The Affordable Care Act (Obamacare) Update

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The Affordable Care Act (ACA) is a piece of legislation that is far from ideal. Many of its provisions should elicit debate and, quite frankly, should be repealed.

Yesterday, the House of Representatives held a roll call vote that would set the stage for a repeal of the ACA. There are many avenues Republicans can take. At minimum, I think they should not repeal the ACA until they have a better replacement. Another option is to improve rather than repeal the law. I don’t think House Republicans will concur. They should, at least, preserve the parts of the ACA that should remain.

Here are some of the provisions of the ACA that I think should be preserved:

  1. Free Preventive Care
  2. Prescription Discounts for Seniors
  3. Protection Against Health Care Fraud
  4. Small Business Tax Credits
  5. Pre-existing Conditions: Health insurers can no longer charge more or deny coverage to you or your child because of a pre-existing health condition like asthma, diabetes, or cancer.
  6. Consumer Assistance Protections
  7. Prescription drugs
  8. Health Insurance Marketplace
  9. Coverage available to children up to age 26
  10. Yearly Wellness Visits for Medicare Recipients
  11. Insurers must justify any premium increase of 10% or more before the rate takes effect
  12. Maternity and newborn care


The ACA requires that all plans in the Marketplace cover the same essential benefits:

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  • Ambulatory patient services (outpatient care you get without being admitted to a hospital)
  • Emergency services
  • Hospitalization (like surgery and overnight stays)
  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care
  • Breastfeeding coverage
  • Young adults can stay on their parent’s plans until 26.

The preventative care provisions cover:

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  • Abdominal Aortic Aneurysm (“AAA”)
  • Alcohol misuse screening and counseling
  • Aspirin use to prevent cardiovascular disease (applies to both men and women of certain ages)
  • Adult blood pressure screening
  • Cholesterol screening for adults of certain ages and high-risk adults
  • Colorectal cancer screening for adults over 50
  • Adult depression screening
  • Type 2 Diabetes screening for adults who have high blood pressure
  • Diet counseling for adults who are at a higher risk for chronic disease
  • HIV screening for everyone ages 15 to 65 and for other ages if the person is at an increased risk
  • Adult immunization vaccines

The ACA makes a number of benefits available to Medicaid recipients:

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  1. Prescription Drugs: Changing the Medicaid prescription drug program by revising the definition of average manufacturer price (AMP), establishing a new formula for calculating the federal upper limit (FUL), increasing the rebate percentages for covered outpatient drugs, and extending the rebates to drugs dispensed to enrollees in managed care organizations. Also, preventing states from excluding tobacco cessation drugs from coverage.
  2. Tobacco Cessation Services for Pregnant Women: Providing comprehensive tobacco cessation services for pregnant women without cost-sharing.
  3. Hospice Care for Children: Assuring that children can receive curative treatment upon the election of the hospice benefit for children enrolled in Medicaid or the Children’s Health Insurance Program (CHIP)
  4. Preventive and Obesity-Related Services: Allowing states to cover specified preventive services at no cost to Medicaid adult enrollees.

The benefits afforded to employees are:

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  1. Coverage offered to employees must be considered affordable (can’t cost more than 9.56% of employee household income) and must provide minimum value (must have an average cost sharing of 60%). If coverage isn’t affordable employees can use the Marketplace and the employer can be fined.
  2. Employers must offer at least a 30 day Special Enrollment Period for employees or qualifying employee family members losing coverage from another source. This means an employee must be given 30 days to enroll in an employer plan after losing non-employer minimum essential coverage for any reason other than non-payment.

A penalty is applied to companies that do not conform to the law.

You must have an individual mandate in order for the system to work. Prices will rise and enrollment will plummet without the mandate. Mitt Romney’s Massachusetts health reform law  contained a mandate for this very reason. Subsidies or some other financial provision should be provided for those who cannot afford health insurance.

What do think should be done with the ACA?

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