Patient Protection and Affordable Care Act: What You Need to Know About Obamacare

Patient care has always been a secondary action of the American government. Dependent on health insurance, citizens of that country saw the situation change starting in 2010 with the creation of the Affordable Care Act (ACA).

A 2018 government report saw 11.8 million Americans re-enrolling in health insurance plans, with 27% being new users. This was about 400,000 people fewer than in 2017—a number lower than expected. A 2020 Gallup survey showed that 55% of Americans were "very concerned" about access, medical assistance, and patient care—the fifth consecutive year that health care topped the list of issues.

What is the PPACA (Patient Protection and Affordable Care Act)?

The PPACA (Patient Protection and Affordable Care Act), also known as the ACA (Affordable Care Act), became known as Obamacare. This is because it was implemented in 2010 by then-President Barack Obama, with the goal of making a broad reform of health care, focusing on patient care.

Obamacare's principle was to ensure that all Americans had access to health insurance. This is because, in the United States, there is no national service like Brazil’s SUS (Unified Health System). According to surveys at the time of its implementation, 15% of the population had no health insurance coverage.

This gap in the system occurred because, in addition to not having health insurance through their jobs or individually, people were also not covered by government health insurance plans. In the U.S., the poor are covered by Medicaid, and the elderly have medical coverage through Medicare.

Through the Affordable Care Act, all residents of the United States were required to purchase some form of health insurance. In other words, those without insurance would pay a penalty that started at 1% of income, increased to 2%, and from 2016, rose to 2.5%.

With Obamacare, people who were previously without health insurance would now receive state subsidies when buying insurance through marketplaces like healthcare.gov. This was expected to reduce the individual market for insurers, where only wealthy citizens could afford health insurance, marginalizing others.

Rules for Accessing Obamacare

In addition to allowing more people to access insurers, Obamacare also changed the rules for access. For example, if someone had a pre-existing condition before, their request for health insurance could be denied, forcing them to pay astronomical amounts at the hospital if they needed care. With the Affordable Care Act, no one can be discriminated against.

Furthermore, the law allowed children up to 26 years old to be included in their parents' health insurance plans, significantly reducing insurers' expenses by bringing in younger, and theoretically healthier, individuals into the system.

And What About Financially Struggling Individuals?

For the poor or those over 65 years old, the U.S. Federal Government provides two programs funded by government resources: Medicare and Medicaid.

Medicare is a social insurance program created in 1966. It is funded by the Federal Government and offers medical care and patient care to individuals over 65 who have paid health taxes during their working years. The system also covers people with disabilities or conditions that prevent them from working, as well as those with terminal illnesses.

Medicare Services

Medicare is divided into four types of services, not all beneficiaries have access to:

• A – Hospital Insurance: Covers hospital admissions, care in specialized nursing centers, palliative care, and some home health care.
• B – Medical Insurance: Covers medical services, outpatient care, supplies, and preventive health services.
• C – Medicare Advantage Plan: These are health plans within Medicare offered by a private company to its employees, including the benefits of parts A and B. In this case, the company pays for the services and has reductions or tax exemptions as compensation.
• D – Prescription Drug Coverage: Plans offered by private health insurance companies or Medicare-approved insurance companies. They cover the purchase of prescription medications.

Medicaid, on the other hand, is a health program that serves individuals of any age with extremely limited financial resources. Unlike Medicare, which is funded by U.S. social security, Medicaid is funded by the federal government in conjunction with state governments. In this model, governments reimburse hospitals and doctors who provide treatment to people who cannot afford their own medical expenses.

This model benefits certain groups of people, such as low-income families and children who already receive supplementary security income from the state government.

Source: Nexto

At 2easy Insurance, we are committed to helping you understand your health choices. Learn more about our medical assistance services and how we can protect you in critical moments by clicking here. Your health is our priority.