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Understanding the Affordable Care Act: Key Elements and Future Challenges

The Affordable Care Act (ACA), passed in 2010, has reshaped the healthcare landscape with measures such as the ban on pre-existing condition exclusions and the establishment of exchanges for health insurance. While its implementation has faced court challenges and calls for repeal, essential benefits and comprehensive coverage remain focal points. With the integration of various government programs like Medicare and Medicaid, the ACA continues to evolve. This overview discusses the crucial elements, their implications, and potential future developments in healthcare reform.

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Understanding the Affordable Care Act: Key Elements and Future Challenges

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Presentation Transcript

  1. Health Care Reform Dee FitzGerald

  2. Terms of Endearment • Personal Protection and Affordable Care Act • Previous Conditions • Exchanges • Medical Loss Ratio • Rate Review • HIPPA-exception Plans • Essential Therapy • Comprehensive Major Medical Coverage

  3. ACA • Passed in 2010 • Staggered implementation • Court challenges • Target for repeal or major revision • Can not work independent of inclusion

  4. Pre-existing Conditions • One of two elements already in place • Popular desire – HIPAA • Minor insurance effect for large groups • Broad interpretation • Recidivism • Rescission

  5. Exchanges in 2014 • Everyone must be enrolled in one of segments below • “Essential” benefits (still undefined) mandated for individual and small group market • Stand-alone dental will have opportunity to separately offer “essential” children’s dental inside, but not outside exchanges • HHS and States to determine rules of the exchange, and whether non-essential benefits can be sold there • Government • Programs • Medicare • Medicaid • CHIP • TRICARE • Veterans Large Group Plans (101+ lives) Individual or Small Group Plans (≤100 lives) Offered Outside Exchange Offered Inside Exchange Grandfathered Plans (Individual, Small or Large Group)

  6. Medical Loss Ratio • Set by regulation and law • Dictated by a business model • The dilemma of corporate bonuses • Shareholders versus the Public • Wall Street versus Main Street • Medical costs related to GNP • Disparity of medical costs by age

  7. Rate Review • WellPoint and the Individual Market • United Health and Medicare • Regulators and the Public

  8. HIPPA-excepted Plans • The Delta Dental Story • What HIPAA was designed to fix • HIPAA and the electronic medical record

  9. Essential Therapy • What is Essential and Why? • Rehabilitation versus Habilative services • Who makes the interpretation? • Cross-state competition

  10. Ten General Categoriesand problem areas • Ambulatory Patient Services • Varicose vein treatment • Emergency Services • Non-emergency care in ER • Hospitalization • Total hip replacement • Maternity & Newborn Care • Fertility treatments • Mental Health & Substance Abuse • Unlimited stay • Prescription Drugs • “lifestyle” drugs • Rehabilitative and HabilitativeServices & Devices • Unlimited physical therapy • Laboratory Services • Biometric testing, DNA markers • Preventive & Wellness Services & Chronic Disease Management • Nutritional counseling • Pediatric Services; including oral & vision care • braces

  11. Comprehensive Major Medical • The concept of rationing care • Medical choice

  12. What Does the Future Hold? • What is likely to happen and when? • What is unlikely to happen? • What might affect this group?

  13. Questions?www.drdeekay.comwww.deefitzgerald.com

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