The Affordable Care Act – What You Need to Know

This blog post was written by Christopher Plein, Ph.D., Professor of Public Administration at West Virginia University and member of the OneOp Military Caregiving concentration team.

Whether you are working with military families, are a caregiver yourself, or simply a citizen concerned and interested where things are going, we can all agree that the health care system in our country is in a state of flux and uncertainty.

In my role with the OneOp caregiving team, I am responsible largely for offering instruction and insights on health programs and policies that affect military families.  I study health policy in general, but have given a lot of attention to our nation’s vast and complex Medicaid system.  While serving primarily low-income populations, Medicaid often provides needed services and coverage for families, including those in the military, with loved ones that have special health needs.  We’ll be exploring this issue later this summer with a special webinar dedicated to Medicaid to be presented on June 21, 2017.

Other OneOp team members are also involved in sharing insights on health policy. Andrew Crocker, PI for the OneOp Military Caregiving concentration, has helped us understand how the Medicare program serves both older Americans and those who qualify because of certain disabilities and health conditions.  You can view Andy’s most recent presentation on Medicare go to Medicare 2017 & What it Means for You.

In recent weeks, our nation’s attention has turned to the future of the Affordable Care Act (ACA) or what many call “Obamacare.”  There have been conflicting calls to repeal, replace, repair, retain, and revise the law. The ACA was enacted in 2010 and was both a response to changes already underway and served as a catalyst for further change.  More specifically, the law was aimed largely at addressing the needs of the uninsured and underinsured in America.

The term “uninsured” is largely self-explanatory, and ACA sought to address this by expanding Medicaid coverage to a broader set of low-income groups (up to 138% of the federal poverty level).  Many, but not all states opted to do this.  The ACA also establish health insurance exchanges for those in the “individual” or non-group market. To make insurance more affordable, the law provides insurance premium subsidies for those making up to 400% percent of the federal poverty level.   In addition, the ACA prohibited denying coverage due to a preexisting condition.

The term “underinsured” is a bit more complex and this has been at the heart of some recent political debate.  Under the ACA, federal law established a more defined and comprehensive definition of what is to be considered essential minimal coverage that mandates certain services and benefits under an insurance policy or program.  This affects the individual exchange market, employer-based insurance, Medicaid, Medicare, and TRICARE. (Click on TRICARE and the Affordable Care Act for more information.)  Some have argued that this standardization has gone too far, making insurance too expensive.  Others caution that these are essential services that allow for uniform quality and needed coverage.

Even if you are covered by TRICARE, it is important to understand what is happening in the broader health policy arena. Last week’s showdown in Congress, which resulted in the ACA being preserved at least for the short run, highlights just how important health insurance and coverage is in our country.

When faced with a contentious present and an uncertain future, it sometimes is helpful to look to the past for guidance.  One of the best resources that I can think of is an article published in the New Yorker magazine by Atul Gawande, a leading authority on health care systems.  Entitled, “Getting There from Here” tells the story of how our health care system has evolved over time in the United States.  Gawande compares our system to other countries as well.  So if you have been stationed overseas, you might find this discussion to be of particular interest.

In the months ahead, we can expect that health policy issues will continue to be at the forefront of national attention – especially as they related to health insurance, including Medicare and Medicaid. Through our blogs, social media, and webinars, we will address and touch on these issues as needed and keep you posted.

This MFLN-Military Caregiving concentration blog post was published on March 31, 2017.



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