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- Health care reform has always been a hot topic during national elections
- Obama introduced the Patient Protection and Affordable Care Act in 2010
- Dependents up to the age of 26 are now covered under their parent’s policies
National health care reform has been a hot topic during national elections for decades. A few major promises have included health insurance for everyone, lower premiums, and better coverage. There is also debate over how to handle the Medicaid and Medicare programs.
While presidential candidates have always promised reform, none were as vocal as President Obama. His 2008 campaign focused heavily on changing health care in America. In 2010, he passed the Patient Protection and Affordable Care Act (PPACA).
Many people do not feel the PPACA is the right way to go or that it has many shortcomings. With the 2012 presidential campaigns starting up, many candidates are focusing on the PPACA and making reforms to it.
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How did PPACA change private insurance?
The PPACA was a major health insurance reform policy. It has made some very important changes to how private insurance companies can write new policies.
The plan increased the coverage age of dependent children to 26 regardless of their status as a student. This is required of all policies already in effect if the dependent child is not eligible for their own insurance policy.
In 2014, all private health insurance companies will have to offer this even if the dependent qualifies for their own employee-sponsored insurance.
Health insurance policies written after September 2010 cannot set lifetime caps on coverage or unreasonable annual limits. In 2014, all annual limits will be done away with as well.
This keeps insurance companies from denying claims because you have had more health care related expenses then premiums paid in.
Polices that took effect after September 2010 will be protected from coverage being rescinded. As long as premiums are paid, the insurance company cannot deny your coverage once a policy is written. The exceptions to this are if fraud is committed or the policyholders intentionally misrepresent themselves.
Health insurance plans cannot apply exclusions on pre-existing conditions for dependent children under the age of 19. Plans written after January 1, 2014 will not be able to implement any pre-existing condition clauses.
All new insurance policies must offer immunizations and well-baby care without cost sharing. When a primary care provider must be assigned, each beneficiary must be able to have his or her own designated provider, which includes having a pediatrician for minors.
Pre-authorization requirements for emergency services either in network or out can no longer be required. In addition, an increase in cost sharing associated with these services cannot be imposed.
What changes did PPACA make to Medicaid?
The PPACA also made key changes to Medicaid. Medicaid is a government-funded program to offer health care to people who cannot afford private insurance or in certain cases not eligible.
One change the act made was to raise eligibility requirements. Individuals under the age of 65, who make less than 133 percent of the set federal poverty level, are now able to apply for Medicaid.
The previous limit was set at 100 percent. This will expand eligibility to people who could not qualify under the previous limit but could also not afford private insurance.
Medicaid is required to maintain their current coverage levels for all adults until 2013. Coverage levels for children must stay the same until 2019. Provisions were also put in place to get states to improve their outreach and enrollment programs.
The act also implemented new mandatory benefits. These included tobacco cessation for pregnant women, coverage of freestanding birthing centers, and helping with premiums from employer offered insurance.
States can now offer some optional benefits like preventive care for adults, healthy homes for people who suffer from chronic medical conditions, and community-based services.
The PPACA reduced the amount it will pay for hospital stays, prescription drugs, and emergency services. This is an effort to cut program costs and funding. The plan also created monitoring tools that will be required of all states and providers in which to comply.
What changes are presidential candidates promising?
The biggest debate surrounding the PPACA is whether it is constitutional. The Republican Party has been opposed to this type of health care reform since it first started. Their standpoint is that it is unconstitutional for the government to force people to purchase health insurance.
Democrats are in favor of a single pay health care plan. They want to impose more government control on health care standards and costs. Their plans are modeled after other countries, such as Canada, that use a government-run health care program only.
Republicans oppose government-run health care. They believe the quality of care will go down because standards will be lowered. They also look to other countries for examples of this.
Medicaid is another item in which the parties do not agree. The Democrats want to expand Medicaid coverage and increase spending. Republicans do not want this because taxes will need to be increased to fund these expansions.
Medicare will be a source of major debate for this election year as well. The Republican Party declared that they plan to do away with the Medicare program and replace it with a voucher program.
This plan would give elderly people on Medicare vouchers to use to purchase private insurance, allowing people to choose the coverage that best suited them.
Additional costs would fall on the individual though. The government would issue grants to each state each year. The states would then be responsible for dividing the funds and issuing voucher to qualified individuals.
Democrats oppose this plan. They feel that lower-income elderly will not be able to afford proper coverage and that vouchers will not be enough, opting to increase Medicare funding instead of doing away with it.
You can end up with a big headache trying to make any sense out of the way politicians work in America. Citizens just want the right to affordable healthcare and politicians seem more interested in winning votes.
Either way, the next election will be just as comical to watch as the last one. Obama’s plan has been the biggest positive change to healthcare in decades and offered many people access to healthcare they may have never received otherwise.
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