By Corinne McSpedon, AJN senior editor
Congressional Republicans are moving quickly to repeal the Affordable Care Act (ACA), but have yet to offer a replacement plan or indicate when one might be introduced. The possibility that more than 20 million Americans who gained health insurance through the ACA may lose their coverage is a rising concern among health care providers and patients alike. The ANA detailed its Principles for Health System Transformation in a letter to President-elect Donald Trump last month, advocating for “reforms that would guarantee access to high-quality, affordable health care for all,” and the American Medical Association sent an open letter to members of Congress last week urging them to develop a replacement plan before making any changes to the existing law.
Voters—including Trump supporters who have health insurance through the ACA—are also voicing surprise and disapproval that the current law might be repealed without a replacement. The Kaiser Family Foundation conducted focus groups of working class supporters of Mr. Trump from Ohio, Michigan, and Pennsylvania who have insurance through the ACA marketplaces or Medicaid. The nonprofit organization’s president and chief executive, Drew Altman, detailed the results of the focus groups in an
By Jacob Molyneux, AJN senior editor In a brief analysis of the gradual rollout and effects so far of the Affordable Care Act (ACA) at the start of this year (“The ACA Continues to Run the Gauntlet”), I reviewed a few of the issues the law was intended to address when it was passed in 2010:
* the highest per capita expenditures of any health care system in the world
* consistently worse outcomes on measures such as infant mortality rate than most other developed nations
* increasing numbers of uninsured Americans each year, to over 50 million in 2009, the year before passage of the ACA
* unsustainable annual increases in health insurance premiums and drugs costs, leading to astonishing rates of medical bankruptcy
* a Medicare reimbursement process that rewarded the volume of care provided rather than the effectiveness of that care
These worsening issues had become impossible to ignore. No one believes the ACA is a perfect law; there were too many cooks in the kitchen for that. But it’s at least a good faith attempt to address real problems, to get a framework on the table that can potentially be improved upon. […]
By Jacob Molyneux, AJN senior editor/blog editor
I am amazed at the amount of time being wasted on the relatively mundane matter of health care exchanges. It seems we are now facing a government shutdown; there are creepy and misleading advertisements funded by conservative billionaires like the Koch brothers in order to scare people from signing up for insurance; some red states have actually enacted laws forbidding the health care navigators from helping people understand the new system and sign up for it, and many of these states have refused to create their own exchanges to help their citizens comply with the new law.
The ACA is a law. You can’t just ignore it if it doesn’t meet your personal preferences or political ideas. Given the heated rhetoric the Republicans are trotting out about it, you’d think the government was trying to take away our puppies, instead of implementing ideas originally floated by Republicans themselves to make life a bit easier for millions of Americans whose life decisions are unduly ruled by crazy health care billing practices, byzantine insurance regulations, discrimination against those who have chronic conditions, insanely varying pricing for simple tests, and the like. […]
By Shawn Kennedy, AJN editor-in-chief, and Jacob Molyneux, senior editor
Next week marks Medicare’s 48th anniversary. President Lyndon Johnson signed the legislation creating Medicare on July 30, 1965, guaranteeing health coverage for the elderly. With the gradual implementation of the Affordable Care Act (ACA; 2010), Medicare, along with other government and private forms of health insurance, is undergoing changes, with efforts being made to rein in rising costs, combat fraud, tie quality of care to reimbursement, and so on.
With the ACA’s date for mandated purchase of health insurance fast approaching, some states are setting up state-run health insurance exchanges to provide consumers with a standardized menu of health insurance plans in order to make it easier to purchase a plan that fits both budget and health care needs. Other states have refused to participate (see “
By Gail M. Pfeifer, MA, RN, AJN news director
My husband and I both recently had preventive screening colonoscopies, which are now covered under the Affordable Care Act (ACA) as preventive care for adults over 50. That coverage, if you purchased a new health insurance plan on or after September 23, 2010, which we did, means you do not have to pay a copayment or coinsurance or meet a deductible if you use an in-network provider (here’s a full list of preventive services covered under the new law). You would think that medical office billers and insurance companies would know that by now.
Although some plans have clauses that let them off the hook on this rule, ours does not—these tests should have been covered. Lucky for us, we knew it when the bills came in. To make a long story short, I was billed for the “surgery” and for the anesthesia. So I first called the billing department of the GI specialist’s office and asked them to rebill the procedure correctly, as preventive screening. No further bills from them, for me, but shortly afterward, my husband was billed by the same office for “surgery” occurring months later—same doc, same procedure, same billing office. He’s following up with phone calls as I write.
I next called the anesthesia billing office, which said our insurance company […]