Health Care Reform Explained

The purpose of the Affordable Care Act’s (ACA) health care reform was to make health insurance affordable for those who didn’t have it through employers, the subsidized Health Insurance Marketplace or on the private market. It may have been a tough first year, with kinks still to be worked out, but reports are that more than 7 million Americans, who did not have health insurance or had unaffordable coverage, signed up in 2014. This is only the first step to fixing the health care delivery system in the United States. Unfortunately, there are many important details you will need to understand to get the coverage you are looking for, at an affordable price.

Goals of Health Care Reform

The phrase “Health Care Reform” has many connotations. It can refer to changes in government policies, improving health care delivery, changes in the how insurance is paid for, as well as improving the actual care delivered to you and others. Through the years, many health care reform efforts have been attempted in the United States. There have been discussions about universal health care models like those in Canada and the United Kingdom, improving outcomes in hospitals, and more. In general, here are some ways the U.S. has tried to reform health care, medical insurance and the delivery of care with the ACA and other legislation:

  • Broadening access and eliminating barriers to health insurance.
  • Expanding the health care providers available to consumers.
  • Improving the quality of the health care delivered.
  • Decreasing the out-of-pocket cost of health care treatment, medications, etc.
  • Eliminating the fear of not having coverage, by requiring a level of coverage for all and removing any possibility of coverage being denied.
  • Bringing down health care costs.
  • Provide coverage to all.

Successes So Far, With More Needed

While other attempts at Health Care Reform have faltered, the ACA has fostered some successes you may have seen already:

  • Preventive Care Services: All health insurance plans now cover preventive screenings for cancer, diabetes and heart disease, immunizations and other care designed to identify or prevent illness before they are serious with no copayment or deductibles.
  • Extending Coverage for Young Adults: Many people in their 20s did not have access to health insurance coverage because they had “aged” out of their parents plans and did not have insurance yet through an employer. Under the ACA, young adults who do not have coverage through jobs can stay on their parents’ health insurance plans until they reach age 26, in most states. This change has reportedly enabled more than 3 million young adults to get coverage.
  • Coverage for those with Pre-Existing Conditions: Before ACA, many who had pre-existing health conditions, such as diabetes or cancer, could not obtain insurance or had to pay exorbitantly for it. Some stayed at bad jobs just to keep their coverage, afraid they wouldn’t be able to get a new policy. This has all changed. People cannot be denied coverage now.
  • Making Health Insurance Mandatory: Under ACA, everyone must have health insurance coverage or pay a tax penalty. Employers over a certain size also must offer health care insurance to their employees or pay a tax penalty.
  • Affordability: One highly publicized change in the past year was the introduction of subsidies to help those who earn up to 400 percent of the poverty level to pay health insurance premiums.
  • Better Prescription Drug Coverage: Historically, many did not have coverage for prescriptions through their health insurance. Or, in the case of Medicare, there were coverage gaps that created financial hardships. Drug coverage is now included in policies and the Medicare issue is being phased out.
  • No More Limits on Care Available: In the past, if you had an expensive condition or medication, there was a risk of running out of coverage because if your expenses reached the dollar maximum on how much annually or even lifetime could be spent on care. This care limitation is no longer allowed.
  • Value for Premiums Paid and Limits on Increases: Insurance companies are now accountable for how they spend premium dollars, with a minimum of 80 percent going to medical care. They also have limits on how much they can raise rates each year.
    Better Policy Options for Small Businesses and Individuals: Small employers or individuals have traditionally paid more for health insurance than large employers. This is changing with the introduction of new plan designs, tax credits for small employers, etc.

U.S. Health Care System Falling Behind

Further reforms are undoubtedly needed to improve the health care actually delivered. Numerous studies have shown that the health care system in the U.S. is overpriced and ineffective. Health Care in the U.S. is the world’s most expensive with care costing more per person and a greater portion of gross domestic product than other nations. In spite of the money expended, the U.S. is last in quality of health care among developed countries, according to the 2008 Commonwealth Fund report. The World Health Organization ranked the U.S. system 72nd out of 191 member nations in 2000. Another sobering statistic that came out this year is that maternal deaths in the U.S. are increasing and the U.S. mortality rate is more than double rates in Canada and Saudi Arabia. It is three time the rate for the United Kingdom. In fact, the U.S. is now number 60 out of 180 countries.

The U.S. Health Care system has made progress with reforms introduced so far. However, it is clear more changes are needed in the future. Until things get better, you should rely on an expert insurance agent to help you navigate the new world of health insurance. Contact us today to get started!

X