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The Affordable Care Act: What it Prohibits, Protects and Creates

Created Jun 16 2014, 8:00 PM by Lippincott Solutions
  • ACA
  • individual mandate
  • insurer
  • health plan
  • Affordable Care Act
  • healthcare reform adoption
  • healthcare reform

Tuesday, June 17, 2014

The U.S. healthcare system underwent its most significant overhaul in 45 years when President Obama signed The Patient Protection and Affordable Care Act into law in March 2010. The law aimed to increase Americans’ access to affordable, quality health insurance, but a firestorm of criticism quickly zeroed in on one aspect of the act in particular: the individual coverage mandate. Forcing an American to obtain health insurance coverage or pay a penalty is unconstitutional, opponents argued, and they took their argument all the way to the U.S. Supreme Court.

The justices disagreed, however, ruling 5-4 in June 2012 that the government’s authority to do exactly that existed within Congress’ power to levy taxes.

“Whatever the politics, today’s decision was a victory for people all over this country whose lives are more secure because of this law,” President Obama said in response to the ruling.

But how? Consider this: Beyond the individual mandate, the Affordable Care Act put in place a bevy of reforms aimed at bettering the healthcare experience of Americans as a whole. Most of the major provisions were phased in by January of this year, yet they still remain shadowed by opponents’ ongoing threats to repeal what many consider a controversial law because of  the individual coverage mandate.

Here’s a look at what the Affordable Care Act prohibits, protects and creates.  

The Affordable Care Act prohibits

  • insurers from imposing annual and lifetime limits on essential benefits such as hospital stays, emergency services and prescriptions; insurers can still cap benefits not deemed “essential.”
  • health plans from refusing to cover or bumping up copays for out-of-network emergency services.
  • insurers from charging any copays at all on preventive services, including mammograms and colonoscopies for adults, depression screening for adolescents, and a dozen different immunizations for children.

The Affordable Care Act protects

  • children and adults with preexisting conditions from health plan discrimination; insurers can neither refuse coverage nor increase rates.
  • women from being charged more for a health plan than men.
  • adult children 25 and younger from being dropped from their parents’ health plans.
  • individuals and small businesses from unreasonable rate increases; health plans intending to hike insurance rates by 10% or more must first justify the increase to a state or federal Rate Review program.

The Affordable Care Act creates

  • an online Health Insurance Marketplace, where individuals and small businesses can compare and purchase affordable and qualified health plans. Remember that individual coverage mandate?
  • state Consumer Assistance Programs to help individuals enroll in health plans and file complaints and appeals.
  • additional funding to go toward scholarships and loan repayments for primary care physicians and nurses who work in underserved areas.
  • funding to create, modernize and expand thousands of community health centers to serve millions of new patients across the United States.

How has the Affordable Care Act most affected your patients and nursing practice?