Hot Topic #17: The Affordable Care Act

There’s been a lot of chatter online recently regarding the Affordable Care Act (ACA).

I started writing this post about two weeks before Election Day. It’s only been 17 days since that day, but the whole world has now changed.

Like many people, I was stunned at the outcome. I know that the ACA is now under a stronger microscope now, more than ever.

Full disclosure: I work for a health system in Virginia. For the last four years, I have been immersed in the world of healthcare and the insurance companies. My department helps negotiate the contracts between the health insurance companies, and our health system.

As with all of my blog posts that involve research and sources, I try my best to be well-read and as well-informed as possible.

The official name for the ACA is the Patient Protection and Affordable Care Act (PPACA). It was signed into law by President Obama on March 23, 2010.

There were three main goals with enacting the PPACA:

  1. Increase health insurance quality and affordability
  2. Lower the uninsured rate by expanding insurance coverage
  3. Reduce the costs of healthcare

The law requires health insurance companies to accept all applicants, cover a specific list of conditions, and charge the same rates regardless of pre-existing conditions or sex.

On a positive note, the law has appeared to help reduce the number of Americans without health insurance.

According to the Centers for Disease Control and Prevention (CDC), the percentage of people without health insurance was 16.0 percent in 2010.

Between the period of January-June 2016, the percentage of people without health insurance was down to 8.9 percent.

That breaks down to a 7.1 percent reduction. Dividing that by six years, it’s been roughly a 1.18 percent reduction since the law was enacted.

In March 2016, the Congressional Budget Office (CBO) reported that 23 million people now have insurance due to the law.

Those 23 million people break down as follows:

  • 12 million people covered by the exchanges (10 million of those received subsidies to help pay for their insurance).
  • 11 million made eligible for Medicaid.

I’m going to stop for a second and try to answer some questions that may have arisen with what you just read.

What are the exchanges?

  • They are regulated marketplaces, mostly online, where individuals and small businesses can purchase private insurance plans.
  • They are in all 50 states.
  • They are administered by either the federal or state government.

What are subsidies?

  • Subsidies are money, in the form of a refundable tax credit, made available to certain households. The U.S. has a federal poverty level (FPL), and households that have incomes that equal a certain percentage of the FPL can get help to purchase insurance on the exchanges.
  • For example, in 2014, the FPL was $11,800 for a single person, and $24,000 for a family of four people. Households with incomes between 100 percent and 400 percent of the FPL were eligible.
  • $24,000 x 133 percent (1.33) = $31,920 per year income. The maximum insurance premium that family would pay was $992 for that year. The family could also be eligible for a little over $5,000 in subsidies.

What is Medicaid?

  • Medicaid is a government program that helps provide health insurance for people with low income, such as adults, children, and people with certain disabilities.
  • One caveat of the PPACA is that Medicaid expansion was left up to the individual states. Virginia, for example, is one of the states that chose to not expand Medicaid.

It’s tough to wade through all of this information. I can see why there have been numerous challenges and criticisms of the ACA. It’s been six years since it’s been enacted. Even though I work for a health system and I work with the health insurance companies on an almost-daily basis, it’s difficult for me to try to explain all of this.

I feel extremely fortunate that my employer offers health insurance that covers almost all of my needs. The premium is taken directly out of my paycheck, and my out-of-pocket costs are relatively low. There are certain things, such as my chiropractor visits and dermatology procedures, that are not always covered, but I’m fortunate to have a good job that allows me to pay those bills. I feel at peace, knowing that if I had to go the emergency room or be admitted to the hospital any time soon, that my insurance would be able to cover me.

Because of my job, I’ve tried really hard to immerse myself in learning about the ACA and how it works, or how it’s supposed to work. By educating myself, I’m able to think and speak more intelligently about it, and try to think ahead. The world of healthcare is constantly changing, nearly every day.

I’ll leave you with a list of resources that I used while constructing this post. I hope this post was educational, informative, and helpful.

I certainly don’t know everything, but I definitely like to learn.

Until the next headline, Laura Beth πŸ™‚

9 thoughts on “Hot Topic #17: The Affordable Care Act

  1. Laura Beth,
    I am in a state that did not choose to expand Medicaid, NC, and even though I am employed, the health insurance from my employer would essentially take the majority of my paycheck, so unfortunately I do not currently have health insurance, but my hope is with the election of Governor Roy Cooper, Medicaid will be expanded in my state and I will be able to be covered. One bright side is that my employer also offers vision and dental insurance, I was able to afford the vision insurance, so when I have to get my eye exams and new frames, I will not have to pay much which is a good thing. The Affordable Care Act was meant to help, but I think over time it seems it hurts the very citizens it was meant to help. I hope the Act is not outright repealed, but maybe some changes can be made so that it can truly get and keep citizens insured.

    • Catherine,

      Thank you, first, for reading. Second, thank you for commenting.

      I’m sorry to hear that your circumstances leave you without health insurance. I hope that Medicaid will be expanded in North Carolina, for your sake and likely thousands, if not millions of others.

      I agree that the intent of the ACA was good. Unfortunately, good intentions don’t always equal good results. I hope changes will be made as well. Best of luck to you! Thank you again for reading and commenting.

  2. OMG!! I have been waiting to read this post for two weeks. WordPress kept getting my hopes up by sending me notifications saying it was posted. Then, when I click on it, the page said it didn’t exist.

    That’s one way to get people interested!! LOL

    Do you have any personal feelings/opinions on the ACA?

    • Sorry to keep you in suspense! I kept pushing back the publish date because I wasn’t finished!

      I think it was enacted with good intentions, but it’s not working out as well as people have hoped. I know I’m biased since I work in the industry. Unfortunately, the insurance companies are so greedy and they want companies like mine to become more competitive every year, which is difficult for us. Riverside is a good company, but it’s tough to be profitable and be fair to employees and patients alike when the insurers want more and more. It’s complicated! We’ll have to wait and see what happens in Washington!

      • It’s all good! It just made me wanna read it more! πŸ™‚

        Hahaha… “see what happens in Washington.” That’s a good one with the obstructionist partisanship & what I imagine (I don’t have any hard numbers) is more money spent by lobbyists working for insurance companies than you & I will ever see in our lifetimes.

        But – your way of looking at it is much more hopeful & optimistic. I’ll try to keep that in mind.

        Personally, I would have liked to see how the original ACA would’ve worked out. I feel (haven’t researched it; reading the original bill & comparing it to the enacted bill might give me a aneurysm lol) like the changes made it worse.

        I can’t know that for sure, however, since the original could have been worse if enacted.

      • I agree with you about the lobbyists. There’s so much greed and corruption, it’s a wonder anything gets accomplished in our nation’s capital.

        I try to be hopeful and optimistic, as much as possible. There’s so much doom and gloom in our world. The least I can do is try to bring some sunshine along!

        That said, I also try to be realistic and fact-based. I was struggling with researching for this post, just reading parts of the enacted bill made me cross-eyed. I’d bet money that some of our country’s best lawyers would gag at some of the language and provisions!

        I like your thought – It would be interesting to see what it would be like if the original bill had gone into effect.

      • I totally agree (although, I might say that not a lot gets done in the capital as it is… lol).

        I’m also so grateful that you try to keep upbeat & spread some optimism. I really need it right now. πŸ™‚

      • I’m happy to help!

  3. Pingback: Hot Topic #18: What’s Up With Washington? | Hot Shot Headlines

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