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California and Health Insurance Exchanges Under ACA

Under the presidency of Barack Obama, this country has seen great changes, especially in the realm of health insurance. Perhaps the most famous of these changes is the Affordable Care Act, commonly known as “Obamacare”. The purpose of this act, as the name implies, is to increase the affordability, increase the rate of health insurance coverage, and reduce the overall costs of health care for Americans. Under this act, insurance companies are required to cover applicants with new minimum standards and offer the same rates regardless of pre-existing conditions or sex. The Congressional Budget Office has predicted that the ACA will lower both future deficits and Medicare spending. The main goal of this act is to improve healthcare by streamlining it and making it more accessible (http://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act). The state of California, one of the strongest supporters of the act, is currently leading the charge.

Obamacare

What does ACA do?

As mentioned before, the main purpose of the Affordable Care Act is to making health insurance more readily available to Americans. It hopes to achieve this in various ways. In terms of coverage, the ACA does the following:

  • Removes any pre-existing health condition that excludes or limits coverage for children and teenagers under the age of 19
  • Ensures young adults under the age of 26 have coverage under their parents’ health care plan
  • Ends arbitrary cancellation of health insurance coverage
  • Guarantees the right to appeal any denial of payment

For costs, the ACA includes:

  • Banning lifetime limits on insurance coverage for all new health plans
  • Reviewing premium rate increases
  • Making sure the money the client puts in is used properly, such as spending it on health care instead of administrative costs

For the health care itself, the ACA introduces:

  • Coverage for preventive health care at no additional cost to the client
  • Protection of the client’s choice of medical doctors
  • Removal of barriers set up by insurance companies for emergency services

(http://www.hhs.gov/healthcare/rights/index.html)

 California Health Benefit Exchange under the ACA

California is the perhaps the one state in America the most affected by the Affordable Care Act. Under this legislation, California has enacted the California Health Benefit Exchange. This policy seeks to increase the number of Californians insured by health insurance, improve the quality of health care, reduce costs of health insurance, and lower health disparities. This is achieved by giving the people of California the freedom of choice so that they may choose the best health plan for their individual needs. The California Health Benefit Exchange follows these guidelines:

  • The Exchange will be more consumer-focused by having the policy’s actions recognize the diverse cultural, language, economic, educational and health status needs of Californians
  • This new Exchange will make health insurance much more affordable while still maintaining quality and access
  • The Exchange will be a help set the foundation for positive change in the health care system of California by using its market role to form new strategies for providing high-quality, affordable health care, promoting illness prevention, and reducing health disparities
  • The Exchange will make stronger relationships with the people of California by earning their trust through accountability of faults, responsiveness of actions, transparency of dealings, speed of aid, flexibility and reliability of policies, and cooperation with the people
  • The Exchange advocates partnerships with various health care providers, health plans, doctors, government agencies, consumers, and employers
  • The results of the Exchange will be measured by its strong contributions to the Californian public such as the levels of equality of health care, health care quality, health care coverage, and health care diversity

(http://www.healthexchange.ca.gov/Pages/HBEXVisionMissionValues.aspx)

The ACA’s impact on Insurance Exchange

The actual impact of the Affordable Care Act as of now varies. For physicians and those in the medical field, the effects are modest at best.  This is most likely due to the law’s relatively young age. However, the full impact of the act is said to go into effect by January 2014. It is projected that up to 4 million Californians are to actually get health insurance. This includes the health insurance exchange program and Medicaid expansion. California has poured in an estimated $43 million for the Health Benefit Exchange program, the most any state in the US has done for a sanctioned ACA program. The main reason behind such a large budget is the sheer diversity of people in the state, which holds a population that speaks over a hundred different languages.

(http://www.medpagetoday.com/Washington-Watch/Reform/40157)

The Future of Medicaid in California under the ACA

In terms of Medicaid expansion, this is where the real faults of the new act seem to lie. One of the main goals of the California Health Benefit Exchange program is to increase the availability of Medicaid. This would include everyone under the 133% level of federal poverty. This however, does not exactly guarantee good access to these services.  The reality is that this act becomes a sort of false promise for service. The patients often times are unable to get a medical doctor in a timely fashion because the physicians simply cannot afford to participate in the program as much as they would like to. While the ACA may be initially beneficial to patients in California, it may be detrimental in the long term. Healthcare professionals such as doctors are less willingly to enact such drastic changes to their current practices. This will in turn negatively impact patients as they will not get the healthcare they were promised, making the future for the California Health Benefit Exchange act seem grim.

(http://www.medpagetoday.com/Washington-Watch/Reform/40157)

The ACA’s effects on Hospitals in California

The hospitals in the state of California are expected to experience heavy cuts in costs. Many of these cuts come from the payments to physicians and hospitals in order to support the expansion of health care. As a direct result, drastic new hospital practices are taking place. Hospitals are now focusing on preventing their patients from even having to return to hospitals. In the last year and a half, there have been considerable efforts to reduce the use of emergency services by increasing the capacity of urgent care. The idea is to reduce the likelihood of complications or any need to go back to the hospital.

(http://www.medpagetoday.com/Washington-Watch/Reform/40157)

 

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