Changes That Affordable Care Act Made to Reform Payment for Healthcare Services.
With the help of Obamacare, millions of Americans have been able to conveniently access quality healthcare. President Obama signed the Bill to Law in 2010. Since then, wasteful spending has been immensely reduced and healthcare in America greatly streamlined. Americans can now access affordable health insurance covers. Every American (with some exceptions) is expected to pay for an elaborate insurance cover. The goal is to ensure that each American is covered. Anyone who fails to maintain health cover faces fees. For a person buying insurance, income and time covered are considered in order to come up with a fee structure.
Affordable Care Act has brought total transformation in insurance. Insurance companies are tasked with the provision of insurance policies and programs that conform to some set standards. For instance, they cannot overcharge anyone in the event of a deteriorated health status; they can only do that in case of age, residence and smoker status. In case of failure to conform to this, they cannot be allowed to operate in the Health Insurance Marketplace. This is different from the past when insurance companies used to exploit Americans by all means. Additionally, insurance companies must use a language that is easy to understand when elaborating their health insurance plans. Moreover, the Federal government controls the amount the insurance company charges on the premiums. Consecutively, it controls the amount of profit an insurance company can make. With this, the citizens are protected against any form of exploitation and manipulation.
With Obamacare, very few insurance covers are being cancelled. In the past, the cases of policies being cancelled in the event of cancer treatment were rampant. Insurance companies did not want to spend more on sickly patients and those suffering from fatal diseases. Nowadays, they can only cancel ones cover in case of non-conformity, fraud or default in payment of premiums. However, all decisions regarding a claim must be well elaborated with the reasons for the denial of a claim (Kinney, 2015, p. 66). The insurance company should also advice on how a client can retract the declined claim.
Concurrently, states that are providing Medicaid programs are tasked with the provision of such benefits to all eligible citizens. With Medicaid expansion, states are not limited to poverty levels; they can provide the benefits to all eligible citizens. This has spread in the majority of the states with many Americans expressing satisfaction with the service.
In almost all states, families with children are expected to acquire dental insurance for the children. Moreover, children can remain on their parents insurance covers for up to 26 years (Emanuel, 2014). In addition to this, they can enjoy catastrophic plans until the age of 30. Unlike in the past, you can enjoy emergency room access even without prior arrangements with your insurer.
Values Considered in the Goal of Assuring that Almost Everyone in the United States Has Some Sort of Healthcare Insurance and Its Comparison with Netherlands.
The United States is undergoing a transition in its structures and systems after adopting the Affordable Care Act. The government of Netherlands has already adequately regulated the healthcare sector and achieved enormous success. This is why the two countries are world leaders in provision of quality healthcare.
Netherlands and the United States share a similar healthcare system. Like the US, the Dutch government has set up in place distinct regulations to curb any form of exploitation and avail quality healthcare to its citizens. For instance, the citizens can enjoy the services of private doctors, government subsidies, low taxation and flat-rates.
Netherlands tops in provision of the best healthcare in the entire European Union. They use a chaos system that gives patients liberty to choose insurance companies to buy covers from and where to seek healthcare. However, unlike in other countries, the chaos system in Netherlands is regulated.
The two countries have invested heavily in healthcare. In terms of healthcare spending, Netherlands comes second after the United States. This can be credited for the high life expectancy in the United States and Netherlands with 80 and 78 respectively. In Netherlands, it is mandatory to have a health insurance cover for both middle and low income earners and this has been the case since 1941 (Papanicolas & Smith, 2013, p. 98). Citizens with high incomes go for private health insurance. Similar to the United States, where premiums charged by insurance companies are regulated by the government, in Netherlands, insurance companies must also charge premiums accepted by the community.
In the US, decision making is devolved to states. For instance, the Supreme Court ruling left it to the governors and state leaders to decide whether they want to adopt the Medicaid coverage to their states or not. Most governors adopted it, whereas others expressed fear that it would burden the States financially (Faguet, 2013, p.115-124). In contrast, Dutch medical legislation, drug prescriptions, prices and the delivery of services are the same all over the country.
Impacts of Non-expansion of Medicaid Coverage to All States and Its Effects on the Lower Income Americans in These States.
The non-expansion of Medicaid coverage by some states had detrimental implications for the lower income Americans in those states. The primary intention of the ACA was to expand Medicaid in all states and have lower income Americans access insurance covers. However, it has not been received well in all states, with some states expressing budget concerns.
The Supreme Court ruling on Medicaid coverage left it open for governors and state leaders to choose whether the states they represent will adopt the Affordable Care Act or not. Some decided to adopt it while others chose to forego it (Rawal, 2016, p. 12). For instance, in 2015, Governor of Alabama Robert Bentley took a go-slow position on the expansion of Medicaid to the state. He insisted that Alabama would think over it and would not join at that time.
In such states, lower income Americans who meet the Medicaid requirements but are below the average poverty level would find Medicaid or the normal covers out of reach. As a result of the low incomes they would find healthcare covers too expensive, leaving many uninsured. The research shows that around 11.5 million people in America are uninsured. Additionally, figures show that these people are low income earners who would not afford to pay the periodic premiums (Emanuel, 2014).
Another implication of the non-expansion of Medicaid coverage is that the lower income Americans strive extra hard in order to qualify for health insurance. Such people work long hours just to attain eligibility. For instance, Texas has close to 1 million people without health insurance covers (Selker & Wasser, 2014, p. 74). The high figures can be attributed to laxity in adopting the Medicaid policy, leaving most citizens working extra hours and the ones who fail to reach 100 percent of the poverty level locked out from accessing vital health provisions. Only the high income earners and middle income earners end up having access to quality healthcare while the low income Americans end up uninsured as they cannot afford to pay for the expensive covers. This is contrary to the primary mandate of Medicaid as it aims at the provision of affordable healthcare to all Americans regardless of the income they earn. States that fail to adopt the policies deprive the citizens of the right for essential healthcare.
In conclusion, lower income Americans risk going uninsured in the states that have been reluctant in adopting Medicaid coverage to expand the Affordable Care Act. Without Medicaid, many low-income earners are locked out. In some cases, adults without children are denied access to Medicaid.