The Affordable Care Act, also known as the ACA or Obamacare, is a revolutionary piece of legislation, spanning a whopping 2,700 pages of legal rhetoric. Within it are new laws that have completely changed the way healthcare in America works. This law has been the source of heated debates and many people and legislators are seeking its repeal. And, this relatively newly elected Republican House and Senate have planned changes to the ACA, as stated by the Speaker of the House John Boehner. Politics aside, what is so controversial about healthcare reform, and what has really changed?
America is finally catching up with the rest of the developed world’s healthcare systems. The ACA has proven to be such a controversial law because it is changing the business strategy of the healthcare industry. Instead of offering incentives to healthcare providers based on how often they can see a patient and the quantity of patients they can see, the new law makes it more profitable for companies to keep their patients healthy. A PPS (per patient seen) rate is a predetermined dollar amount awarded to healthcare facilities for each patient they see, every time they see them. Under a PPS rate, healthcare providers have the incentive to see as many patients as possible to maximize their revenue. With the ACA requiring health insurance companies who sell plans in the new marketplace to provide free preventive care, over time the amount of patients coming into healthcare facilities will drastically decrease. With profit margins already at an all time low, healthcare titans such as St. Jude and Kaiser are competing vigorously to have patients walk through their doors and enroll in the programs they offer. In addition to the free preventative care initiated by the ACA, alterations to PPS rates have also ensued. In some cases, they have even been replaced by PMPM (per member per month) payment plans: institutions will only receive a predetermined dollar amount per month for every member enrolled in their facility’s program, regardless of if they see a doctor once one month and have fifteen visits the next. However, the healthcare revolution doesn’t stop at payment plans. it even forces health insurance companies to play fair.
Before the ACA, health insurance companies were notorious for refusing insurance to individuals who had any pre-existing conditions. The economically sound principle of refusing to provide insurance to those who will actually be using it allowed them to reap billions in revenues at the expense of American lives. These insurers found avenues to positively impact their bottom line with existing customers. Gruesome stories of health insurers refusing treatment to their premium-payers, whose only crime was developing diseases sooner than the statisticians predicted they would. Almost immediately after realizing that a premium-payer is going to force the insurance company to come out-of-pocket for large medical bills, the insurer would begin looking for ways to cancel the policy. Circumstances that were discovered by these insurers which allowed them to cancel a policyholder’s coverage were often completely irrelevant to the premium-payer’s health. These refusal letters had served death sentences to Americans for years. With the ACA in full effect, health insurance companies are barred from using this unethical business strategy. Under the new law, health insurance companies can no longer claim a policy moot based upon “an honest mistake that has no bearing on your health.” It is now illegal for healthcare companies, who choose to sell insurance through the marketplace, to charge more or refuse service to individuals who have pre-existing conditions.
Medical centers across the country have already started receiving some funding from government grants to help enroll people into the new marketplace; Citizen or not, everyone can now have access to healthcare.
Eddie Vasquez, one of UMMA Clinics enrollment coordinators, recently told a story of an uninsured elderly woman who was diagnosed with cancer. Before the ACA became law, she had attempted to qualify for health insurance, but not a single provider would accept her. During the last enrollment period, Eddie was able to secure her a health insurance plan that offered her the treatment she needed to live. The ACA saved her life. Similar stories are echoed across the nation as Americans find that being healthy is no longer far from reach.