The ACA provides all Americans with some level of healthcare coverage. This includes an uptick in preventive care, a reduction in healthcare costs and makes physicians and hospitals responsible for quality care.

The Patient Protection and Affordable Care Act (PPACA), commonly called the Affordable Care Act (ACA) was signed into law on March 23, 2010. The ACA is the most significant overhaul in the U.S. healthcare system since 1965, when Medicare and Medicaid started.

According to the ACA, "affordable insurance" means paying no more than 8% of a person’s annual income on the federal Marketplace or 9.5% of family income for insurance purchased through an employer.

Introduction to the Law

The ACA contains provisions taking effect from 2010 to 2020, most of them by January 1, 2014. The ACA addresses medical insurance and calls for reform to inefficient areas of the healthcare system and those that increase taxpayer costs.

The ACA does not offer public or government-run health insurance. It offers more private insurance options in every state.

ACA Purposes

• Increase the quality and affordability of health insurance
• Expand public and private medical insurance coverage to lower the number of uninsured Americans
• Reduce the cost of healthcare

ACA Benefits

• Reduce cost for individuals by capping out-of-pocket costs
• Requires all preventive care to be fully covered and without cost to the individual

The Actual Law

The ACA is 2,409 pages and contains ten titles, each of which delineates a different facet of the healthcare system.

Title I Quality Affordable Health Care for All Americans

• Everyone must have coverage
• No one can be turned down due to a preexisting illness
• Those who cannot afford coverage will get assistance or be entitled to Medicaid, if they are under the 133% poverty level

Title II Role of Public Programs

• Includes Medicaid and Indian Health Services
• Development of medical care homes and home-based care for the chronically ill

Title III Improving Quality and Efficiency of Health Care

• Changes fee structure from fee-for-service to payments based on the quality of care delivered

Title IV Prevention of Chronic Disease and Improving Health

• Timely prevention and treatment of chronic illness to help avoid expensive complications
• Reduce preventable illness and disability to keep healthcare; this includes yearly physicals, maternity care, mental health care, mammograms and colonoscopies at no out-of-pocket cost
• Elimination of co-payments for seniors for preventive care

Title V Health Care Workforce

• Prevent shortage of healthcare workers, especially primary care physicians (PCP)
• Fund scholarships and loan repayment to help students entering the healthcare related professions

Title VI Transparency and Program Integrity

• Reduce fraud and abuse to save billions of dollars annually
• Providers penalized in one state will be prevented from practicing in another state
• Access to more data for physicians and patients allows better decision-making about treatment plan
• Better regulation of nursing home standards

Title VII Improving Access to Innovative Therapy

• Improved access to generic drugs, especially for seniors

Title VII Community Living Assistance Services and Support

• Long-term care insurance program, similar to current Social Security disability; this is unlikely to be implemented

Title IX Revenue Provisions

• Delineates paying for the ACA healthcare plan

Title X Strengthening Quality Affordable Health Care for All Americans

• Pilot and special interest programs to strengthen and support the law

Individual and Healthcare Provider Impact

Individuals

This law is a tax, not a federal mandate to have medical insurance.

60% of personal bankruptcies are the result of medical bills. The ACA helps prevent this by eliminating annual and lifetime limits.

Most Americans must have health coverage in 2014 or pay a fee/penalty to the federal government. The fee/penalty or Individual Mandate is $95 per adult, $47.50 per child or 1% of the individual’s income, whichever is higher. It will be paid on a person’s federal income tax return.

Exemptions to the law:

• Individuals on Medicare, Medicaid or COBRA are covered; no change is needed
• Job-based insurance is acceptable coverage; individuals can search the Marketplace for a better deal based on income level
• Any personally purchased, retiree or VA health coverage is acceptable

As of October 1, 2013, individuals can search the Health Insurance Marketplace to find the appropriate and affordable health coverage. The Marketplace offers open enrollment until March 31, 2014.

Marketplace assistance is available to Americans making $45,960 for an individual or $94,200 for a family of four.

Young adults can stay on their parent’s health insurance until they are 26 years old. About 82% or about 16 million young adults qualify for cost assistance or Medicaid through the ACA.

About half of Americans purchasing medical insurance from the Marketplace can do so for under $100. Many low income Americans will have a free insurance option. In some states, smokers will pay up to 50% more than non-smokers for the same coverage plan, a tobacco surcharge.

Healthcare Institutions

The bill has incentives for healthcare institutions and professionals to improve care.

Keeping patients healthier before they become Medicare eligible is important. It will reduce Medicare payment to hospitals caring for previously uninsured patients.

Hospitals and Nursing Jobs

Title III delineates the fact that insurance payment is changing from fee-for-service to a quality of delivery system, especially by Medicare. Once Medicare makes any such transition, private insurance usually follows the same payment plan. This is a major step towards controlling healthcare costs.

Medicaid payments will be raised to match what Medicare pays doctors. Therefore, PCPs will see an average 73% pay increase. It will be easier for Medicaid patients to locate a doctor who accepts their coverage.

Nursing is impacted because the bill provides financial support for advanced practice and general nursing education. The ACA includes a grant program for nurse-managed health clinics, which helps compensate for the shortage of family physicians and solidifies the need for more nurse practitioners.

Hospital-based nurses will experience a higher census. The focus of the ACA and reimbursement to the hospital is to improve care and prevent re-admissions. Hospitals need sufficient nursing staff to prevent patient complications.

The End Result

The ACA provides all Americans with some level of healthcare coverage. This includes an uptick in preventive care, a reduction in healthcare costs and makes physicians and hospitals responsible for quality care. It is the law; all Americans must address their health insurance coverage options or pay the tax to be exempt.