Patient Protection and Affordable Care Act of 2010
The healthcare Act signed by President Obama to ensure that the Americans have access to better healthcare in a way that they can afford, has provisions addressing almost all aspects of ones health. The preventive care and the young adult coverage are some of the provisions given. A personal interpretation of the provision, the advantages/disadvantages of a particular provision in relation to the health, covering have been discussed. The federal contradicts itself in the preventive care and young adult coverage provisions. Exempting some health plans from these provisions is not a way of ensuring that all the citizens’ health care is taken care of.
This provision means that in relation of the health covering one has, they do not have to pay for co-insurance or other extra payments that were paid before in order to seek for preventive health services. This simply means that one can receive counseling services, vaccinations, health tests, and screenings at no extra charge. Preventive services such as cancer tests, which are carried out on people of all ages, are also available. The tests include screenings, mammograms, pap smears, and others depending on the cancer type. The check on the sugar level especially on the elderly and the mature adults are carried out. The checks on the blood pressure and cholesterol level come hand in hand. Vaccination against diseases such as meningitis, polio, measles, and tuberculosis is another service offered. For people who are addicted to alcohol, and smoking and are finding it hard to stop it on their own, counseling services are available for them. Prenatal care for pregnant women and antenatal care are all given at no extra cost (HealthCare.gov, 2010).
This provision has been very advantageous to the people being covered by the HMO (Health Maintenance Organizations) health plan. This prepaid plan covers the doctors’ visits, emergency care, therapy, tests, staying in hospital and emergencies among others. The insurance cover caters for individuals and their families and requires one to pay monthly premium. There are other co-payments of around $5 for a visit to the doctor and $25 for emergencies (Kongstvedt, 2009). In the PPO plan (Preferred Provider Organizations), which differ with the HMO in some way is a health plan that has more advantages than the former. In this plan, one can change a doctor if they wish to and do not need referrals. Whether on HMO or PPO, the provisions cater for all the individuals. The care is more personalized and less hectic than the This plan also provides preventive care like doctors’ visits, antenatal care, vaccines and immunizations, cancer tests, just to mention but a few (Bihari, 2010).
Since this plan is job related and the provision caters for people in job related health plans, it has been an advantage to me. It also covers the preventive health care. People being covered by it do not have to pay the co-payments any longer. One can now visit the doctor, take the cancer tests, have antenatal care, or be counseled, just to mention but a few, all at no extra costs. However, one of this might be the primary reason why you went to the hospital/clinic. For instance, visit the doctor then deciding to take a mammogram will attract extra charges. You can either visit the doctor or have the test. This comes in handy for people who are no longer working but need to get the regular checks done. I do not have to accompany my children in order to pay the additional amount but rather to offer psychological support and get the doctor’s opinion (Bihari, 2010).
Another advantage is that it does not matter the age one is, the provision caters for that individual. This provision has catered for the children, adults and even the elderly. There is no group of people who do not need preventive health care and so having it at no extra charge makes it all the more better. Some times one needs to visit the doctor regularly and so having this at no extra charge is advantageous. Different age groups also need different tests to be done on them on a regular basis. This provision helps people to gain a type of service that may prevent one from incurring the cost of having the treatment itself. Most people may fail to have these services due to the fear of incurring extra costs but when they can now have them at no extra cost, they are more encouraged and some major treatments might be avoided in the long- run.
The main goal/agenda of managed care is to help the American citizen control costs on health care. Through health insurances, the people get to access health care without incurring the original cost. Through designated premiums paid within the time agreed, one can easily and affordably access health care. This provision, gives people of all age groups access preventive health care at no extra charge. In other words, the cost is catered for by the insurer. However, it has really ‘kicked’ many citizens out. This is because those who are unemployed or have individual insures registered earlier than 23 March 2010, (HealthCare.gov, 2010) cannot enjoy the advantages of these provision. This is like putting money in the pocket with one hand then removing it with the other.
This is contradicts the concepts that advocate for affordable health care to all citizens. All citizens should be allowed to gain this service without any obstacles or ultimatums. Putting barrier sin such a kind of a provision may leave majority of the citizens ‘outside’ thus failing on managed care original intention and goal.
This means that health plans can include your children in the plans until they reach the age of 26 unlike in the past where they were insured up to the age of 19 years. This is regardless of their status. In summary, this means that your children get insurance coverage whether or not they are employed and financially stable and can readily live alone and support themselves. They also qualify if they are studying full time or part time. Whether they are living with their parents or not is not an issue in this provision. They are qualified to have the benefits of this plan even if they are qualified to be in their employer’s health care plan. Marriage is also not a hindrance in this provision (HealthCare.gov, 2010).
The advantage of having my children covered until they are the age of 26 years irrespective of their status puts a general advantage to all parents and children. In most times, some children are not so stable by the time they hit the age of 19 years and so it becomes a little hectic for the parents catering for them. However, the people who are in “grandfathered” health plans are at an advantage as the health plans do not have to adhere to this provision (Merlis, 2010).
Another advantage is that the young adults can slowly be independent without having to worry about health care insurance for sometime. They can visit doctors and take tests without having employment. For those who are in school full time, they can have medical care without getting part time jobs in order to pay the insurers. Couples under the age of twenty-six having financial difficulties do not have to sacrifice their health as their health is covered through their parents. However, the parents have to include their children before the plan year starts. This is done by the insurance plan issuing a 30 day written notice to the insured (HealthCare, 2010).
This provision greatly contributes to the concepts and the goals of managed care. The inclusion of young adults into their parents’ health care plans captures as many people as possible in the health plans. Young adults can no longer worry about their medical costs. It encourages them to visit regularly the health facilities even when undergoing health facilities. It also enables the young adults have the right to good health even with the absence of financial stability. They are ensured of better health and attention without meeting the whole cost.
To the parents, seeing their parents covered is something that brings joy to them. However, this means that they will have to pay more premiums for the children who will be newly enrolled. To the parents in the grandfathered plans, they may not apply to them. This becomes a hindrance to the people in the in the nature of the people in this plans. It hinders the young adults from accessing health care through their parents as with the other health plans. In general, it puts an obstacle in managed care concepts (Kongstvedt, 2009)
Both provisions have made it easier for Americans to access good health more affordably. People of all ages can access good health care without incurring an extra cost. The preventive care provision and young adults’ coverage work hand in hand to ensure that the young adults also get the preventive care without incurring the cost, as that would be taken care of by their parents. However, the exemption of “grandfathered” plans puts many citizens at a disadvantage. These citizens will not enjoy these provisions unless they seek otherwise. The elderly people are the ones mostly in these plans. They will to get the preventive care at the extra cost originally incurred. It is like there were no provisions made at all for these people. Life almost remains the same (Merlis, 2010).
It is important for the government to include every citizen in these provisions. Having some people exempted will only make it harder for them and make them feel left out in an expense that is costly in this part of the world. It is important for every citizen to access all the advantages these provisions have to offer unless otherwise.
As mentioned earlier, what the government is doing is like putting with one hand and removing the other. Some revisions should be done to these provisions so that every citizen feels as pat of these great country. All children should be taken care of by their parents in all aspects, especially where they are not full stable financially.
Bihari, M. (2010). HMOs vs. PPOs – What Are the Differences Between HMOs and PPOs? About.Com, Health insurance. Retrieved from http://healthinsurance.about.com/od/understandingmanagedcare/a/HMOs_vs_PPOs.htm
HealthCare, gov (2010). U.S Department of Health & Human Services. Retrieved from http://www.healthcare.gov/law/provisions/index.htm
Kongstvedt, P.R. (2009). Managed care: what it is and how it works. Ontario, Jones & Bartlett Publishers.
Merlis, M. (2010). Grandfathered Health Plans .Health Policy Brief. Oct. 29