Tag Archives: ACA

Health Care: Prompt One

One of the most important aspects of the ACA is the 10 essential health care benefits. This added specific criteria of what insurance must cover in their policies.What are the 10-essential benefits insurance must cover? Healthcare.gov (2017) lists them as:

  1. Ambulatory patient services (outpatient care you get without being admitted to a hospital
  2. Emergency services
  3. Hospitalization
  4. Pregnancy, maternity, and newborn care
  5. Mental health and substance use disorder services
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management
  10. Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)

I feel like a lot of people don’t really understand how health insurance works (or why companies would not want to cover these 10 things); I had no idea before I took an introduction to public health policy. To sum up private health insurance (very basically): all eligible individuals are placed into a risk pool and each one pays a monthly premium to spread the risk/cost around. These monthly payments pay will cover the costs for health services for sick or injured individuals in the pool.

For example: If you have a risk pool of 100 people and each person pays $100 per month, insurance has $10,000-dollar revenue. But let’s say 10 people in the pool get sick and their care ends up being $15,000 that month, the insurance then is at a loss of $5,000. Insurance is a business and therefore the goal is to make a profit. The company makes more money when their risk pools are comprised of healthy individuals.  This is why insurers used to deny coverage or charge more to individuals with pre-existing conditions.

A preexisting condition is “a health problem you had before the date that new coverage starts” (HHS, 2017). Things like cancer, HIV, pregnancy, Alzheimer’s, acne, mental illness, domestic violence and rape victims, etc. fall into this category. When I found out that people could be denied coverage (and the things which counted as a pre-existing condition) I was stunned. It seemed so wrong and unethical. How could we as a nation leave so many people exposed to huge finical and health risks? People who were already incredibly vulnerable.

The 10 essential health care benefits also require maternity care coverage. Prior to the ACA very few women had maternity coverage. An uncomplicated birth could cost already insured women $10,000 and uninsured women $30,000 (THA 2013). Some Republican politicians do not think men should have to pay for prenatal care, as ‘a man has never delivered a baby’ (Woodall, 2017). I learned in my policy class that every dollar spent in family planning has a 400% return. How is it not in our best interest (morally and economically) to provide this coverage?

Women’s health care protections are especially in danger; just this Friday some protections on birth control coverage were removed from health insurance policies. This allows a company or non-profit to remove contraceptives from their coverage due to religious or moral objections (Kodjak, 2017).

There is an ongoing debate about healthcare in the US. The current administration wants to ‘replace and repeal’ the ACA. The 10 essential health care benefits are in danger, all the proposed replacements have severely weakened or removed them. The US is one of the only developed countries who does not have universal health coverage. These policies largely stem from the belief that healthcare is a privilege, not a right.


Works Cited

Kodjak, A., (2017). Trump Guts Requirement that Employer Health Plans Pay for Birth Control. Retrieved from http://www.npr.org/sections/health-shots/2017/10/06/555970210/trump-ends-requirement-that-employer-health-plans-pay-for-birth-control

Healthcare.gov. (2017). What Marketplace health insurance plans cover. Retrieved from https://www.healthcare.gov/coverage/what-marketplace-plans-cover/

Health and Human Services. (2017). Pre-existing conditions. Retrieved from https://www.hhs.gov/healthcare/about-the-aca/pre-existing-conditions/index.html

Woodall, C., (2017) GOP Congressman asks why men should pay for prenatal care. Retrieved from http://www.pennlive.com/news/2017/03/gop_congressman_asks_why_men_s.html

Truven Health Analytics. (2013). The Cost of Having a Baby in the United States. Retrieved from http://transform.childbirthconnection.org/wp-content/uploads/2013/01/Cost-of-Having-a-Baby1.pdf

Health Care: Prompt One

In my opinion, the Affordable Car Act is extremely important for a large majority of people. There were three goals that the law put its primary focus into. Those goals were:

  1. Make affordable health insurance available to more people. The law provides consumers with subsidies (“premium tax credits”) that lower costs for households with incomes between 100% and 400% of the federal poverty level. (ACA, 2017)
  2. Expand the Medicaid program to cover all adults with income below 138% of the federal poverty level. (Not all states have expanded their Medicaid programs.) (ACA, 2017)
  3. Support innovative medical care delivery methods designed to lower the costs of health care generally. (ACA, 2017)

Health care in the United States has been less than perfect for many years. The ACA was very controversial because many people do not accept change well and the policy is extremely complicated. It can be very difficult to understand all the different aspects of the law. I think the very most important thing for people to understand when discussing the Affordable Care Act is that the main goal was to “move closer to the one objective almost everyone agrees upon: making health care more affordable and more accessible to all people” (Wanamaker, 2017).

Because of the ACA, millions of Americans are given the ability to receive health care. This policy, “eliminates the ability for insurance companies to reject a patient due to pre-existing conditions, allowing children to remain on their parents’ health insurance until age 26 and expanding the eligibility of Medicaid for millions of Americans” (Goldberg, 2012). There is a lot more that the health care act entails. It is extremely detailed and very complicated for most to understand. One of the most difficult things to understand is how or who is paying for the ACA. There are many resources online that explain in detail what the law is about and all it entails. USA Today and CNN have plenty of articles regarding the subject and are very useful tools to use wen educating yourself on our nation’s current health care bill.

The very best aspect of this law is that it was helped a huge majority of Americans. Before we implemented the Affordable Car Act, “about 16 percent of Americans had no health insurance of any kind. Now, that’s down to less than 9 percent — a record low” (Haynes, 2016). Millions of Americans have been helped drastically in the recent years that this law became effective. There were rapid and tremendous improvements since Obamacare. Of course, the law is not perfect and there is much that could be changed. If I had one recommendation, I would suggest that the qualifications of subsidies be decreased. If a family does not qualify, then purchasing insurance through exchanges can be extremely expensive (Cassidy, 2017). “Until policy-holders have covered their deductibles, they have to pay for the full cost of most of the medical services” which are often highly expensive (Cassidy, 2017). The fact of the matter is that this law was created because prices are an issue. The best way to help people afford health care would be to spend more money so that it would bring down the costs that many people face. Nothing will be a quick fix, but my belief is that the ACA was a step in the right direction for the United States.



Works Cited


Affordable Care Act (ACA) – HealthCare.gov Glossary. (n.d.). Retrieved October 07, 2017, from https://www.healthcare.gov/glossary/affordable-care-act/


Cassidy, J. (2017, June 19). Three Ways to Fix Obamacare. Retrieved October 07, 2017, from https://www.newyorker.com/news/john-cassidy/three-ways-to-fix-obamacare


Goldberg, L. (2012, March 19). Discuss: Share in Our Policy Ideas. Retrieved October 07, 2017, from https://www.nasi.org/discuss/2012/03/affordable-care-act-turns-two?gclid=Cj0KCQjw9uHOBRDtARIsALtCa95bg0snF_S0QNQQL91fanr_o3ujnA-msmHbfGawvKW3_VMT26sUeTUaAscOEALw_wcB


Haynes, C. T. (2016, November 04). Even With Its Faults, Obamacare Has Helped Millions. Retrieved October 07, 2017, from http://www.nationalmemo.com/obamacare-helped-millions/


Wanamaker, B. (2017, February). Seize the ACA: The innovator’s guide to the Affordable Care Act. Retrieved October 07, 2017, from https://www.christenseninstitute.org/publications/aca/?gclid=Cj0KCQjw9uHOBRDtARIsALtCa96Lkw4RnTSg0BIZwlDs7pWUEkC2sSMrpN-4nhuFjvcgIiL-0rNm0dcaAiuCEALw_wcB