AFFORDABLE CARE ESSAY 2
The most prominent healthcare reform is that of the Affordable Care Act. It paved the
way for cost-efficient healthcare while providing access to healthcare coverage for all, regardless
of age, income, or pre-existing conditions. While it was a controversial conversation within
politics, it has been proven to promote healthcare coverage for those who previously were not
able to have that access. It incentivized providers and healthcare systems to provide standard
quality care to all patients regardless of their coverage. It encouraged preventative medicine as a
cost-effective way to provide consumers with care instead of the typical reactive medicine trends
of the US Healthcare System. It promoted wellness in the workplace, encouraging health
promotion opportunities for employers and their employees. It strengthened public and
community health by creating initiatives to nurture the relationship between local and state
governments and their community health establishments. It provided consumers with rights and
knowledge of the denial appeals process and held health plan providers accountable for
delivering relative and concise explanations for denials within a specific time frame. In all of its
parts, the ACA has people and patients at the forefront of its initiatives, creating a healthy
population while reducing overall costs. Proverbs 19:17 says, “Whoever is generous to the poor
lends to the Lord, and he will repay him for his deed” (English et al., 2001/2016). The ACA
allows access to quality healthcare for all, and this was a theme of the work of Jesus. To meet
people where they were and provide them with all they needed.
The Affordable Care Act is a comprehensive reform law that expanded healthcare
coverage access to all and encourages preventative healthcare. “The Patient Protection and
Affordable Care Act (Pub. L. 111–148) was enacted on March 23, 2010. The Health Care and
Education Reconciliation Act of 2010 (Pub. L. 111–152), which amended and revised several
provisions of the Patient Protection and Affordable Care Act, was enacted on March 30, 2010. In
AFFORDABLE CARE ESSAY 3
this final rule, we refer to the two statutes collectively as the ‘Affordable Care Act’ (Patient
Protection and Affordable Care Act; program integrity: Exchange, SHOP, and eligibility appeals.
Final rule, 2013). The Act was passed in 2010 and has three primary goals: to make affordable
health insurance accessible to all, to expand the Medicaid program to cover more people, and to
support innovative medical care delivery models designed to lower the overall costs of medical
care. This Act allows more people access to healthcare coverage while giving providers and
healthcare facilities incentives that encourage quality care that is still affordable. "There was a
significant decrease in the percentage of young adults who lacked insurance for the entire year.
To our knowledge, the increases in young adults’ receipt of routine examinations and preventive
services after ACA found in this study have not been reported previously. This increase in
insurance rates is primarily owing to the expansion of private dependent coverage to 26 years of
age. Full implementation of ACA provisions, including those related to state-based marketplaces
and Medicaid expansions (for states choosing this option), is likely to further expand coverage
and has the potential to increase young adults’ use of preventive services" (Affordable Care Act;
HealthIT.gov). Statistics show that the ACA has allowed for affordable access to healthcare
coverage for all, while improving care quality concurrently.
A significant goal of the Affordable Care Act is to promote preventative medicine and
deter reactive medicine. Reactive medicine is often costly and has the potential for more
complex and dangerous outcomes for the patient. Preventive medicine encourages screenings
and monitoring of specific health concerns and diseases that, if caught and treated early, can
allow for more positive outcomes and survival for the patient. These include cancer screenings
like colon cancer colonoscopies, pap smears, mammograms, prostate exams, etc. It also
encourages well-check visits for all, including monitoring for high blood pressure and diabetes
AFFORDABLE CARE ESSAY 4
screenings, mental health screenings, and vaccinations. “The Act provides individuals with
improved access to clinical preventive services. A major strategy is to remove cost as a barrier to
these services, potentially opening new avenues toward health. For example, new private health
plans and insurance policies (for plans or policy years beginning on or after September 23, 2010)
are required to cover a range of recommended preventive services with no cost sharing by the
beneficiary. These services include those rated as "A" (strongly recommended) or "B"
(recommended) by the U.S. Preventive Services Task Force (USPSTF), vaccinations
recommended by the Advisory Committee on Immunization Practices (ACIP), and preventive
care and screening included both in existing health guidelines for children and adolescents and in
future guidelines to be developed for women through the U.S. Health Resources and Services
Administration (HRSA),” (Koh et al., 2010). It was also established after the passing of the ACA
that beginning in January of 2011, Medicare will cover all preventative well-checks annually,
including a health risk assessment and customized preventative care plan. This extension also
prevented cost-sharing for preventative care visits and tests.
Workplace wellness was another initiative defined by the ACA. Promoting wellness
inside and outside the workplace encourages the healthy lifestyle that the ACA inspires.
Improving the health and quality of people’s lives will naturally enhance productivity and
performance in the workplace. As those in the workforce age, so does the prevalence of chronic
illnesses. This increases the health-related expenses in both the cost of the healthcare services
and the cost of workers that must be absent from work. Wellness programs and incentives have
been proven to save money. “With the passage of the Affordable Care Act (ACA), worksite
wellness programs will become part of a national public health strategy to address the increase in
chronic diseases, which are predicted to cost the US health care system an estimated $4.2 trillion
AFFORDABLE CARE ESSAY 5
annually by 2023. Evidence suggests that worksite wellness programs are cost-beneficial, saving
companies money in health-care expenditures and producing a positive return on investment
(ROI). Baicker et al calculated an average return of $3.27 in medical costs for every dollar spent
on worksite wellness programs,” (Anderko, L. 2012).
Another part of the ACA is a consumer’s rights after a denial of care, treatment, or
medications. The Center for Consumer Information and Insurance Oversight (CCIIO) assists and
implements many parts of the ACA. It oversees the parts of the act responsible for the health
coverage marketplace for all states and the implementation of private health insurance. Its
mission is to support consumers, ensuring the ACA supports their needs. Regardless of your
healthcare coverage, some claims can be approved or denied. In the denial process, the insurance
company must inform the consumer of the denial with an explanation in writing. The consumer
may then file an appeal. The insurance company must then review their denial and determine
whether or not the policy was followed. (Harrington, M., 2021). The Employee Retirement
Income Security Act (ERISA) governs all private health insurance plans. Before the ACA,
ERISA did not require insurance plans to allow their consumers access to an external appeal
system; they were at the discretion of the plan administrators. The administrators also
intentionally left out documents delayed the appeal process and issued denials without providing
reasons or valid explanations for the denial. This process is a part of the ACA protecting
consumers and insurance companies. “The ACA does not remove ERISA's bar against damages
for injuries caused by the wrongful denial of coverage by plan administrators. Instead, the Act
introduces significant reforms in the process used to review claims in an attempt to level the
playing field among consumers, insurers, and plan administrators. With the exception of
‘grandfathered’ plans (i.e., plans that were in effect March 23, 2010—the day the ACA was
AFFORDABLE CARE ESSAY 6
signed—and not subject to some of the insurance reforms contained in the legislation), the ACA
reforms apply in both the employer and individual health plan markets, including the ERISA
plan marketplace,” (Espinosa, 2012). The ACA appeal process levels the playing field for
consumers and insurers so that all parties are transparent in their plans and expectations of those
plans.
While it was a controversial conversation within politics, it has been proven to promote
healthcare coverage for those who previously were not able to have that access. It incentivized
providers and healthcare systems to provide standard quality care to all patients regardless of
coverage. It encouraged preventative medicine as a cost-effective way to provide consumers with
care instead of the typical reactive medicine trends of the US Healthcare System. It promoted
wellness in the workplace, encouraging health promotion opportunities for employers and their
employees. It strengthened public and community health by creating initiative opportunities to
nurture the relationship between local and state governments with their community health
establishments. It provided consumers with rights and knowledge of the denial appeals process
and held health plan providers accountable for delivering relative and concise explanations for
denials within a specific time frame. In all of its parts, the ACA has people and patients at the
forefront of its initiatives, creating a healthy population while reducing overall costs. Hebrews
13:16 says, “Do not neglect to do good and to share what you have, for such sacrifices are
pleasing to God,” (English et al., 2001/2016).
AFFORDABLE CARE ESSAY 7
REFERENCES:
Affordable Care Act (ACA). Retrieved
from: https://www.healthcare.gov/glossary/affordable-care-act/ Links to an external
site.
Anderko, L., Roffenbender, J. S., Goetzel, R. Z., Howard, J., Millard, F., Wildenhaus, K.,
Desantis, C., & Novelli, W. (2012). Promoting prevention through the Affordable
Care Act: workplace wellness. Preventing chronic disease, 9, E175.
https://doi.org/10.5888/pcd9.120092
English Standard Bible. (2016). https://esv.literalword.com.(Original work published 2001)
Espinosa J. F. (2012). Strengthening appeals rights for privately insured patients: the
impact of the patient protection and affordable care act. Public health reports
(Washington, D.C. : 1974), 127(4), 460–463.
https://doi.org/10.1177/003335491212700414
Harrington, M. K. (2021). Health care finance and the mechanics of insurance and
reimbursement. (2nd ed.). Burlington, MA: Jones & Bartlett.
Koh, H. K, M.D., M.P.H., & Sebelius, K. G., M.P.A. (2010). Promoting Prevention through
the Affordable Care Act. The New England Journal of Medicine, 363(14), 1296-9.
https://doi.org/10.1056/NEJMp1008560
Patient Protection and Affordable Care Act; program integrity: Exchange, SHOP, and
eligibility appeals. Final rule. (2013). Federal Register., 78(169), 54069–54146.
