Patient Protection and Affordable Care Act, PPACA its affect on Public Health



Patient Protection and Affordable Care Act, PPACA its affect on Public Health

Introduction

The Affordable Care Act is a watershed in U.S. public health policy. Through a series of extensions of, and revisions to, the multiple laws that together comprise the federal legal framework for the U.S. health-care system; the Act establishes the basic legal protections that until now have been absent: a near-universal guarantee of access to affordable health insurance coverage, from birth through retirement. When fully implemented, the Act will cut the number of uninsured Americans by more than half. The law will result in health insurance coverage for about 94% of the American population, reducing the uninsured by 31 million people, and increasing Medicaid enrollment by 15 million beneficiaries. Approximately 24 million people are expected to remain without coverage.

Consisting of 10 separate legislative Titles, the Act has several major aims. The first—and central—aim is to achieve near-universal coverage and to do so through shared responsibility among government, individuals, and employers. A second aim is to improve the fairness, quality, and affordability of health insurance coverage. A third aim is to improve health-care value, quality, and efficiency while reducing wasteful spending and making the health-care system more accountable to a diverse patient population. A fourth aim is to strengthen primary health-care access while bringing about longer-term changes in the availability of primary and preventive health care. A fifth and final aim is to make strategic investments in the public's health, through both an expansion of clinical preventive care and community investments.

Discussion

Health insurance coverage reforms

Through a series of provisions that create premium and cost-sharing subsidies, establish new rules for the health insurance industry, and create a new market for health insurance purchasing, the Affordable Care Act makes health insurance coverage a legal expectation on the part of U.S. citizens and those who are legally present. The Act both strengthens existing forms of health insurance coverage while building a new, affordable health insurance market for individuals and families who do not have affordable employer coverage or another form of “minimum essential coverage” such as Medicare or Medicaid. In expanding existing coverage, the Act fundamentally restructures Medicaid to cover all citizens and legal U.S. residents with family incomes less than 133% of the federal poverty level (as measured through a new “modified adjusted gross income” test) and to streamline enrollment (Department of Health and Human Services (US)). (Medicaid's five-year waiting period for legal residents will continue to apply to recently arrived people, who during this time will qualify for tax subsidies and enrollment through a health insurance Exchange.)

The quid pro quo for near-universal legally guaranteed coverage is the duty to secure it, as it is not possible to extend such a guarantee of insurance coverage without an attendant coverage obligation. This duty extends to all U.S. taxpayers, but individuals not legally present in the U.S. are excluded from both the coverage guarantee and the obligation to secure coverage. The law also provides exemptions for people ...