Health Insurance Exchanges ( Hix )

Insurance can be purchased through private companies or the Marketplace. The Marketplace provides “income-based premium subsidies for low and middle income people.”

There is a connection between socio-economics and health.79 Therefore, it’s expected when a states decided to expand Medicaid for more low-income residents, and then that population of people tend to be sicker than the rest of the population (Gershon & Sullivan, 2014). These reasons for expanding Medicaid will transfer those individual’s off the exchange policy into Medicaid, especially those within 100%-133% FPL range. Medicaid expansion could cause the exchange risk pools to become healthier, which means a healthier-risk pool that may be a financial boom for insurance companies that have participated in the exchange. Insurers that participate in the exchange are subject under law, to loss of medical ratio’s; which prevents them from retaining more than a certain level of profit (Gershon & Sullivan, 2014). In cost savings, with a healthier- risk pool possibly can be passed down for other consumer’s to use.

Health Insurance Marketplaces are virtual spaces run by the federal government or by states, where the customers can see different plans and prices offered by insurance providers.

Medicaid is a social health care program that covers nearly 60 million Americans, including children, pregnant women, seniors, parents and individuals suffering with disabilities. Medicaid is the biggest source of funding for health related services and medical needs for the people with low income in the United States. This program is funded jointly by the state and federal level governments, but it is the state’s responsibility to manage this program. The Medicaid program is not a required program that states have to use, but all 50 states have implemented this program. With the introduction of the Affordable Care Act (ACA), and its passing in 2010, the ACA unveiled its plans to expand Medicaid eligibility to nearly all low-income adults as an addition to the other groups that fall into the Medicaid eligibility. The Medicaid program had “many gaps in coverage for adults” because it was only restricted to the low income individuals and other people with needs in their own specific category. In the past, the majority of the states who had adults that did not have children dependent on those parents were not eligible for Medicaid. These low income adults without dependent children would be without medical insurance assistance before the ACA was introduced. Medicaid is now available to all Americans under the age of 65 whose family income is at or below the federal poverty guideline of “133 percent or $14,484 for an individual and $29,726 for a family of four in 2011” (NSCL).

ACA expanded Medicaid to all Americans below 133% of the federal poverty level from the previous cut-off at 138 percent. The enrollment for Medicaid and CHIP has been simplified. ACA prohibits insurance companies from denying coverage based on pre-existing conditions. This is known as guaranteed issue. ACA also extends dependent coverage for young adults unto the age of 26; so they can stay insured on their parent’s insurance. Individuals upto 400% of the federal poverty level are entitled to tax subsidies in order to assist them in having a health insurance. The subsidy is meant to achieve 2 goals: (1) provide sufficient funds to ensure that people can afford their health insurance premiums and (2) provide a financial incentive for people to choose lower-cost plans. These two goals are opposing, but both are essential. Families who earn more than 400% of the FPL can also purchase health insurance from the exchange, but they receive no subsidy.

A series of events has recently occurred to cause the passage of PPACA. Economics are explicitly linked to health care. In the United States, health care coverage is provided primarily through an employer-based system. This system began in the depression era when pay was federally frozen. Companies, in an attempt to lure scarce workers, used benefits packages including health care as bait. Described as a “uniquely American” “private social security” health care system, the employer-sponsored system is the “cornerstone” of United States health care system (Blumenthal, 2006). This system has left many un- or under-insured. Blumenthal states (2006), “The United States’ dependence on employer-sponsored insurance means that the protection of its citizens against the costs of illness depends directly on the ability of private businesses to manage and absorb health care expenses that have defied all efforts to contain them.” Recently, economic downturn and the need to reduce expenses to better compete on the global market has caused many companies to both reduce their insurance benefits package and their work force causing many to lose their health care coverage. The employer-based system merged with the economic downturn, unaffordable health care costs for businesses, and

Obamacare expands Medicaid and created a Health Insurance Marketplace, a universal way to sign up for subsidized health care plans. It makes it easier for low income families to receive benefits from Medicaid and other unsubsidized loans. Over half of uninsured Americans can get free or low cost health insurance, and some can get help on out-of-pocket costs using their state’s Health Insurance Marketplace. Through the Marketplace, though, you can only get certain plans from certain providers, as many of them are unwilling to provide subsidized loans. Protections from Obamacare also ensure that you can’t be dropped from … or denied coverage or treatment for

Understanding the Affordable Care Act (ACA) can be problematic, the goal of the ACA is to address the fact that millions of Americans do not have health insurance, yet they are contributors to the health care market, consuming health care services for which they do not pay. While this may seem to be a great idea, many Americans are not really sure how they are affected by this Health Care Reform. The goal is to make health insurance affordable, secure, and reliable for all. The ACA is a minimum coverage provision, individuals are given health insurance by amending the tax code. There is an individual mandate which stipulates all non-exempt individuals must maintain a minimum level of insurance or pay a tax penalty. ACA extends Medicaid, states have to accept or they will not receive Federal funding. The act also includes an employer mandate to obtain health coverage for employees. The Affordable Care Act has changed the way health care is provided and the way individuals will participate (The Affordable Care Act Cases. (n.d.). Retrieved September 3, 2015)

The PPACA was structured to accomplish insurance reform through several avenues (Vincent & Reed, 2014). Medicaid program expansion and the individual mandate are two of the primary elements of healthcare insurance and finance reform (Vincent & Reed, 2014). Additionally preventative health services delivered without cost, removal of health insurance exclusions for preexisting conditions, allowing children under the age of 26 to remain on their parent’s healthcare insurance, and gradually decreasing the out of pocket costs for Medicare Part D participants are mandated by the provisions of the PPACA (Vincent & Reed, 2014).

The Affordable Care Act (ACA) extended healthcare coverage to millions of formerly uninsured individuals by expanding eligibility of Medicaid and the formation of Health Insurance Marketplaces. The ACA also included reforms to assist individuals sustain coverage and have the availability of affordable and accessible private healthcare insurance. Analysis from 2014 and early 2015 and have shown significant increases in public and private healthcare insurance coverage and have attributed the remarkable decreases of the rates of uninsured individuals from marketplace.gov and health insurance exchanges from the first year the ACA had healthcare coverage available.

The Affordable Care Act (ACA) highlighted the importance Medicaid played in insuring every American receive healthcare coverage. (42 U.S.C., 2010) Medicaid provides health benefits to over 71 million across the country. While involvement is optional, all 50 states participate in the program and requirements differ across the nation. The flexibility given to each state has allowed them to make their own decisions to work towards improvements that they believe would best benefit their region (Feldstein, 2015, p. 125-126).

Once the foundation of the U.S. health care system was reviewed, we began our study of the new regulations. The Affordable Care Act contained three main provisions. The first provision was expanding Health Insurance Coverage. Elements of the regulation included offering coverage to the vast majority of currently uninsured Americans by expanding access to Medicaid to cover all non-elderly individuals below 133 percent of the federal poverty level (FPL), and establishing state-based health insurance exchanges, which will offer Americans a range of private health plan options, with federal tax

The primary goal of the Affordable Care Act was to expand health care access to Americans and subsequently reduce the number of uninsured in the nation. From September 2013 to March 2015, there was a significant reduction in uninsured Americans from 17.6% to 10.1% (Anderson, Hempstead, Karpman, Kenney, Long, Shartzer, Wissoker, Zuckerman , 2015). This was achieved through the new laws affecting private insurance and the expansion of the government’s Medicaid program. The ACA started the process by extending tax credits to an estimated 4 million small businesses that would help them provide insurance for their workers in 2010 (Implementation, 2016). In 2013, a marketplace exchange was finally opened for the American people to compare and purchase

According to the United States Census Bureau, in 2012 the percentage of people without health insurance was of 15.4 percent. The percentage of people covered by employment health insurance was of 54.9 percent or 170.9 million. The percentage of people covered by Medicare was of 15.7 percent or 48.9 million. The percentage of uninsured children under age 18 was of 8.9 percent or 6.6 million (De Navas-Walt, 30). One of the mandates under the ACA is the individual mandate. This mandate requires that most Americans obtain health insurance by March 31, 2014 (“ObamaCare Individual Mandate", n.d.). Another mandate under the ACA is the employer mandate. Under this mandate, the ACA requires “all businesses with over 50 full time equivalent employees to provide health insurance for their full-time employees” ("ObamaCare Employer Mandate", n.d.) The ACA has also created a health insurance exchange also known as the Marketplace. This Marketplace allows the public to shop and compare different insurance plans side-by-side by guaranteeing the best deal as the prices are regulated by this law. Uninsured Americans will be able to get free or low cost health insurance through the State’s Health Insurance Marketplace and Medicaid has been expanded up to 15.9 million men, women and Children below 138% of the poverty level. ("ObamaCare | Health Insurance Exchange", n.d.).

The PPACA imposes an individual mandate requiring most U.S. citizens and legal residents to have health insurance coverage or pay a penalty. There are exceptions to this requirement for financial hardship, religious objections, American Indians, those without coverage for less than three months, incarcerated individuals, and certain low–income