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Affordable Care Act Pros And Cons Pdf

affordable care act pros and cons pdf

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Facing the paradox of rising health care expenditure and an average life expectancy that is below the advanced OECD economies, the US has embarked on a massive health system strengthening exercise that has had no equivalent during the last half century.

Diagnosing Four Pros and Four Cons of Obamacare

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Learn more here. This final rule sets forth payment parameters and provisions related to the risk adjustment and risk adjustment data validation programs; cost-sharing parameters and cost-sharing reductions; and user fees for Federally-facilitated Exchanges and State-based Exchanges on the Federal platform.

It also finalizes changes related to essential health benefits and will provide states with additional flexibility in the operation and establishment of Exchanges. The rule includes changes related to cost sharing for prescription drugs; notice requirements for excepted benefit health reimbursement arrangements offered by non-Federal governmental plan sponsors; Exchange eligibility and enrollment; exemptions from the requirement to maintain coverage; quality rating information display standards for Exchanges; and other related topics.

This final rule also repeals regulations relating to the Early Retiree Reinsurance Program. Usree Bandyopadhyay, , Kiahana Brooks, , or Evonne Muoneke , for general information. David Mlawsky, , for matters related to excepted benefit health reimbursement arrangements HRAs.

Allison Yadsko, or Krutika Amin, , for matters related to risk adjustment. Joshua Paul, , for matters related to the premium adjustment percentage.

Alper Ozinal, , for matters related to timely submission of enrollment reconciliation data and dispute of HHS payment and collections reports. Rebecca Zimmermann, , for matters related to value-based insurance plan design. Becca Bucchieri, , for matters related to essential health benefit EHB -benchmark plans and defrayal of state-required benefits.

Jill Gotts, , for matters related to eligibility appeals. Emily Ames, , for matters related to coverage effective dates and termination notices.

Marisa Beatley, , for matters related to employer-sponsored coverage verification and periodic data matching PDM. Carolyn Kraemer, , for matters related to special enrollment periods under part LeAnn Brodhead, , for matters related to cost-sharing requirements. Christina Whitefield, , for matters related to the medical loss ratio MLR program. Jenny Chen, , Shilpa Gogna, or Nidhi Singh Shah, , for matters related to quality rating information display standards for Exchanges.

Legislative and Regulatory Overview. Stakeholder Consultation and Input. Structure of Final Rule. Collection of Information Requirements. Regulatory Impact Analysis. Regulatory Alternatives Considered. Regulatory Flexibility Act. Congressional Review Act. Reducing Regulation and Controlling Regulatory Costs. Many individuals who enroll in QHPs through individual market Exchanges are eligible to receive a premium tax credit PTC to reduce their costs for health insurance premiums and to receive reductions in required cost-sharing payments to reduce out-of-pocket expenses for health care services.

The PPACA also established the risk adjustment program, which is intended to increase the workability of the PPACA regulatory changes in the individual and small group markets, both on and off Exchanges. On January 20, , the President issued an Executive Order which stated that, to the maximum extent permitted by law, the Secretary of HHS and heads of all other executive departments and agencies with authorities and Start Printed Page responsibilities under the PPACA should exercise all authority and discretion available to them to waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the PPACA that would impose a fiscal burden on any state or a cost, fee, tax, penalty, or regulatory burden on individuals, families, health care providers, health insurers, patients, recipients of health care services, purchasers of health insurance, or makers of medical devices, products, or medications.

In this final rule, we are, within the limitations of current law, finalizing provisions to reduce fiscal and regulatory burdens across different program areas and to provide stakeholders with greater flexibility.

In previous rulemakings, we established provisions and parameters to implement many PPACA requirements and programs. In this final rule, we are amending some of these provisions and parameters, with a focus on maintaining a stable regulatory environment.

These changes are intended to provide issuers with greater predictability for upcoming plan years, while simultaneously enhancing the role of states in these programs. The provisions will also provide states with additional flexibilities, reduce unnecessary regulatory burdens on stakeholders, empower consumers, ensure program integrity, and improve affordability. In the proposed rule, we solicited comments on modifying the automatic re-enrollment process for enrollees who would be automatically re-enrolled with advance payments of the premium tax credit APTC that would cover the enrollee's entire premium.

We also announced that, pending such future rulemaking, HHS will not take enforcement action against Exchanges that do not implement a random sampling methodology during plan years and Risk adjustment continues to be a core program in the individual and small group markets both on and off Exchanges, and we are finalizing the proposals to recalibrate the risk adjustment models used in the state payment transfer formula of the HHS-operated risk adjustment methodology, among other updates.

As a refinement to the risk adjustment program, we are finalizing changes intended to improve the reliability of risk adjustment data validation RADV.

As we do every year in the HHS notice of benefit and payment parameters, we are finalizing the user fee rates for issuers offering plans through the Exchanges using the Federal platform.

As we do every year, we are updating the maximum annual limitation on cost sharing for the benefit year, including those for cost-sharing reduction CSR plan variations. These updates, which are required by law, will raise the annual limit on cost sharing, thereby increasing cost sharing and out-of-pocket spending for consumers who have out-of-pocket spending close to the annual cost-sharing limit. We are committed to promoting a consumer-driven health care system in which consumers are empowered to select and maintain health care coverage of their choosing.

To this end, we provide information to QHP issuers on ways in which they can implement value-based insurance plan designs that would empower consumers to receive high value services at lower costs. These value-based insurance plan designs will empower consumers and their providers to make evidence-based health decisions.

We also finalize new rules related to special enrollment periods. We will allow Exchange enrollees and their dependents who are enrolled in silver plans and become newly ineligible for CSRs to change to a QHP one metal level higher or lower, if they choose.

We will require Exchanges to apply plan category limitations to dependents who are currently enrolled in Exchange coverage and whose non-dependent household member qualifies for a special enrollment period to newly enroll in coverage.

We will also shorten the time between the date a consumer selects a plan through certain special enrollment periods and the effective date of that plan. In addition, we will allow all enrollees granted retroactive coverage through a special enrollment period the option to select a later effective date and pay for only prospective coverage. We also finalize the proposals to allow individuals and their dependents who are provided a qualified small employer health reimbursement arrangement QSEHRA on a non-calendar year basis to qualify for the existing special enrollment period for individuals enrolled in any non-calendar year group health plan or individual health insurance coverage.

We will also allow enrollees whose requests for termination of their coverage were not implemented due to an Exchange technical error to terminate their coverage retroactive to the date they attempted the termination, at the option of the Exchange. To increase transparency in terminations of Exchange coverage or enrollment, we will require termination notices be provided in all scenarios where Exchange coverage or enrollment is terminated.

We also will require excepted benefit health reimbursement arrangements HRAs sponsored by non-Federal governmental entities to provide a notice to participants that contains specified information about the benefits available under the excepted benefit HRA. In addition, we are finalizing changes to the quality rating information display requirements for Exchanges. To continue providing flexibility for State Exchanges, we are codifying in regulation the option for State Exchanges that operate their own eligibility and enrollment platforms to display the quality rating information provided by HHS or to display quality rating information based upon certain state-specific customizations of the quality rating information provided by HHS.

Stable and affordable Exchanges with healthy risk pools are necessary for ensuring consumers maintain stable access to health insurance options.

We are sharing our future plans for rulemaking to allow Exchanges to conduct risk-based employer sponsored coverage verification and to remove the requirement that Exchanges select a statistically random sample of applicants when no electronic data sources are available. In order to make it easier for issuers to offer wellness incentives to enrollees and promote a healthier risk pool, we are finalizing the proposal that explicitly allows issuers to include certain wellness incentives as quality improvement activities QIA in the individual market for MLR reporting and calculation purposes.

We are also finalizing annual state reporting of state-required benefits that are in addition to essential health benefits EHB , for which states are required to defray the costs.

This will help to ensure that federal APTC dollars are protected and states are appropriately compensating enrollees or issuers for services that are in addition to EHB. We are finalizing changes to the policy regarding whether drug manufacturer coupons must be applied towards the annual limitation on cost sharing. However, we are not finalizing any change to the definition of cost sharing. We are finalizing additional steps to ensure the proper execution of PPACA requirements and to safeguard and conserve federal funds.

To protect against unnecessary overpayments of APTC funds, we will streamline the process for terminating coverage of enrollees who die while enrolled in Exchange coverage. In order to ensure that MLR reporting and rebate calculations are accurate, we are finalizing the proposal that issuers must report expenses for functions outsourced to or services provided by other entities consistently with issuers' non-outsourced expenses, and require issuers to deduct prescription drug rebates and price concessions from MLR incurred claims, not only when such rebates and price concessions are received by the issuer, but also when they are received and retained by an entity that provides pharmacy benefit management services to the issuer.

Further, we are finalizing that where enrollees provide consent for the Exchange to end their QHP coverage if they are found to be dually enrolled in other qualifying coverage during the Exchange's periodic data matching PDM process, the Exchange will not be required to redetermine the enrollee's eligibility for financial assistance and may discontinue coverage consistent with the consent given by the enrollee.

The program sunset by law as of January 1, Section a of the PHS Act, which is effective for plan or policy years beginning on or after January 1, , extends the requirement to cover the EHB package to non-grandfathered individual and small group health insurance coverage, irrespective of whether such coverage is offered through an Exchange. In addition, section b of the PHS Act directs non-grandfathered group health plans to ensure that cost-sharing under the plan does not exceed the limitations described in sections c 1 of the PPACA.

The law directs that EHBs be equal in scope to the benefits provided under a typical employer plan, and that they cover at least the following 10 general categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.

Section e 1 of the PPACA grants the Exchange the authority to certify a health plan as a QHP if the health plan meets the Secretary's requirements for certification issued under section c of the PPACA, and the Exchange determines that making the plan available through the Exchange is in the interests of qualified individuals and qualified employers in the state.

Section c 4 of the PPACA authorizes the Secretary to establish an enrollee satisfaction survey that evaluates the level of enrollee satisfaction of members with QHPs offered through an Exchange, for each QHP with more than enrollees in the prior year. This section also requires a state to make payments, either to the individual enrollee or to the issuer on behalf of the enrollee, to defray the cost of these additional state-required benefits.

Section c of the PPACA generally requires a health insurance issuer to consider all enrollees in all health plans except grandfathered health plans offered by such issuer to be members of a single risk pool for each of its individual and small group markets. States have the option to merge the individual and small group market risk pools under section c 3 of the PPACA.

Affordable Care Act (Obamacare)

The federal Affordable Care Act ACA includes a special focus on providing newly required coverage for a wide range of health preventive and screening services. This coverage began back in September for some newly issued health plans; effective January 1, , it applies much more broadly, to plans offered in the individual, small, and some large group markets. There are and can be exceptions for some grandfathered employer plans and policies bought by persons who are exempt from the individual coverage mandate. For commercial health insurance, both inside and outside of health exchanges, this no-cost feature applies only when these services are delivered by a network provider. The material and service-specific links below includes material posted online by HHS at www. Effective August 1,

Website and registration issues aside, is Obamacare working? What does the future hold for the Affordable Care Act ACA , and what will its effects on the economy and labor market be? Those are the trillion-dollar questions a recent campus panel debated days before Healthcare. While they debated passionately the particularities of the Affordable Care Act, the experts also came to a consensus on the following points:. In its most basic form, it is successful in restructuring the system to engender more respect for the elderly and for individuals living below the poverty line without consistent access to medical treatment. The ACA should work to standardize coverage offered by different insurers and encourage movement and responsiveness in the labor force. The ACA might help encourage entrepreneurship and increase startup growth by eliminating the fear of being unable to provide employees with affordable health insurance.


PDF | On Mar 1, , Elizabeth M. Dolan and others published The Patient Protection and Affordable Care Act (ACA): Pros and Cons | Find.


A Guide to Obamacare

Obamacare has become a common term, but what is it? Download this report to see charts showing data for industry, family status, region to see if a QSEHRA will work for you. Including cost comparisons, case studies, and other tools. PPACA was signed into law in and represents one of the biggest changes to the American healthcare industry.

The Patient Protection and Affordable Care Act (ACA): Pros and Cons

Diagnosing Four Pros and Four Cons of Obamacare

Also: verification requirements under the new law. Since January , changes in immigration enforcement policy and increased enforcement activity have caused fear among immigrants and their families, undermining trust in government agencies and resulting in eligible people going without access to health care and other critical programs. Members of immigrant families may ask people helping with the health insurance application process if it is safe to apply for health coverage programs, particularly if their family includes someone who is not authorized to be in the United States.

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The act aimed to provide affordable health insurance coverage for all Americans. The ACA was also designed to protect consumers from insurance company tactics that might drive up patient costs or restrict care. Millions of Americans have benefitted by receiving insurance coverage through the ACA. Many of these people were unemployed or had low-paying jobs. Conservatives objected to the tax increases and higher insurance premiums needed to pay for Obamacare. Some people in the healthcare industry are critical of the additional workload and costs placed on medical providers. They also think it may have negative effects on the quality of care.


The Affordable Care Act (ACA), of , or Obamacare, was the most monumental change in US health care care, while workers were con- benefits are subject to interpretation of the insurance companies. pdf. Long SK, Dimmock TH. Health in- surance coverage and health care ac- cess and.


Table of Contents

В его ноздрях торчала английская булавка. Беккер показал на бутылки, которые смахнул на пол. - Они же пустые. - Пустые, но мои, черт тебя дери. - Прошу прощения, - сказал Беккер, поворачиваясь, чтобы уйти. Парень загородил ему дорогу.

Сидя рядом с великим Тревором Стратмором, она невольно почувствовала, что страхи ее покинули. Переделать Цифровую крепость - это шанс войти в историю, принеся громадную пользу стране, и Стратмору без ее помощи не обойтись. Хоть и не очень охотно, она все же улыбнулась: - Что будем делать. Стратмор просиял и, протянув руку, коснулся ее плеча. - Спасибо.  - Он улыбнулся и сразу перешел к делу.

Он ни разу не посмотрел по сторонам. - Это так важно? - полувопросительно произнес Джабба. - Очень важно, - сказал Смит.  - Если бы Танкадо подозревал некий подвох, он инстинктивно стал бы искать глазами убийцу. Как вы можете убедиться, этого не произошло. На экране Танкадо рухнул на колени, по-прежнему прижимая руку к груди и так ни разу и не подняв глаз. Он был совсем один и умирал естественной смертью.

ИСТЕКШЕЕ ВРЕМЯ: 15:17:21 - Пятнадцать часов семнадцать минут? - Он не верил своим глазам.  - Это невозможно. Он перезагрузил монитор, надеясь, что все дело в каком-то мелком сбое. Но, ожив, монитор вновь показал то же. Чатрукьяну вдруг стало холодно.

Фонтейн давно всем доказал, что близко к сердцу принимает интересы сотрудников. Если, помогая ему, нужно закрыть на что-то глаза, то так тому и. Увы, Мидж платили за то, чтобы она задавала вопросы, и Бринкерхофф опасался, что именно с этой целью она отправится прямо в шифровалку. Пора готовить резюме, подумал Бринкерхофф, открывая дверь. - Чед! - рявкнул у него за спиной Фонтейн.

 - Никакая это не паранойя. Этот чертов компьютер бьется над чем-то уже восемнадцать часов. Конечно же, все дело в вирусе.

1 Comments

  1. Babette C.

    15.12.2020 at 20:59
    Reply

    The questions Q and answers A below attempt to answer most of the common questions; however, this document is only intended to highlight some of the ACA requirements applicable to student health insurance plans.

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