The law has 2 parts: the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act. You can view them in PDF or HTML. Entitled The Patient Protection and Affordable Care Act. Be it enacted by the Senate and House of Representatives of the United States of America in Congress. [For continuous pagination in electronic, PDF version, add 19 pages]. Page. Patient Protection and Affordable Care Act (Public Law –).
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Are you interested in reading the entire Affordable Care Act Bill? It is available to download. 6 the Patient Protection and Affordable Care Act ( 7. U.S.C. u–11), as amended by section of the 21st. 8. Century Cures Act, is. H.R. (th): Patient Protection and Affordable Care Act. Compare to a previous version to see how the bill has changed: (Select Other Download PDF .
Early evaluations of ACA impacts, however, have not uniformly documented improvements in access and affordability across all outcomes, and challenges persist 79 , 83 , 85 , In the year following Medicaid expansion, a study found no significant changes in having a usual source of care and in affordability measures such as cost-related delays in medical care, unmet medical care, and lack of a usual source of care among low-income nonelderly adults Others have similarly found positive but nonsignificant improvements in ease of obtaining primary and specialty care appointments and ability to afford care among the poor in Medicaid expansion states compared with nonexpansion states 83 , 84 , For individuals seeking care in the Marketplace, inadequate access to in-network specialty care and incurrence of high OOP costs also remain a concern The potential impact of narrow networks and consequences of selecting plans with high deductibles or copayments require further investigation.
Overall, nonelderly adults who experience access problems e. Encouraging research, however, suggests that the ACA has reduced some income and ethnic disparities in access to care 19 , In summary, consistent with studies of previous expansions, research examining the early impact of the ACA suggests improvements across a variety of dimensions of access and affordability.
By reducing these barriers, the ACA is expected to encourage the use of needed services that prevent or improve health conditions and subsequently reduce the use of other less efficient services.
Impacts of Pre-ACA Expansions With such limited empirical data to address the impact of the ACA on utilization, evaluations of recent pre-ACA health insurance expansions can be helpful in predicting longer-term effects of the law. Results from the OHIE and Massachusetts reform, as well as other state Medicaid expansions, consistently show a significant increase in outpatient utilization e. For inpatient utilization [i.
For example, some OHIE studies using administrative data found a significant increase in ER visits and the probability of hospital admissions among new Medicaid enrollees following the expansion in Oregon 34 , 35 , 91 , whereas another analysis of self-reported data did not reveal any changes 5. Findings regarding inpatient utilization were similarly mixed among studies that evaluated a public insurance expansion for low-income childless adults in Wisconsin 15 , These inconsistencies for inpatient outcomes across evaluations of pre-ACA reforms may be driven by several factors including different methodological approaches, data sources, and follow-up time examined; state policies targeting poor populations prior to the expansion; regional variation patterns in care delivery; and unique features and implementation of individual state Medicaid programs.
Following implementation of major provisions in , significant increases in outpatient utilization and preventive care have been observed 3 , 19 , 79 , 80 , 84 , 85 , After one year, there was a significant increase in the probability of having a physician visit and routine check-up among nonelderly adults overall 19 , Medicaid expansion, in particular, has been associated with a significant increase 6.
Consistent with these national findings, a comparison of two states Arkansas and Kentucky after the first two years of expansion to one nonexpansion state Texas found increases in outpatient office visits and use of preventive care services such as check-ups, regular care for chronic conditions, and glucose checks among those with diabetes Thus, early findings suggest that, similar to pre-ACA reforms, the ACA has encouraged the use of outpatient services and preventive care among low-income individuals.
For inpatient utilization, however, findings have varied over time and by population 19 , 83 , 84 , In the year following implementation of the ACA, there were no changes in ER visits among nonelderly adults overall Early research on Medicaid expansion, in particular, found no change in ER visits within the first year among low-income adults 83 , 97 , though one study revealed a significant increase 7 percentage points in ER visits after excluding young adults who may have benefited from the dependent coverage provision Studies assessing longer follow-up times, however, underscore how the effects of the law may evolve over time 83 , For example, evaluations of Medicaid expansion in three southern states initially found no changes in ER visits after the first year of expansion 83 but subsequently identified reductions in the likelihood of an ER visit and, importantly, reliance on the ER as usual care by the second year Future evaluations of the ACA should continue to examine mechanisms of utilization among low-income individuals.
First, it will be important to understand how the ACA affects the complex relationship between utilization in the outpatient and inpatient settings, namely whether increased use of outpatient services potentially induces inpatient care as observed in the OHIE or, alternatively, substitutes for inpatient care and reduces preventable ER visits e.
Individuals who were previously uninsured may have forgone or postponed necessary care because of financial constraints, and expanded insurance coverage under the ACA may increase utilization that could overwhelm both the health care system and state budgets. Thus, based on pre-ACA expansions, long-term patterns of use among low-income, newly insured individuals remain uncertain.
Health has often been assessed across dimensions of self-reported general and mental health, diagnosed chronic conditions, clinical indicators, and mortality. Many have taken advantage of natural experiments to overcome the endogeneity challenge presented when examining the causal relationship between gaining health insurance and experiencing better health Improvements in self-reported health were observed among nonelderly adults following the Massachusetts reform 88 , as well as among low-income adults who gained Medicaid coverage following expansions in Oregon, New York, Maine, and Arizona 5 , 35 , Although significant changes in mortality were not detected in the OHIE after one year 35 , the other coverage expansions, which were evaluated over a longer period of time, provide compelling evidence that mortality declined among low-income adults 82 , In addition to self-reported health and mortality, clinical outcomes were evaluated in the two years following the OHIE.
Whereas no significant changes were observed for clinical outcomes determined to be sensitive to changes within this time period, such as blood pressure, cholesterol level, or hemoglobin level, a higher probability of diagnosed diabetes and a substantial decrease in probability of depression were found among those who received Medicaid coverage 5. Despite potential limitations of these studies e.
The Affordable Care Act’s Impacts on Access to Insurance and Health Care for Low-Income Populations
After one year, an improvement in self-reported health was found among nonelderly adults overall Medicaid expansion, in particular, was not associated with significant changes in self-reported health among low-income adults after one year 83 , 85 , 97 , but improvements were observed after two years 80 , 84 , most substantially among low-income childless adults, an important subgroup who benefited from expanded Medicaid eligibility Early evaluations of Medicaid expansion have also revealed no associations with changes in rates of self-reported or positive screening results for depression, diagnosed hypertension, or health behaviors such as obesity, but have observed significant increases in rates of diagnosed diabetes and high cholesterol 43 , 80 , 83 , 84 , Overall, these findings further lend evidence to the potential benefits of Medicaid expansion, regardless of expansion approach, and to the notion that health impacts may take more time to materialize.
Researchers have hypothesized that lack of immediate improvements in perceived health status could be explained by increased awareness of newly diagnosed conditions, though these perceptions may improve over time as conditions are treated 47 , 94 , In addition, it will be important to monitor possible reductions in health disparities under the ACA. In a previous study of uninsured adults in the years leading up to Medicare eligibility, health trends were significantly worse and worsening faster for uninsured individuals compared with insured individuals.
After gaining Medicare coverage, however, the health status of the previously uninsured improved to levels comparable to the insured These findings suggest that, by extending coverage to the previously uninsured, the ACA may play a significant role in reducing health disparities experienced by the previously uninsured.
Low-income individuals who are eligible for benefits continue to be uninsured because of ongoing affordability concerns, either because they live in a state that refuses to expand its Medicaid program despite the availability of substantial federal funding or because they are undocumented and prohibited from ACA benefits.
Nevertheless, the early evidence strongly indicates that the ACA is working; it has substantially reduced the number of uninsured and has improved access to coverage for 20 million newly insured people. Over the longer term, further research may show improvements in self-reported health status and better mental and physical health outcomes not only from better access to care, but also from significant reductions in financial stress for low-income individuals and families.
There are limitations to the recent evaluations of the ACA. First, most assessed limited follow-up time, with some relying on only 6 to 12 months of post-ACA data. It will likely take longer for the effects of the law to become evident.
Second, although some of these studies methodologically took advantage of some states choosing to expand Medicaid while others did not i. Thus, the observational studies are susceptible to unmeasured confounders, particularly those that may differentially change over time in expansion versus nonexpansion states. Finally, implementation of Medicaid expansion and the ACA more broadly is not homogenous across states, which could impact eligibility for coverage as well as access, utilization, and health outcomes.
Although steps were taken to mitigate these limitations, future evaluations will need to continue to monitor the impact of the ACA across these domains to fully understand its impact on low-income populations.
Insurance coverage among Americans has significantly increased since ACA implementation, especially those in Medicaid expansion states and among subpopulations targeted by the law, namely the poor, childless adults, ethnic minorities, and young adults.
As undocumented residents do not qualify for assistance under the ACA, the remaining uninsured also include about 5. The ACA has generally been associated with significant improvements in access and affordability and increases in outpatient utilization among low-income populations, but changes in inpatient utilization and health outcomes have been less conclusive.
Despite the availability of subsidies and cost-sharing reductions, the reliance of the ACA on health insurance exchanges might increase access to health insurance, but simultaneously pose unintended barriers to access through creation of narrow networks and existence of high-deductible Bronze plans.
A majority of the states, and numerous organizations and individual persons, have filed actions in federal court challenging the constitutionality of Obamacare. In June , the Supreme Court ruled that the Individual Mandate requirement of the law was constitutional and therefore, held that the main intent of the law, requiring every American to have health insurance, was lawful.
There are new challenges to different provisions of the law reaching the courtroom floor every day and it will be interesting to see what the next big issue will be. In , a few federal district courts held that the plain language of the law stated that the federal subsidy would only available to people living in states with their own state exchange.
Patient Protection and Affordable Care Act (ACA)
It was argued that this was not a design flaw, but an attempt by the authors to compel all of the states to have their own exchange. This would take a big burden off of the federal government so that the money in the budget could go to subsidies and program funding instead of to a website and the administration of it.
In June , the Supreme Court ruled that subsidies tax credits were legal in all states regardless of whether a state had set up its own exchange or not. No matter where you live, you can get cost assistance on the marketplace to reduce your monthly premium. Congress eliminated that tax effective in Obamacare allows more people to get Medicaid. The exact income level varies by state.
The federal government paid all the additional cost for the first three years. After that, the states pay 10 percent. Not all states expanded Medicaid, despite the federal subsidy. Most families that make too much to get Medicaid will still get help.
Many people don't think the federal government should have the right to force people to get insurance. Why is the federal government requiring it?
Obamacare Bill Download
If everyone has insurance, more people will go to the doctor when they are getting sick, instead of waiting until their illness turns into an expensive emergency.
Over time, health insurance should cost your family less. That's because more healthy people will pay more premiums to insurance companies, who will then make more money.
Older people on Medicare will have more of their drug costs covered, meaning they can afford to take all their medicine as they should and stay out of the hospital. That also lowers costs for everyone. By , Obamacare will pay percent of prescription drug costs for those who have Medicare Part D.
They can also get federal financial assistance if they offer health insurance to early retirees age The ruling was placed on hold, pending an appeal. How this will play out over the next few years remains to be seen.
In June , the Supreme Court ruled that subsidies tax credits were legal in all states regardless of whether a state had set up its own exchange or not.
Jack Kingston R-Ga. In a previous study of uninsured adults in the years leading up to Medicare eligibility, health trends were significantly worse and worsening faster for uninsured individuals compared with insured individuals. Impacts of Pre-ACA Expansions With such limited empirical data to address the impact of the ACA on utilization, evaluations of recent pre-ACA health insurance expansions can be helpful in predicting longer-term effects of the law.
Despite enrollment challenges, adults with new Marketplace or Medicaid coverage have reported high satisfaction with their insurance, doctors offered in network, ease of finding doctors, and affordability and access to care, comparable with reports from other insured adults 24 , 26 , An early look at rates of uninsured safety net clinic visits after the Affordable Care Act.
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