for each group of states.
Он спокойно подошел к двери, выглянул на площадку лестницы и всмотрелся в темноту. Хейла нигде не было. Тогда он вернулся в кабинет и прикрыл за собой дверь, затем заблокировал ее стулом, подошел к столу и достал что-то из выдвижного ящика. В тусклом свете мониторов Сьюзан увидела, что это, и побледнела. Он достал пистолет. Он выдвинул два стула на середину комнаты.
Да, Клаус женат. Но он очень толстый. Жена отказывает ему… ну, вы понимаете. - Беккер не мог поверить, что это говорит он. Если бы Сьюзан слышала меня сейчас, - подумал. - Я тоже толстый и одинокий.
The law has 2 parts: the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act. You can view them in PDF or HTML.
Сквош, - чуть не застонал Беккер. Сьюзан сделала вид, что не поняла. - Это похоже на цуккини, - пояснил он, - только корт поменьше. Она ткнула его локтем в бок. Левый крайний Джорджтауна, подавая угловой, отправил мяч в аут, и трибуны негодующе загудели.