Benefits of Obamacare

How the ACA's Benefits Lowers Health Care Costs

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Obamacare has a lot of benefits that people now take for granted. These benefits are designed to save you money and lower U.S. health care costs. In 2010, Congressional leaders realized that the cost of Medicare, Medicaid, and employee health benefits was eating up the federal budget. They agreed that reforming health care was a priority.  

Obamacare's Three Strategies

Obamacare had three strategies to lower health care costs.

  1. The ACA makes health insurance affordable by providing subsidies
  2. Obamacare emphasizes preventive care
  3. The ACA legislation improved how health care itself is delivered

The Affordable Care Act's three strategies means more people can get treatment before they need expensive emergency room care.

Why is preventive care so crucial? A day in the hospital costs $2,517 on average. Most people assume their insurance pays most of this. Some may be unprepared to pay a high deductible. But before the ACA, they could also get hit with another bill. Many found out their plans had a low maximum. They were responsible for any costs above that.

Once a patient declared bankruptcy, the hospital had to declare a loss on any unpaid treatment. To make up the profit, it must pass this cost onto everyone else. 

Obamacare reduced the number of bankruptcy filings. In 2010, 1.5 million people filed. That dropped to 770,846 by 2016. The ACA forced insurance companies to cover all costs by eliminating annual and lifetime limits. That reduced unexpected catastrophic costs for individuals.

Obamacare's strategy has been working to slow the increase of health care costs.

Since 1990, the highest rate of health spending growth occurred in 2002 at 9.5%. This high growth rate followed a steady growth of 7.1 and 8.5 percent in 2000 and 2001, respectively. After the exchanges opened in 2014, spending on health care rose more slowly. It grew by 5.3% in 2014 and 5.8% in 2015. 

In 2018, a Health Affairs study found states that expanded Medicaid saw 40% increase in the number of prescriptions filled for diabetes drugs. States that didn’t expand Medicaid expansion saw no increase.

Lower health care costs are one reason why the ACA was projected to reduce the deficit by $143 billion over its first 10 years. If health care is less expensive, so is Medicare and Medicaid. Obamacare also shifted cost burdens to health care providers and pharmaceutical companies. Last but not least, it raised taxes on those earning at least $200,000 a year. Those taxes would end if Obamacare were repealed, thus adding to the debt.

Make Insurance Affordable

The first of Obamacare's three strategies was to make health insurance more affordable. It did this by offering tax credits, setting up insurance exchanges, and allowing children to go on their parents' plan. It also eliminated the "Part D" prescription drug coverage "doughnut hole" and offering a small business tax credit.

Tax Credits

The ACA provides tax credits for insurance to the middle class, those whose incomes fall below 400% of the poverty level. It limits out-of-pocket costs to $8,150 for an individual plan and $16,300 for a family plan in 2020. It expands Medicaid to 138% of the federal poverty level and provides this coverage to adults without children for the first time.

Insurance Exchanges

In 2014, states were required to set up insurance exchanges or use the federal government's exchange to make it easier to shop for insurance plans.

You can use the exchanges to compare prices and purchase health insurance online. You can also compare doctors, hospitals, and other providers in your area. Make sure you know how to get Obamacare. Each year, the enrollment period starts in November. 

Add Children to Parents' Plans

In 2010, parents were allowed to add their children up to age 26 on their plans. That lowers costs for everyone else by adding the premiums from these relatively healthy people to insurance company revenues.

Eliminate Part D "Doughnut Hole"

The ACA eliminates the Medicare Part D “doughnut hole by 2020. This benefit was phased in over time. It gave seniors a 55% discount on prescription drugs and 42% for generic medicines in 2016. That amount increases until they only pay 25% in 2020.

Small Business Health Care Tax Credit

The Small Business Health Care Tax Credit benefits employers with fewer than 25 full-time equivalent employees. Small businesses get a tax credit worth up to 50% of their contribution to employees’ health insurance. Non-profits receive a 35% credit.

Emphasize Prevention

The ACA emphasis on prevention is critical in cutting health care costs for the nation. Here's how:

10 Essential Benefits

The ACA requires all insurance plans to cover the following 10 essential health benefits.

  1. Preventive and wellness visits, including chronic disease management
  2. Maternity and newborn care
  3. Mental and behavioral health treatment
  4. Services and devices to help people with injuries, disabilities, or chronic conditions
  5. Diagnostic lab tests
  6. Pediatric dental and vision care
  7. Prescription drugs
  8. Outpatient care
  9. Emergency room services
  10. Hospitalization

Most of these 10 essential benefits are preventive care services.

Preventive care cuts costs by identifying and treating diseases before they become emergencies.

These include well-woman visits, domestic violence screening, and chronic disease management. It also covers lab tests to diagnose diseases, including mammograms and colonoscopies. In addition, maternity and newborn care, and dental and vision care for children is free. 

Expands Treatment for Chronic Diseases and Mental Health

The ACA expanded treatment for mental health, addiction, and chronic diseases. These patients can be the most expensive to treat, which is why insurance companies try to avoid coverage. When left untreated, many of them ended up homeless or in prison, which costs the government much more.

The ACA covers services and devices to help people with injuries, disabilities, or chronic conditions. It also covers more drug benefits.

The ACA mandated that the National Prevention Council must coordinate all federal health efforts to promote an active, drug-free lifestyle. It also established the Prevention and Public Health Fund to invest in proven public health programs, from smoking cessation to combating obesity.

Eliminates Lifetime and Annual Coverage Limits

Another way the ACA provides a safety net is by eliminating lifetime and annual limits. That helps those with chronic conditions get enough insurance to cover treatment. This safety net is critical for hemophiliacs and children with heart problems or cancer.  This would probably be repealed.

Prevents Denial of Coverage Due to Pre-Existing Conditions

Obamacare prevents insurance companies from denying you a policy because you have, or get, a health condition. That's known as a pre-existing condition, and it kept millions from getting coverage.

Companies can't drop your coverage because you made a mistake on your application, or because you’ve entered a clinical trial for cancer or another life-threatening disease. Plans can’t make you wait more than ninety days before coverage starts. You can appeal claim rejections or other health insurance decisions through your state regulator.

Limits Administrative Costs and Profits

The ACA requires that insurance companies spend 85% of all premium dollars for large employer plans on health care services and quality improvement. That drops to 80% for plans sold to individuals and small employers.

If insurers do not meet these goals because their administrative costs or profits are too high, they must send rebates back to consumers. You might have already received it and not know it was because of Obamacare.

Improve How Health Care Itself Is Delivered

Here are the ways that Obamacare improved how doctors and hospitals deliver health care.

Accountable Care Organizations

The ACA authorized Medicare to change how it pays doctors and hospitals. It used to pay for every test and procedure you get. It will transition to a system that bases payments on how well you get. That forces hospitals, doctors, and pharmacists to work together in a comprehensive approach. So far, these so-called Accountable Care Organizations have shown significant results. The ACA encourages more of them.

You probably assumed your primary care physician already coordinated the care you receive from hospital visits, specialists, and tests. But like the former system, doctors didn't get paid more for doing that. Doctors today must focus on activities that generate income. That means even the best practices can't afford to coordinate care.

Computerized Medical Records

The ACA works with prior legislation to make sure all medical records are put on computers so they can be transferred electronically. You probably thought that also happened, but medical records have been traditionally kept on paper records. That meant test results had to be mailed or faxed.

The ACA is working toward a system that keeps one electronic record.

That will allow all your doctors to share their diagnoses and treatments as well as your clerical and payment information. Once implemented, electronic records will further lower health care costs.

Funds Health Care Training

The ACA requires states to make sure the Medicaid payments that doctors receive are no lower than payment rates for Medicare. It funds scholarships and loans to double the number of health care providers. It adds funding to attract doctors to medically underserved communities in rural areas.

Center for Medicare and Medicaid Innovation

Obamacare established the Center for Medicare & Medicaid Innovation. It's in charge of creating a national strategy to improve health care and lower costs.

The ACA created the Independent Payment Advisory Board to advise Congress on how to extend the life of the Medicare Trust Fund. The Board will target waste in the system. It will recommend ways to reduce costs, improve health outcomes, and expand access to high-quality care. 

Reduces Fraud

The ACA also targets fraudulent doctor/supplier relationships. It gives guidance to states reviewing excessive insurance rate hikes. It also requires background checks of all nursing home staff to prevent abuse of seniors.

Obamacare created the Community First Choice Option. It encourages states to offer home and community-based services to physically challenged individuals through Medicaid. That lowers costs by keeping them out of nursing homes.

In Depth: Pros and Cons | How Does It Work? | Obamacare Summary | What's in the ACA Bill | The Truth about Obamacare

To make sure you are getting all your Obamacare benefits, check out the author's book, "The Ultimate Obamacare Handbook" (2015 - 2016).

Article Sources

  1. Kaiser Family Foundation. "Hospital Adjusted Expenses per Inpatient Day." Accessed Sept. 17, 2020.

  2. American Bankruptcy Institution. "Annual Business and Non-Business Filings by Year (1980-2019)," Page 2. Accessed Sept. 17, 2020.

  3. Consumer Reports. "How the Affordable Care Act Drove Down Personal Bankruptcy." Accessed Sept. 17, 2020.

  4. U.S. Centers for Medicare and Medicaid Services. "History of Health Spending in the United States, 1960-2013," Page 20. Accessed Sept. 17, 2020.

  5. Health Affairs. "National Health Spending: Faster Growth in 2015 as Coverage Expands and Utilization Increases." Accessed Sept. 17, 2020.

  6. Health Affairs. "Medicaid Eligibility Expansions May Address Gaps in Access to Diabetes Medications." Accessed Sept. 17, 2020.

  7. Congressional Budget Office. "Manager's Amendment to Reconciliation Proposal," Page 2. Accessed Sept. 17, 2020.

  8. IRS. "What Is the Additional Medicare Tax?" Accessed Sept. 17, 2020.

  9. U.S. Centers for Medicare and Medicaid Services. "Subsidized Coverage." Accessed Sept. 17, 2020.

  10. U.S. Centers for Medicare and Medicaid Services. "Out-of-Pocket Maximum." Accessed Sept. 17, 2020.

  11. U.S. Centers for Medicare and Medicaid Services. "Medicaid Expansion & What It Means for You." Accessed Sept. 17, 2020.

  12. U.S. Centers for Medicare and Medicaid Services. "When Can I Enroll in a 2020 Marketplace Plan?" Accessed Sept. 17, 2020.

  13. U.S. Centers for Medicare and Medicaid Services. "How to Get or Stay on a Parent’s Plan." Accessed Sept. 17, 2020.

  14. Congressional Research Service. "Medicare Part D Prescription Drug Benefit," Pages 18, 20. Accessed Sept. 17, 2020.

  15. IRS. "Small Business Health Care Tax Credit and the SHOP Marketplace." Accessed Sept. 17, 2020.

  16. U.S. Centers for Medicare and Medicaid Services. "Ending Lifetime & Yearly Limits." Accessed Sept. 17, 2020.

  17. U.S. Centers for Medicare and Medicaid Services. "What Marketplace Health Insurance Plans Cover." Accessed Sept. 17, 2020.

  18. U.S. Centers for Medicare and Medicaid Services. "Rate Review & the 80/20 Rule." Accessed Sept. 17, 2020.

  19. Urban Institute. "Medicaid Physician Fees After the ACA Primary Care Fee Bump." Accessed Sept. 17, 2020.

  20. U.S. Department of Health and Human Services. "The Affordable Care Act and the Prevention and Public Health Fund Report to Congress for FY2012," Pages 6-7, 9. Accessed Sept. 17, 2020.