Patient Protection and Affordable Care Act (PPACA)

For this assignment, you will select a topic (see list below for possible topics) and identify an existing federal health policy problem in that area. Then develop a paper that addresses the following:

• Analyze the role of research information in reshaping that policy
• Propose changes/improvements in the existing public law dealing with that policy, or propose a new policy.

A good starting point is to analyze a current issue pertinent to Patient Protection and Affordable Care Act (PPACA). Possible topics include the following:

• Long-term care
• Healthcare costs
• Access to care
• Quality of care
• Obesity epidemics / pandemics
• Health insurance

Your well-written paper should be twelve pages in length and conform to CSU-Global Guide to Writing and APA Requirements. Include five to eight current scholarly references (not more than five years old) in addition to the course textbook. Remember that you must support your thinking/opinions and prior knowledge with references; all facts must be supported; in-text references used throughout the assignment must be included in an APA-formatted reference list. You should also consider additional reference articles from the popular press such as the Wall Street Journal and Washington Post. The CSU-Global Library is a good place to find these references. Before developing your paper, review the grading rubric.

Introduction

On March 23, 2010, the U.S. President Barack Obama signed the first US comprehensive health care reform bill, the PPACA (Patient Protection and Affordable Care Act) into law after repeated attempts and failures by the previous Presidents of the United States of America. In 2008, an estimated 46.3 million US individuals were uninsured and a further 25 million were underinsured (Connors and Gostin, 2010). The PPACA was proposed to expand health insurance coverage to more individuals through a variety of schemes and measures. According to the act, state-level health insurance exchanges were to be created under the PPACA and they were to play a major role in sale and purchase of health insurance when the act became operational. Patient Protection and Affordable Care Act (PPACA). The purpose of this report is to focus on the health insurance coverage issues pertinent to the Patient Protection and Affordable Care Act (PPACA). And further examines how the issues can be addressed effectively by the PPACA.

Features Of The PPACA

To make insurance affordable to people of all statures, PPACA offers sliding-scale subsidies and limits out of the pocket spending. And to increase the number of increased individuals, the premium rates were lowered and it was proposed that individuals without insurance coverage will pay a penalty of 695 USD or 2.5% of household income. One of the important features of the PPACA was to expand Medicaid to individuals with comes of up to 133% of the Federal poverty level and thus covering low income adults without children who were previously not eligible for coverage by Medicaid. This offers standardized benefits of Medicaid and a minimum package of essential services (Connors and Gostin, 2010).

Another important feature was the plan to establish state-level health insurance exchanges. American Health Benefit Exchanges and Small Business Health Operations Program (SHOP) Exchanges were to be formed in all states and would act as market places for consumers to shop for and purchase health insurance at affordable rates. These exchanges would provide the consumer with the necessary details, and private health insurance choices. Low-income US citizens who are not eligible for coverage under Medicaid were offered private health insurance benefits through these exchanges by providing with subsidies and credits for premiums. For small businesses with fewer than hundred employees, tax credits were provided for offering insurance.

The PPACA prohibits the insurers from limiting or denying insurance coverage to children under nineteen with pre-existing medical conditions and allows young adults under the age of twenty six to remain covered under their parents’ health plan. It ends insurers’ ability to withdraw coverage due to an honest mistake made on part of the insured, restricts annual limits and eliminates life time amount that insurance will pay for certain conditions. The PPACA offers a rebate of 250 USD to Medicare part D enrolees efficiently closing the coverage gap in Medicare part D.

Issues Pertinent To The PPACA

The state-level health insurance exchanges play the central role in the private health insurance reform of the Patient Protection and Affordable Care Act (PPACA). The functioning of these exchanges as planned is mandatory for expanding health insurance coverage in the US, improve the quality of coverage and health care in the nation and reduce the cost of health care. But there are some issues that the Federal and state governments face in implementing these health insurance exchanges. Patient Protection and Affordable Care Act (PPACA). The Commonwealth Fund, in its report has mentioned eight issues in implementing these exchanges that include: the proper governance of the exchanges, adverse selection (against and within the exchanges), ways to make self-funded insurance plans compatible with the exchanges, ways to make the exchanges attractive to employers, exercising of regulatory authority by exchanges, type of information made available to consumers and employers by these exchanges, ways to determine eligibility, ways to reduce the administrative costs, costs of their uses and attract funding (Jost, 2010).

Governance Of The Exchanges

The exchanges in each state could be outsourced to a private agency under the PPACA for some of its functions such as managing the website, processing enrolments and premium payments while certification activities are inherent government functions. Any publicly run exchange is subject to the state administrative and operational laws but it is important that the health insurance exchanges be flexible and agile to react quickly to market change concerned with insurance. So the state administrative and operational laws can be made flexible with respect to these exchanges. But again it is important that public law pertaining to ensure transparency, public participation and to avoid corruption must apply so that the management is apolitical and professional. Exchanges can also outsource mechanical, non-discretionary functions such as premium billing, premium collections, data processing and customer services to private agencies.

Avoiding Adverse Selection

It is important to avoid adverse selection both against and within the exchanges. It is one of the greatest issues the exchanges face. State regulation of an individual as well as small-business market outside of these exchanges should also be identical to the corresponding regulation inside the exchanges to an extent. It is necessary to retain a range of coverage choice within the exchange that would appeal to variety of population. Patient Protection and Affordable Care Act (PPACA). By this way, it is possible to eliminate the coverage market outside of the state-level exchanges. An efficient risk adjustment system to eliminate adverse selection within and against the exchange among participating insurers and non-participating insurers must be designed by the HHS (Baker, 2011).

Ways To Make The Exchanges Work For Employers

In addition to focussing on serving the needs of individual customers, it is also important that these exchanges take care of the relationship between the insurers, the employers and the employees. It is mandatory for the exchanges to make available qualified health plans for the employers qualified for coverage. In a provision called the SHOP (Small Business Health Option Program) exchange, it is required small employers be assisted in enrolling their employees for health plans offered in the small business market. And to overcome adverse selection issues, the exchanges in the state have to have a maximum number of enrolees which is possible only if they enrol both individual customers as well as employees of small business employers. This is possible only when the packages are made attractive to the employers and actively marketed. Patient Protection and Affordable Care Act (PPACA).

Possible recommendations include offer of aggregated bill to small business employers when they enrol their employees. The aggregated bill must cover the premiums of all the employees of the firm. Or allow the employers to pay a percentage of the premium required with the employee paying the rest. Lower-income employees can be offered greater support by their….