[su_box title=”Here’s what you need to know…” style=”default”]
- The Individual mandate and Need to Amend the Law
- Refusal to Establish State Exchanges and Expand Medicaid
- State regulated insurance, plans, price, and services
- Criticism and Continuing Efforts to Repeal Obamacare
- Limited Enrollment period and only four types of plans
- Establishing CO-OPs and Controlling costs
Listing the top ten problems with Obamacare should not diminish the facts about its impact. Millions of previously uninsured Americans have coverage by insurance plans, Medicaid, and CHIPs. One can also view problems as opportunities for change. When shopping on Obamacare, it is important to find the best fit. Comparison shopping is the best way to find a health plan that meets the individual or family needs. Start comparing health insurance plans now by entering your zip code in our FREE tool above!
The Individual Mandate
A basic premise of Obamacare is that everyone must have health insurance coverage. Those who fail or refuse must pay a penalty. The law labels the penalty as the shared responsibility tax. It is not a penalty that is intended to punish an individual; rather, it is intended to promote participation in a national effort to improve health and reduce avoidable illnesses.
Improve and Amend the ACA
The ACA was one of the largest pieces of legislation ever enacted in US history. It changed many other laws and established an even greater number of rules and regulations. There is an opportunity to gain from the experience and strengthen the law. Some of this has been done by regulations. The amendment process is the traditional way to improve the operation of a major health reform effort, and this includes the basic idea of maximum economic bargaining power for the sixteen million plus that participate in Obamacare.
Refusal on State Exchanges
Thirty-six states failed or refused to establish state exchanges. A few went further and obstructed implementation of the law within their borders. The state exchanges were intended to have a favorable effect on prices and services for state residents.
The ACA recognized the vital role of state governments in the regulation of insurance business within their borders.
States license insurance companies and regularly review insurance practices to protect citizens and ensure that insurers have adequate resources to cover the insured risks. The refusal of many populous states created barriers for residents to participate in gaining health insurance coverage. Healthcare.gov became the only source of participation for millions of Americans.
Refusal to Expand Medicaid
Medicaid expansion was an integral part of the health care reform design of the ACA. The heath insurance programs had a lower income limit, and Medicaid had an upper-income limit. Between the two limits, many low-income people would have too much income for Medicaid and not enough for health insurance coverage. The expansion removed that gap and provided federal funds for many years of coverage. The door was open for a further subsidy based upon the initial years experience. Many states refused to expand Medicaid and left their most vulnerable citizens without needed coverage, and the local institutions that treat the uninsured vulnerable to failure. The four types of plans are limited to the metal plans described below:
- Platinum Plan: covers the highest percentage of plan costs at about 90 percent.
- Gold Plan: covers about 80 percent of plan costs, high premiums and moderate costs.
- Silver Plan: covers 70 percent or more of plan costs; some buyers qualify for payment assistance.
- Bronze plan: covers 60 percent or more of plan costs; they offer low monthly premiums
- Catastrophic Level plan: designed for those under 30 and in special circumstances like hardships. They offer only emergency-type coverage, low premiums, and high out of pocket costs.
Active or passive action, the state could have a profound impact on prices and services. Particularly when encouraging maximum numbers of insurers and promoting competition for all parts of the state, the state governments had a great potential for positive contributions.
There have been government shutdowns and more than fifty votes in the House of Representatives to repeal Obamacare. Despite the fact that President Obama would not sign such a law, it has persisted as a major congressional activity. The apparent successes of Obamacare go unnoticed in these proceedings and the impact of repeal would probably threaten the lives and well-being of millions. Congressional oversight of Health Care reform is a necessary part of their role in government; the focus on an impossible repeal has not produced favorable changes in the law, improved its impact on the population, or increased its role in improving health and reducing costs of health services.
Open Enrollment Limitations
Open Enrollment provisions offer four ways to enroll. The time limits have reduced the time in which to get health insurance coverage that meets the requirements of the ACA. Private insurers have joined Healthcare.gov and the state exchanges by limiting enrollment to the Open Enrollment. Open Enrollment sets the conditions for plan coverage and prices. These factors change for insurance providers throughout the year:
- For 2016, Open Enrollment runs from November 1, 2015, to January 31, 2016
- Outside of Open Enrollment, insurers do not offer qualified health plans
- Short-term health plans offer protection but do not meet the requirements of the ACA
- Hardship exemptions cover up to three months without insurance coverage.
Exceptions to Open Enrollment
The ACA provides Special Enrollment periods for Life Events. These are changes in status that are so fundamental that they require an additional period for sign-up. The recognized life events include the below-described occurrences:
- Birth of a child
- Moving to different state
- Loss of insurance due to job loss
- Loss of insurance as a dependent
A major goal of the ACA was to reduce healthcare costs to the public. The Act established programs for increased early detection and routine treatment of conditions that if untreated would become large expenditures with poor health outcomes. These include diseases like diabetes that has reached a near epidemic proportion ion the United States. The key is reducing the uninsured rate and promoting prevention.
Ending Denials and Discrimination
The ACA was a massive undertaking, and it affected, amended or rewrote large portions of the tax code, occupational health and safety, pensions, state insurance procedures, Medicaid, Medicare, and related health laws. It limited factors such as tobacco use, location, and age that insurers can lawfully use to discriminate in issuing and pricing health insurance.
Some states that passed Medicaid expansion had had political movements aimed at taking away those benefits. Kentucky is an example. Kentucky has been a model of Obamacare implementation and over 400,000 low-income Kentucky residents have Medicaid coverage. They face repeal of that program and cancelation of benefits that have saved many local hospitals from failures due to unpaid bills. This is a major issue for Obamacare, that even when established and working well, saving money and providing life-saving care, the proposed 2016 House budget positions the federal and state governments to take it away.
Overcoming Negative Responses
The popular perception of the ACA had deep controversy from the beginning. As a political question, the nation needed full and vigorous debate. Some actions were aimed at blocking the law, such as states that banned the public assistance personnel, the navigators, or that urged young people not to get health insurance coverage. Like most others, young healthy people need medical care to stay healthy.
The ideal situation is to maintain health rather than the expensive and difficult task of healing a disease.
For some young people, the sign up meant an opportunity to detect a disease that might someday disable them or shorten their lives.
Saving Money Reducing Fatalities
The Obamacare record supports findings that it has saved more than more than 50,000 lives and in that process reduced costs for health care by more than $12 billion. The improved standards for hospital care have reduced the number of hospital-acquired conditions, saved lives, and lowered the costs impact of the disease.
Mental Health and Addictions
The ACA provides a right to mental health care services and this includes detection and treatment for addictions. One problem noted by many observers is that the health services provider determines the type and extent of treatment for mental illness and addictions. For addictions, a given provider might offer an essential basic set of services for everyone rather than a customized set of features for each subscriber. Restrictions on out of network services might limit choices and require other sources of services.
One experimental feature of the ACA involved seed grants to start consumer-owned health services providers. The Act envisioned CO-OPs as a way to increase services in areas with no or few providers and to help drive down costs. CO-OPs were designed to reinvest profits to increase services and drive down prices. Many CO-OPs did not survive the startup period needed to establish market positions and develop enrollments.
Health insurance competition drives prices down and increases value to consumers. In many areas of the US, there are few choices for health insurance coverage and providers have little incentive to reduce prices or offer more services.
The ACA intended to help states promote competition by providing guidance and direction to insurers.
Active engagement or passive review, the states were uniquely well positioned to encourage and promote competition. The ACA has increased the number of firms offering policies on the exchanges.
Finding Obamacare Values
Obamacare has transformed the health insurance business in the US; it gives consumers powerful rights and powers to control their health care options. With fewer fears of rejection and restrictions, they can focus on value. The value of a health insurance plan goes beyond the monthly costs and financing out of pocket expenses. It goes to the medical care needs of the individual of family and whether a plan matches well. Comparison shopping focuses the search for health insurance. Consumers can place priority on the features that mean most to them and their situation. Start comparing health insurance plans now by using our FREE tool below!