Obamacare bill or the Patient Protection and Affordable Care Act became law on March 23, 2010. Though the majority of Americans have a basic idea of this act, but they are not aware of the many components of the bill. The Affordable Care Act comes with 10 sections known as titles, and the Secretary of Health and Human Services has implemented these titles except for Titles VIII and IX, as these two titles are implemented by the Secretary of the Treasury Department.
Title 1 – Affordable and Quality Health care for All Americans
According to Title 1, all uninsured Americans from the year 2014 were required to buy health insurance or pay a federal tax. However undocumented immigrants were exempted from this, as they were not eligible for ACA coverage. Though the tax penalty for not having health insurance was repealed in 2019 and is no more in effect in the majority of the states. Only some of the states still have tax penalties. The health insurance exchanges were set up by the government to allow people to compare health plans. The exchanges were set up even by the states, who received federal funding to set these up. However, some of the states decided to use the federal-run exchange instead of opening their exchange. People also used these exchanges to find out their eligibility for Medicaid or tax credits.
Title 1 also requires businesses with 50 or more full-time employees to provide health insurance, as failing to do so they are required to pay an excise tax of $2,000 per employee leaving only the first 30 employees. Businesses having less than 100 employees were able to use the exchanges and businesses with 25 employees or less offering health insurance to their employees were offered a tax credit of 50%.
According to Title 1, health insurance companies were required to provide the following additional benefits:
- Health insurance companies were prevented from dropping from coverage in case if they become sick, and they were also not allowed to put a cap on their life-time coverage.
- Children can be included in their parent’s plans up to the age of 26 years.
- People with pre-existing conditions were no more denied coverage.
- Health plans were required to provide coverage for wellness and pregnancy exams
- health insurance carriers were required to spend a minimum of 80% of premiums on healthcare services or should give a discount to policyholders. On increasing the premium price they were supposed to give justification for the rate hike.
Title II – The Role of Public Programs
The Affordable Care Act extended Medicaid coverage in 2014 to include individuals below 138% of the federal poverty level under Medicaid. Due to the extended Medicaid coverage states were also allowed to cover low-income adults who don’t have children. Initially, the federal government paid 100% of the Medicaid expansion cost but after 2017 the federal government reduced assistance. The states that expanded Medicaid received more assistance compared to states that did not expand Medicaid.
Title III – Enhancing Efficacy and Quality of Health Care
The Affordable Care Act also bridges the gap present in Medicare Part D, prescription drug coverage called the doughnut hole. In the year 2011 50% of discounts were offered to medicare beneficiaries on branded prescription drugs during the coverage gap that has increased to 75% in the year 2020. The Medicare beneficiaries also receive free wellness and preventive care visits as per this Act.
Title IV – Improving Public Health and Preventing Chronic Diseases
To support preventive health care, the Affordable Care Act established Health Promotion, National Prevention, and Public Health Council. The Public Health Council was headed by the Surgeon General that comprises the heads of 12 federal agencies along with the others deemed appropriate by the Surgeon General. The seven factors based on which the National Prevention Strategy coordinates federal health efforts include:
- Healthy eating
- Tobacco-free living
- Active lifestyle
- Preventing excessive alcohol use and drug abuse
- Mental and emotional health
- Injury and violence-free living
- Reproductive and sexual health
Title V – Health Care Workforce
To increase the number of healthcare professionals such as primary care physicians, nurses, dentists, and mental health providers the ACA funds loans and scholarships. ACA also funded training programs in different areas for dentistry, cultural competency, and generic medicine.
Title VI – Transparency and Program Integrity
Doctors are required to report their financial interest if any with the imaging companies, and diagnostic centers and should provide a list of alternative service providers to patients, as per title VI of the ACA. It also requires pharmaceutical companies and medical device manufacturers to disclose their financial arrangements made with their doctors. Organizations managing the prescription drug part of Medicare or the state exchanges should report any financial concessions receiving from pharmaceutical companies. Title VI requires background checks for home nursing staff so that incidents like elder abuse are reduced and this title also provides training. This Title identifies high-risk providers to crack down on fraud and prevent them from establishing in another state. The states are also given power by this Title to test legal reforms to enhance the safety of the patient, have an effective resolution of disputes, and have better access to liability insurance.
Title VII – Better Access to Innovative Medical Therapies
Title VII of the Affordable Care Act provides discounts on drugs to hospitals serving low-income patients. This Title also ensures competitive pricing for vaccines and hormone therapies.
Title VIII – Community Living Assistance Services and Supports Act
Title VIII of the Affordable Care Act allows Americans with a disability to receive $50 per day toward assisted living. Disabled Americans are required to pay premiums for five years and work for three of those years. The collected amount was used for home health care, adult daycare, along with other services, thereby allowing them to stay in their homes. The amount was also used for assisted living facilities, nursing homes, and group homes. It was a self-funded program that would have reduced the deficit by $70.2 billion in ten years. This would have motivated people to continue working and live active, helping them to stay away from hospitals. This Title became effective on January 1, 2011, and by October 1 it was considered unworkable, as it was not able to compete with private-sector plans that offered better benefits.
Title IX – Revenue Provisions
Title IX of the ACA charge 40% of excise tax on carriers offering health plans whose annual premiums are above $8,500 for single coverage and $23,00 for family coverage. This Title also increases taxes on HSA amounts if it is not used for medical expenses and limited FSA contributions.
Title X – Strengthening Quality, Affordable Care
Title X of the ACA provides low-income patients access to vital family planning-related health care services, and it serves a vulnerable population, most are young females belonging to the low-income group. Title X facilities also provide vital preventive care that can identify serious health conditions. It provides healthcare that many low-income patients would otherwise not be able to afford.