Being part of the healthcare education field, I am frequently asked for my opinion on the ACA (Affordable Care Act). As an educator, it’s not necessarily my opinion that matters but in teaching my students to form educated opinions on these issues themselves. Being part of a career field isn’t just about learning how to do the job, but also in forming educated opinions on issues affecting that job or career. I encourage you to Google “Affordable Care Act” and learn as much as you can about it, and then form your own opinion on your thoughts about it. It’s okay if your opinions evolve or change over time. Intelligent people do change as they gain more information and insight.
The Affordable Care Act was designed to address the large number of Americans that do not have health insurance (about 50 million as of 2013) as well as elevating healthcare costs. The Affordable Care Act contains legislation that mandates small business owners who have 50 or more full-time employees provide health insurance coverage to each full-time staff member or pay a financial penalty. In addition, the ACA establishes many layers of public health insurance for people. If citizens choose to opt out of coverage, they must pay a penalty of $95 or 1% of their total income, whichever is higher (2014 figures).
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Whereas the Affordable Care Act is expected to allow tens of millions of Americans access to healthcare they might not otherwise have been able to afford, the law has come under harsh criticism for its mandates and their outcomes. One example of this is that the ACA opponents have cited the pre-emptive shift by many large companies to part-time labor in order to avoid the ACA’s full-time employee health insurance requirements. While the full effects of this shift remain to be seen, many people have found themselves suspended between two part-time positions, neither of which offers health insurance benefits. Also, the term “affordable” is being debated by those who make around $60,000 a year but have high-cost mortgages. Some have said their rates were coming in at $600 a month for just husband and wife. If that husband and wife duo also have many prescription medication copayments having the insurance but not being able to use it becomes an issue. What good is insurance that you cannot afford to use? It does protect against a medical catastrophe, but there has been talk that buying from the healthcare exchanges is not “affordable” according to most middle-income families. Another problem is that some companies are bringing in healthcare care coverage, but again the cost to the employee is prohibitive. I personally know of a male working full-time for under $10 an hour. The company he works for didn’t offer creditable coverage health insurance before the ACA went into effect. Now, they do, but his rate is nearly $200 a month for a healthplan with high deductibles, copayments, and he is unable to afford his monthly medications at this point.
Looking toward the future of healthcare delivery in the United States, the Affordable Care Act may serve as a transition to universal coverage, a system in which the socialized programs of Medicare and Medicaid are expanded to cover all citizens. A taxpayer-funded, government managed healthcare fund would allow the government to negotiate effectively with healthcare providers, health insurance companies, and medical product manufacturers by awarding national contracts. Private manufacturers would then have tremendous incentive to keep their products and services safe, effective, and affordable. There was a similar system instituted in the state of New Mexico under Governor Bill Richardson called State Coverage Insurance. The goal of that plan was to make the state plan affordable and available for everyone up to 300% of the federal poverty level. They were able to institute up to 200% of the poverty level. The cost for a family of 2 at 200% FPL was just $110 per person with medication copays being $3 per prescription. This plan was eliminated with the advent of the ACA. A new plan took over called Centennial Care which covered only those up to 150% of the FPL. Others were expected to pick up coverage through their employers or healthcare exchanges. No opinion is right or wrong regarding the ACA and its pros or cons. However, as a medical billing student or new professional, it is important to know what is going on within the healthcare industry and to form your own thoughts and opinions.
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By: Dawn Moreno, PhD, CBCS, CMAA, MTC. Lives in the beautiful Southwest United States and has been an instructor for medical coding/billing for the past 7 years. Interested in quality medical billing training?