The Affordable Care Act (ACA)

The Affordable Care Act (ACA) law that was passed a couple of years ago was upheld by the US Supreme Court as being Constitutional on June 28, 2012.

Gregory French, CELA, CAP, President of the National Academy of Elder Law Attorney’s said, “Although the law isn’t perfect, it’s a start at moving America in the right direction by making improvements to Medicare coverage, such as better prescription drug coverage, preventive care, care coordination, and extending affordable health care options to a large number of uninsured Americans.”

Jo Rosen, President & Founder of Parkinson’s Resource Organization said, “With a majority of the care and health care in the Parkinson’s world paid through MediCal in the State of California and Medicaid, and other State’s named Medicaid programs, this may be a ‘Godsend’ to the Parkinson’s community for both care coverage as well as medicine coverage.”

If you have Parkinson’s and you have not yet figured how much it will cost to get you through the Parkinson’s journey; unless a cure is found, and unless you are a millionaire, you should thank the creators of the Affordable Care Act (ACA) law because that’s how the expenses in the advanced stages of your disease process will more than likely be paid.

The suggestions here, for people with Parkinson’s, would be to: 1) work hard on finding the cure 2) take a look at the advancement of Parkinson’s and 3) start planning the financial needs for you, and YOUR CAREGIVER, who should not be left impoverished because all of your assets were spent on you.

Overview of ACA

The Patient Protection and Affordable Care Act (ACA) was signed into law on March 23, 2010 by President Obama. Some love it, others hate it, but many people have only a vague idea of what’s in the almost 2000-page law. John McDonough, DPh, MPA, a Professor of Health Policy and Management at Harvard University School of Public Health, was invited by Senator Ted Kennedy to participate in the committee that helped draft the law. In his book, Inside National Health Reform, McDonough offers a look at the ACA many haven’t seen. It breaks down the law according to the 10 Titles that comprise it, offering an easy-to-follow guide of the changes affecting the insurance and medical industries, as well as patients, and when these changes will happen. Here is an overview of the titles as explained in the book.

Title I. Quality, Affordable Health Care for All Americans

nature and operation of private health insurance in the United States. Beginning in 2014, no health insurer will be able to sell or rate coverage based on an individual’s medical history; most Americans will be required to obtain health insurance; and substantial financial subsidies will be available to low- and moderate-income Americans to help them afford the cost of health insurance. Most states will operate new “health insurance exchanges” to make shopping for health insurance easier. Small businesses and individuals can shop these insurance exchanges for competitive rates. Other important changes in health insurance, including the banning of lifetime and annual benefit limits, were implemented in 2010.

Title II. The Role of Public Programs

This title creates substantial changes to Medicaid, the federal-state program for many low-income persons. Beginning in 2014, all lower-income individuals will be eligible to enroll in their state’s Medicaid program, not just those who fit into categories such as disabled, children, or parents. For the first time, Medicaid will become a more uniform national program with uniform eligibility and enrollment standards as well as quality improvement requirements.

Title III. Improving the Quality and Efficiency of Health Care

This title establishes new mechanisms to improve the quality of medical care in the United States by making it more efficient and effective, and more patient-centered. Medicare will be improved with the addition of new preventive benefits for enrollees; and the Medicare Part D drug benefit will be made more affordable by closing the coverage gap known as the “donut hole.” Medicare’s rate of growth will be lowered to provide about $450 billion in savings between 2010 and 2019, which should fund about half the cost of the ACA.

Title IV. Prevention of Chronic Disease and the Improvement of Public Health

Title IV is the most ambitious law ever passed to promote healthier lifestyles for all Americans and to prevent disease and disability. A National Prevention, Health Promotion, and Public Health Council will devise a national prevention strategy, backed up by a $13 billion Trust Fund. Evidence-based clinical preventive services will be provided in most public and private health insurance policies without cost-sharing. Chain restaurants will be required to post the calorie content of their foods.

Title V. Healthcare Workforce

This title establishes a National Healthcare Workforce Commission to analyze and plan for workforce needs and to make recommendations to congress and the administration. Support is provided to expand the healthcare workforce, especially in primary care. Major expansions for community health centers and the National Health Service Corps are funded.

Title VI. Transparency and Program Integrity

Title VI provides new authority to federal and state agencies to combat fraud and abuse in Medicare, Medicaid, and private health insurance. Drug companies and medical suppliers will report most gifts and other gratuities to physicians for public release on a federal Website. The Patient Centered Outcomes Research Institute is established as a public-private entity to support research on comparative clinical effectiveness. New transparency requirements on the nursing home industry will provide information to protect and empower patients and their families. The Elder Justice Act provides a national framework to combat violence, neglect, and financial exploitation of senior citizens.

Title VII. Improving Access to Innovative Medical Therapies

This title directs the US Food and Drug Administration to develop a regulatory pathway to permit the development, manufacture, marketing, and sale of biosimilar biologic products, generic-like versions of biopharmaceutical drugs. It also ends anticompetitive efforts to keep generic drugs off the market, and offers drug discounts to hospitals and communities that serve low-income patients.

Title VIII. CLASS: Community Living Assistance Supports and Services

This title authorizes a new national and voluntary long-term disability insurance program to provide workers with daily cash payments and support if they become permanently and temporarily disabled. People who enroll in CLASS must pay premiums for a minimum of 5 years. The funding is flexible and can be used for a range of services. No tax money will be used to fund this program. Its only permitted financing source — enrollee premiums — must be sufficient for at least 75 years if the Health and Human Services Secretary is to launch the program.

Editor’s Note: The Obama administration announced on October 15 that it was abandoning plans for CLASS. Congress is expected to quickly draft legislation to repeal the provisions of this title.

Title IX. Revenue Provisions

This section covers the financing for slightly less than half the cost of the ACA. Key provisions establish new Medicare taxes on high-income wage earners, as well as new taxes on pharmaceutical manufacturers, health insurance providers, and medical device manufacturers. Also included is an excise tax on high-cost, employer-provided health insurance; changes to health savings accounts and other individual health accounts; and a 10% tax on indoor tanning services.

Title X. Strengthening Quality, Affordable Healthcare for All Americans

The final title in the act is the “Manager’s Amendment,” which includes amendments and additions to Titles I-IX, reflecting the unusual legislative process leading to passage of the ACA. Additional changes to Titles I-X were approved in a separate measure called the Health Care and Education Reconciliation Act (HCERA) signed into law by President Obama 1 week after he signed the base law on March 23, 2010. This title also reauthorizes the Indian Health Care Improvement Act, which provides healthcare to American Indians and Alaskan natives.

Contributor Information:

John E. McDonough, DPh, MPA
Professor of Health Policy and Management
Harvard University School of Public Health
Boston, Massachusetts