Regulatory_and_Legislative_Issues

Regulatory and Legislative Issues HCS578 May 30, 2011 Lisa Uhlich Regulatory and Legislative Issues The Patient Protection and Affordable Care Act (PPACA) There are several problems with our current health care system. The first problem is money and the high cost of insurance policies. According to the U.S. Department of Health and Human Services (2011), insurance companies often leave patients without coverage when they need it the most, causing them to put off needed care, therefore compromising their health and driving up the cost of care when they get it. Another contributing issue to high cost of health care is the fact that our population is aging, meaning there is an increase in the amount of people with health problems. The second problem is that the current health care system is full of holes. For example, people buying insurance can be turned down for having a pre-existing health condition such as heart disease, cancer or asthma. Small businesses may be charged extra if some of the co-workers are sick, making insurance unaffordable. Some insurance policies have a lifetime limit on benefits, meaning that some of the people that are least likely to have coverage are the ones who need it most. High costs and holes in the health care system have lead to The Patient Protection and Affordable Care Act (PPACA). The Patient Protection and Affordable Care Act (PPACA) is a federal statute that was signed into United States law by President Barack Obama on March 23, 2010. This act is part of the health care reform of 2010. This act will not be implemented all at once. There are two phases: the first phase from 2010 to 2014 and the second phase from 2014 to 2019. This law is suppose to provide better health security by putting in place comprehensive health insurance reforms that hold insurance companies accountable, lower health care costs, guarantee more choice, and enhance the quality of care for all Americans (Antos, Wilensky, & Kuttner, 2008) PPACA Impact on Cost of Health Care According to The Congressional Budget Office (CBO), the health insurance reform will reduce the deficit by over $100 billion in this decade and by more than $1 trillion over the following 10 years (Rosenbaum, 2011). Exactly how will the PPACA do this' The PPACA claims to decrease the cost of health care by allowing health plan members to designate their primary care provider, initiating a national Health Insurance Exchange, and requiring individual and small group insurers to spend at least 80 percent of premium dollars on direct medical care and efforts. The PPACA states that health plan members are free to designate any available participating primary care provider as their provider. According to the U.S. Department of Health and Human Services (2011), people who have a regular primary care provider are more than twice as likely to receive recommended preventative care and are less likely to be hospitalized. This improves people’s access to needed preventative and routine care, which has been shown to improve the health of those treated and avoid unnecessary health care costs. Another factor to decreasing health care cost is the initiation of the national Health Insurance Exchange, which offers individuals a choice of health plans. The exchange makes sure insurance companies compete fairly. The idea is that by giving consumers good information, a fair playing field, and access to several choices, competition among insurers will keep rates competitive. In addition to allowing Americans to choose their primary care provider and pick from the national health insurance exchange, the PPACA also helps to decrease the cost of health care by requiring individual group insurers to spend at least 80 percent of premium dollars on direct medical care and efforts. This will limit spending on overhead, salaries, and bonuses paid to insurance company executives. PPACA Impact on Quality of Health Care In addition to decreasing the cost of health care, the implementation of the PPACA hopes to improve the quality of health care by banning lifetime limits on coverage, stopping insurance companies from dropping coverage, prohibiting discrimination of individuals with pre-existing conditions, and creating incentives for health care providers to change clinical practice to foster better coordination and quality. Prior to implementing the PPACA, individuals suffering from chronic diseases such as cancer were often forced to limit or go without treatment because of an insurer’s lifetime limit on their coverage. With this law, insurance companies are not allowed to put a lifetime limit on the amount of coverage, therefore giving individuals the security of knowing they will have coverage when they need it. Another way the PPACA will improve the quality of health care is by stopping insurance companies from dropping coverage. Currently insurance companies are able to cancel a policy when an individual becomes sick, if there is a mistake in the paperwork. With the new law, this is prohibited. Support or Oppose' Like any political issue and law, there are two sides: There are those that are supportive of a law and those that oppose it. Those in support of the health care reform, such as the democrats, have called it a “historic victory” and “landmark legislation” that reforms the US health care system by reigning in health care costs, making health care affordable, and protecting consumers from unfair insurance practices. They say the law will reduce the nation’s deficit by more than $100 billion by 2020 and by $1 trillion by 2030 (U.S. Department of Health and Human Services, 2011). Those against the PPACA law have called it a “socialist” and “unconstitutional” government takeover of the health care system that will increase the cost of health care and decrease the quality. They say the law will cost more than $2.5 trillion over 10 years and drive the US deeper into debt. Several congressional representatives and special interest groups have initiated attempts to repeal the law. (U.S. Department of Health and Human Services, 2011). References: Antos, J., Wilensky, G., & Kuttner, G. (2008, November). The Obama plan: More regulation. Unsustainable spending. Health Affairs, 27(6). 462. Department of Health and Human Resources. Fact sheet: the affordable care act’s new patient’s bill of rights. Retrieved from http://www.healthreform.gov/newsroom/new_patients_bill_of_rights.html on May 27, 2011. Rosenbaum, S. (2011, January-February). Law and the public’s health. Public Health Reports, 126(3), 130-135.