Affordable Care Act
The Patient Protection and Affordable Care Act (PPACA) was signed into law March 23, 2010. The law represents one of the largest health care reform laws in United States history. The full bill can be viewed at opencongress.org, with regular updates of passed ammendments, as well as summaries of the bill written by both parties.
The government has set up a website, healthcare.gov, to provide information to the general public about the PPACA, as well as providing a timeline explaining when certain provisions of the PPACA will go into effect. Summaries of the bill are also available from whitehouse.gov and an independent summary is available from the Kaiser Family Foundation website [pdf].
The bill is split into 10 separate titles, each covering a different aspect of health care reform.
Title 1: Quality, Affordable Health Care For All. This title mainly focuses on insurance market reform. Some of the key provisions involve:
- Tax credits to assist individuals and small businesses in acquiring health insurance
- Allowing children to stay on their parent's health insurance until the age of 26
- Establishing state based "Affordable Insurance Exchanges"
- Establishing Pre-Existing Condition Insurance Plans
One of the more controversial provisions in Title 1 involves "individual responsibility," also known as the "individual mandate," which allows for government fines for uninsured individuals. Many states have passed legislation opposing the individual mandate. This includes Missouri with the passing of Proposition C.
Title 2: Role of Public Programs. This title focuses on expansion and improvement of pre-existing public programs. This includes:
- Expansion of Medicaid eligibility
- Enhanced support for the Child Health Insurance Program (CHIP)
- Establishment of the Federal Coordinated Health Care Office to integrate care for Medicare/Medicaid dual-eligibility individuals.
Title 3: Improving the Quality and Efficiency of Health Care. This title focuses on reducing cost and improving the quality of health care. Some of the provisions include:
- Linking Medicare payments to quality of care.
- Establishment of The Center for Medicare and Medicaid Innovation to help improve patient care and cost effectiveness.
- Enhancements to Medicare Parts C and D
Title 4: Prevention of Chronic Disease and Improving Public Health. This title focuses on improving preventative care to reduce instances of chronic diseases. Provisions include:
- Expansion of Medicare coverage to more preventative services.
- Expanding immunization services for children and adults.
- Establishing government grants for preventative health services and chronic disease management.
Title 5: Health Care Workforce. This title focuses on increasing both the quantity and quality of the health care workforce. The American Public Health Association has published an excellent summary of the provisions involved.
Title 6: Transparency and Program Integrity. This title focuses on increased transparency in both the private and public health sectors in order to decrease fraud and abuse. Some key provisions focus on:
- Increased monitoring and reporting standards for nursing homes
- Development of new tools to combat health care fraud of medicare, medicaid, CHIP and private insurance
- Establishment of the Elder Justice Act
Title 7: Improving Access to Innovative Medical Therapies. This title has two main parts:
- Establishment of the Biologics Price Competition and Innovation Act
- Expansion of the 340B Drug Pricing Program
Title 8: Community Living Assistance Service and Support. This title established the Community Living Assistance Service and Support (CLASS) Act which was designed as a self-financed voluntary insurance program for long term care. Implementation of the CLASS act has halted after a report from the Department of Health and Human Services showed that the program could not remain solvent.
Title 9: Revenue Provisions. This title covers the financial aspects of the programs and provisions established by the PPACA. Summaries of the revenue provisions are available from Whitehouse.gov and the Congressional Budget Office.
Title 10: Strengthening Quality, Affordable Health Care for all Americans. This title focuses on amendments and modifications to the previous 9 titles. The title also reauthorizes the Indian Health Care Improvement Act.
The library has books available on the PPACA, and health reform. They include:
Remedy and Reaction: The Peculiar American Struggle Over Health Care Reform by Paul Starr
Inside National Health Reform by John E. McDonough
The New Health Care System: Everything You Need to Know by David Nather.
Landmark: The Inside Story of America's New Health Care Law and What it Means for Us All by the staff of the Washington Post
Getting it Done : How Obama and Congress Finally Broke the Stalemate to Make Way for Healthcare Reform by Tom Daschle with David Nather.
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