University of Nebraska Medical Center

Health Care Reform

source: reid.senate.gov. President Obama signing the Affordable Care Act in March 2010.

Public Health in the National News – Health Care Reform
By Jim Stimpson, PhD, Associate Professor, Department of Health Services Research and Administration

The Affordable Care Act of 2010 was the most sweeping change to the US health care system since the passage of Medicare and Medicaid in 1965. There are 10 titles of the law, which touch nearly every aspect of the US health care system:

1.   Quality, affordable health care for all Americans
2.   Role of public programs (Medicaid and the Children’s Health Insurance Program)
3.   Improving the quality and efficiency of health care (Medicare and more)
4.   Prevention of chronic disease and improving public health
5.   Health care workforce
6.   Transparency and program integrity
7.   Improving access to innovative medical therapies
8.   Community living assistance services and supports (CLASS Act)
9.   Revenue provisions
10.  Strengthening quality, affordable health care for all Americans

The main goal of the law is to expand access to coverage by requiring US citizens and legal residents to have health insurance. The process of selecting health insurance will be facilitated by state-run health insurance exchanges, which are centralized marketplaces where consumers can purchase insurance. Persons who choose to not have health insurance could incur a tax penalty. There are also requirements and penalties for business depending on the number of employees. The requirement for individuals to obtain health insurance coverage is among the most controversial aspects of the law. The Supreme Court is expected to rule on this issue sometime in 2012.

There are over 90 specific provisions in the law, which will be implemented through 2018. Since the passage of the law in 2010, 48 provisions have gone into effect. The Kaiser Family Foundation has an interactive tool to track the implementation of the law over time (http://healthreform.kff.org/Timeline.aspx). Recently, the US Department of Health and Human Services, which is in charge of implementing the law, reported that title 8 of the law, community living assistance services and supports (usually referred to as the CLASS Act), will not be implemented because analyses concluded that the title is not financially self-sustaining.

So far, implementation of the health reform law has produced several benefits for Americans, including the following:
A Patient’s Bill of Rights protects consumers by prohibiting insurers from denial of coverage to children with pre-existing conditions and from making lifetime dollar limits on coverage.

New tools crack down on unreasonable health insurance premium increases and ensure that at least 80% of premium dollars are spent on quality care, not administrative costs.

Young adults up to age 26 can be covered through a parent’s private health insurance plan.

Research dollars, which are being managed primarily by the Center for Medicare and Medicaid Innovation (http://innovations.cms.gov/) and the Patient-Centered Outcomes Research Institute (http://www.pcori.org/), have been allocated to test innovative ways to deliver quality, patient-centered care.


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