WK5A1: Please use APA format and list and site all sources and references: There
ID: 122368 • Letter: W
Question
WK5A1:
Please use APA format and list and site all sources and references:
There is great controversy over whether a patient will be able to retain or choose his or her doctors with the advent of the PPACA. In addition, many existing plans are being ruled as incompatible with the requirements of the PPACA and discontinued or canceled as a result. Explore and explain whether the patients will be able to continue with their physicians and the rationale behind the plan cancelation. Additionally, identify the effect of expanding state Medicaid roles and the impact it has upon cost and non-reimbursable care.
Please support your response with credible references.
Please use APA format and list and site all sources and references: cite your sources in your work and provide references for the citations in APA format.
At least one Page in APA format.
Explanation / Answer
The Patient Protection and Affordable Care Act (PPACA) is far–reaching legislation that will change how millions of citizens access health care coverage. The scope of PPACA is so broad that it will be years before all of its provisions will be fully implemented and its ramifications fully understood.
PPACA Intends to Make Health Coverage More Accessible:
In order to make coverage more accessible and affordable, PPACA creates new entities called American Health Benefit Exchanges, through which individuals and small businesses can purchase coverage. A few years after these exchanges are established, they can be opened to allow purchases of coverage by larger employers. The PPACA places requirements on certain employers to provide coverage, and provides some subsidies to encourage the expansion of employer–based coverage.
The PPACA provides low–income persons greater access to health coverage by expanding the Medicaid program. The new federal law also establishes a temporary high–risk insurance pool that will allow persons with preexisting medical conditions to purchase coverage.
PPACA is designed to create a health coverage purchasing continuum that is accessible to persons with low, middle, and high incomes. As individuals’ incomes rise and fall, as they become employed, change employers and become unemployed, and as they age, they are to have access to different sources of coverage along the coverage continuum. The PPACA also seeks to impose greater standardization on the coverage that is offered.
Expansion of Medicaid:
The new federal law significantly expands the Medicaid program. This is accomplished primarily by mandating coverage of certain population groups not previously required, such as childless adults. Until this mandate takes effect, Medicaid beneficiaries generally have needed both to have a low income and to be in certain specific categories, such as being pregnant or having a disability. Beginning January 1, 2014, federal law will require coverage of all individuals under age 65 (children, parents, and childless adults) with incomes at or below 133 percent of the FPL regardless of disability or other categories. Furthermore, states will be eligible for federal reimbursement at existing matching rates if they chose to expand their programs earlier to this new population. Taken altogether, we estimate various provisions of PPACA could ultimately add up to two million beneficiaries, or more, to the 7.3 million now on Medi–Cal rolls.
Beginning on January 1, 2014, PPACA allows states the option of establishing a so–called Basic Health Plan as an alternative to providing coverage through the exchange for certain individuals. Specifically, the plan would provide coverage to individuals with incomes from 134 percent to 200 percent of the FPL who do not qualify for Medicaid or have access to employer–sponsored coverage. The persons receiving coverage under a Basic Health Plan also must otherwise have been eligible for coverage through the exchange.
The PPACA makes several changes to how states determine Medicaid program eligibility that generally simplify these processes and, in some cases, make program eligibility more generous. Most changes take effect January 1, 2014. It is unclear at this point whether some of these changes could make eligibility more restrictive. At this time, the net fiscal impact of these changes is unknown. These required changes include:
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