When discussing the US health care laws, the recently implemented Patient Protection and Affordable Care Act (PPACA) of 2010 and the Health Care and Education Reconciliation Act of 2010 are the most important. The reason for its importance is that these legislations are responsible for substantial transformation of the health care system in the direction of offering more protection to most number of people while restricting the manipulative powers from the insurance sector. However, the legislation still encounters resistance and criticism from many corners of the US health care system, as well as in the political arena. This article will elaborate on the overview presented by the healthcare.gov, which is the public relations arm of the proposed legislation by the US government.
Accordingly, the US health care laws can be seen as addressing several important areas and these were identified as rights and protection, insurance choices, insurance costs, 65 or older, and employers.
Rights and protection
Some of the important clauses that are included in the rights and protection section include the necessity to provide a summary of benefits and coverage about the health plan by the insurer and the establishment of a consumer assistance program to help those who experience health insurance related issues. In the event of a denial or payment for service, the patients are given the right to appeal, while some of the preventive health services are also made available to the patients through their insurance coverage. The ‘patient’s bill of rights’ is also an integral part of this section and it outlines the consumer protections and provides for making an informed choice with regard to the insurance plan by any individual.
When it comes to insurance coverage, insurers are no longer able to deny coverage for children under the age of 19 years for pre-existing health conditions while the patients are given the right to choose a doctor of their wishes within the plans network or else seek emergency care even at an ER unit outside the said network. At the same time, insurance companies are no longer able to cancel coverage just because the patient made an honest mistake at the time of applying for the insurance.
Under this section, people are given a variety of choices when selecting insurance from public and private insurance markets. A newly established pre-existing condition insurance plan would make those who have been rejected from previous insurance coverage’s to obtain insurance. At the same time, a person under the age of 26 years would be eligible to receive insurance coverage through his or her parents insurance. The establishment of the ‘affordable insurance exchange’ would mean that a person would be able to shop for insurance pertaining to that particular state in order to choose the best and the most affordable plan.
This section is important in relation to keep the insurance companies accountable as well as keep the costs down. One aspect with regard to insurance costs is the limitations imposed on the amount of spending that insurers can do using the premiums paid by the people. In addition, lifetime limits on most benefits are banned on new health insurance while annual limits on health benefits are now restricted to a certain extent. The rate reviews done by the insurance companies are also restricted through the new laws and accordingly a rate increase of more than 10% should now be justified before implementation.
65 or older
Aimed mainly at Medicare, elderly individuals who are in possession of a Medicare plan will now receive additional preventive services free. A discount with regard to certain medications, as well as in relation to certain instances has also been implemented through this section and is known as the ‘Medicare drug discount’. In addition, the health care law targets wastage, fraud and abuse when providing services to the seniors in order to provide better Medicare to those who are eligible.
Special emphasis has been given to small employers through the new health care laws as it provides tax credits to such entities and to non-profit organizations to bring down the cost of providing health insurance to its employees. At the same time, organizations providing early retiree insurance for those who are between the ages of 55 to 64 would be eligible to receive support from Early Retiree Reinsurance Program.
However, it should be remembered that the proposed legislation with regard to the US health system takes effect in stages and according to the proposed time line, these laws should be fully implemented by the year 2015.