Morrison 1 Amy Morrison Tammy Frailly HUM 220-2W1 25 February 2014 Patient Protection and Affordable Care Act:

Is it Really Affordable? Over the last several years the level of health care costs have skyrocketed while insurance premiums also rise at rates not in proportion to wage increases. As people are making less money in comparison to what they are paying out of pocket for health care, the needs of the people on the bottom of the spectrum are being unmet. These individuals are striving to make ends meet, and are unable to afford even the most basic health care. This leads to skyrocketing costs in the healthcare industry as they pass the cost for uninsured and underinsured patients on to those that can afford to pay them. In an attempt to alleviate those costs and help the people in that bracket of uninsured/underinsured, Congress passed the Patient Protection and Affordable Care Act (hereafter referred to as: PPACA) in 2010. This landmark bill was meant to ensure that everyone had access to adequate healthcare at a reasonable cost. While this is the bills main goal, is it really fulfilling its main purposes? The bill set to be fully in force by 2014, has helped some people, but most of the people signing up through exchanges are in fact people that already had insurance, and just switched plans, not new insureds. According to a study performed by Schoen approximately 42% of all Americans are either uninsured or underinsured as of 2007. Her statistics show a rapid increase in these number between 2003 and 2007. Schoen defines underinsured as those that have relatively high out-ofpocket medical costs in relation to their specific wages. She describes three categories; people must fit one of these categories to be considered underinsured. They include paying medical costs that are: 10% or more of out-of-pocket relative to their income, at least 5% of the income

Morrison 2 of those 200 % below the poverty level, and or paying at least 5% of their income in deductibles and premiums (Schoen 299). She further explained that the number of adults in the 19-64 age range who had adequate health insurance, meaning you didnt meet one of the above criteria, dropped 7% from 2003 to 2007. Her study showed that there were numerous people that didnt use healthcare because the cost exceeded what they could pay. With this situation, Schoen recommends that there is a need for health care reform in order to control costs and eliminate those that are either uninsured or underinsured. Her view was that this should be enacted through federal policies Woolhandler and Himmelstein seek to give an overview of how the healthcare reform came about and why it was necessary to seek to pass the ACA. One of the main problems cited is that about 45,000 Americans die each year due to lack of insurance (Woolhandler & Himmelstein 720). They also discuss the payment system behind the insurance, and how it is contributing to the problems in the rising health care costs. They argue against corporate power asserting itself in health care reform. They also discuss the Massachusetts model, and how it affects the national health care model. This comparison shows how people in this plan went from being uninsured to underinsured. Woolhandler & Himmelstein compare Massachusetts reformation results to what will happen when PPACA is in full effect, stating that it too will force people into the underinsured model (726). Additionally they mentioned that even if it works as it is designed there will still be 24 million uninsured people in 2019 (Woolhandler & Himmelstein 720). Overall, this article cites that reform is needed, but the PPACA is not going to solve the problem as it was supposed to. It in fact could make the problem worse, by putting people in the position to have to purchase insurance, they cant really afford or penalize them for not purchasing insurance.

Morrison 3 Joel Cantor is a Professor at Rutgers University and the Director of Center for State Health Policy. His partners in the study include Alan Monheit, Ph.D. with School of Public Health, University of Medicine and Dentistry, New Jersey; Derek DeLia, Ph.D. and Kristen Lloyd M.P.H. are both with the Center for State Health Policy. Joel Cantor et al. provides some research for one of the earliest phases for implementation of the Affordable Care Act. This study details how many of the previously uninsured 21 26 year olds were able to maintain policies under their parents plans. As of 2009, Cantor et al. cite that 31.4% of adults in this age range were uninsured (1773). Their findings cite a 6% increase in people insured in a non-spousal dependent status, with a correlating 2.4% drop in uninsured people of the age group 19 25 (Cantor et al. 1780-1781). The many new people staying on their parents insurance are expected to have wide reaching implications. Most notably, increased premium costs and employers beginning to cut back on offering insurance to these young people. This article offers specific statistics for how the uninsured population is affected by the implementation of the provisions of the Affordable Care Act. Ryan A. Crowley, American College of Physicians, and Thomas G. Tape, MD with the University of Nebraska Medical Center, discuss the various methods for signing up for health care via the marketplaces. They cite that in 2014 sixteen states and DC will be offering their own marketplaces, seven will work with the federal government, and twenty-seven states didnt create the marketplaces (Crowley and Tape 784). This statistic show how the different states are handling the marketplaces and the distrust of the PPACA and its provisions. They go one step further and explain what possible complications could arise from the marketplaces. Some of these problems include people that are again uninsured because they cant afford to pay the premiums; wide range of copayments and deductibles; sufficient medical personnel to keep up

Morrison 4 with influx of new patients; and/or insurance creating smaller networks. Thus the people with insurance could be pulling from an even smaller pool of in-network doctors. Further, Crowley and Tape cite that despite problems, the provisions of PPACA are expected to insure millions of people that were previously uninsured or underinsured (786). Scott Greer, of the University of Michigan, wrote this article to discuss what role the individual states play in the implementation of the Affordable Care Act. Additionally, this article covers how the states are required to comply by forming marketplaces where citizens can obtain healthcare in accordance with PPACA. Greer also discusses the various statues built into the PPACA to deal with states that refuse to comply or are slow to comply. He cites that there will be some difficulty in separating states that are willfully noncompliant with those that are just incapable of meeting the demands of the PPACA. Without a clear cut line of demarcation, the federal government will have difficulty enforcing the penalties for noncompliance. Scott Harrington, Alan B Miller Professor of Health Care Management and Insurance and Risk Management, presents the Affordable Care Act as it will be implemented. He includes the provisions, tax implications, penalties, and projected costs and savings as a result of implementation. The main idea of the article is that despite the controversy of the health care legislation it is going to be a cost saver and is projected to increase the insured rate to more than 90%. The language of this article is mostly projections and was written in a profession journal for the insurance industry. Its purpose is to inform those that work in the insurance industry about the provisions of the ACA and the impact on the insurance market. I will be using this to discuss the specific provisions of the ACA and the penalties involved with not procuring insurance. Harrington discusses the implications for insurance, whereas Wocjik discussed the implications for the employers offering insurance and how it would impact them.

Morrison 5 Steven Wojcik highlights the provisions employers are required to implement as part of the Affordable Care Act. His article discusses the various benefits to the company for maintaining these benefits and the penalties for not complying with the law. There is also a brief discussion on whether or not companies will decide to stop offering coverage because of the cost-benefit ratio. His main purpose in writing this article was to give information on the provisions being implemented in 2014 and how the business are reacting and implementing these new requirements. Wojcik wrote this article in an easy to read language; however, there is an underlying tone of business and its publication in Benefits Quarterly leads me to believe that the intended audience is business people and people that work in human resources related fields. These people would benefit most from the information contained within the article. Wojcik discusses the penalties and provisions that affect employers. In 2013, the US House of Representatives Committee of Energy and Commerce published a report on their study of how the PPACA would affect insurance premiums upon implementation. Their study included information gathered directly from the insurers, and thus is reliable on how the see the implementation of provisions affecting the cost of health insurance. One of the more ostentatious predictions based on their study was that on average people will see an increase of 100 percent in premium costs with some people seeing more than 400 percent increases (The Looming Premium). Their explanation that the law was purported to be reducing costs is refuted throughout this study. One of the health insurers is quoted as having said the bottom line is that the PPACA does not contain many provisions that will reduce costs and improve affordability, especially in the short term (The Looming Premium). This report reflects significant increases for people that already have insurance as well: 96% for people seeking new plans, and 73% for people keeping their existing plans. Overall, the

Morrison 6 committees conclusion is that there might be a few states that see premium decreases, the majority will see significant increases. Throughout history, this country has attempted to ensure the needs of all are met, without infringing up those same peoples rights. As time has progressed, many federal programs have sprung up under the guise of helping the people. The PPACA is not different; this law was passed under the auspices of making health care and insurance more accessible and affordable. The studies that have been produced thus far, by and large propose that this will not be the result. Not only are premiums going to increase, but the increased deductibles and copayments will only put people from the uninsured category into the underinsured category. Despite its proposal for making health insurance more affordable and helping those that are uninsured and underinsured, the PPACA will raise premiums and just shuffle people into another group of insureds that isnt any more affordable.

Morrison 7 Works Cited Cantor, Joel C, et al. "Early Impact Of The Affordable Care Act On Health Insurance Coverage Of Young Adults." Health Services Research 47.5 (2012): 1773-1790. MEDLINE. Web. 28 Jan. 2014. Crowley, Ryan A., and Thomas G. Tape. "Health Policy Basics: Health Insurance Marketplaces." Annals Of Internal Medicine 159.11 (2013): 784-786. Consumer Health Complete - EBSCOhost. Web. 01 Feb. 2014. Greer, Scott L. "The States' Role Under The Patient Protection And Affordable Care Act." Journal Of Health Politics, Policy And Law 36.3 (2011): 469-473. MEDLINE. Web. 28 Jan. 2014. Gruber, Jonathan. "The Impacts Of The Affordable Care Act: How Reasonable Are The Projections?." National Tax Journal 64.3 (2011): 893-908. Business Source Complete. Web. 28 Jan. 2014. Harrington, Scott E. "U.S. Health-Care Reform: The Patient Protection And Affordable Care Act." Journal Of Risk & Insurance 77.3 (2010): 703-708. Business Source Complete. Web. 28 Jan. 2014. The Looming Premium Rate Shock. US House of Representatives Committee On Energy and Commerce. Chairman: Fred Upton. 13 May 2013. Web. Accessed 14 February 2014. Qazi, Khalid J. "Healthcare Reform in the United States; Facts, Fiction and Drama: Act II." British Journal of Medical Practitioners Dec. 2012: 4+. Academic Search Complete. Web. 18 Feb. 2014. Schoen, Cathy, et al. "How Many Are Underinsured? Trends Among U.S. Adults, 2003 And 2007." Health Affairs 27.(2008): w298-w309. Academic Search Complete. Web. 01 Feb. 2014.

Morrison 8 Wojcik, Steven E. "Implementing The Patient Protection And Affordable Care Act: The Time Is Now." Benefits Quarterly 29.2 (2013): 30-33. Business Source Complete. Web. 28 Jan. 2014. Woolhandler, Stephanie, and David Himmelstein. "Healthcare Reform 2.0." Social Research 78.3 (2011): 719-730. Business Source Complete. Web. 10 Feb. 2014.