The Patient Protection and Affordable Care Act: What Are the Facts, and Where Do We Go from Here?

Article excerpt

The Patient Protection and Affordable Care Act (PPACA), also known as the Affordable Care Act or Obamacare, has split the nation on the issue of health care reform. The mere mention of the act can cause emotions to run high for the majority of Americans one way or the other. PPACA defines its role as being established "to help Americans who found themselves uninsured and unwanted in the health insurance market find a health care home." This act includes an opportunity for every American to be provided with appropriate insurance coverage to protect these individuals from financial ruin if they become ill and in need of care: "PPACA puts consumers back in charge of their health care. Under the law, a new 'Patient's Bill of Rights' gives the American people the stability and flexibility they need to make informed choices about their health." (1) Regardless of where we stand on the issue, the act is scheduled to take effect Jan. 1, 2014. To that end, we must not allow ourselves to be ignorant of what the PPACA stands for and what is required of us as correctional health care professionals.

As corrections professionals, we understand how to care for inmates who lack the resources to meet their own needs, especially as it relates to health care services in the community. Correctional health authorities nationwide have struggled for years to negotiate contracts and services for inmates when the community at large has viewed this population as undesirable. This is largely due to both the heavy level of services that they consume, and the community's attitude about mingling offenders with citizens in community waiting rooms.

This raises several important questions: How does this act really affect the incarcerated population? How do we define "inmate" and "inmate patient" within the health insurance arena, and what rights and requirements do inmates have to access and comply with PPACA? Are they covered under the "Patient's Bill of Rights?" The American Correctional Association's Coalition on Correctional Health Authorities (CCHA) formed a working group to evaluate the data, understand the language of this extensive law and then provide an unbiased look into how the new mandate may affect the incarcerated population. The CCHA-PPACA working group has spent many hours assisting secretaries and directors of corrections in understanding and developing a plan for managing this new act. The following provides an outline of that work.

PPACA--What Does It Mean?

PPACA is a U.S. federal statute signed into law on March 23, 2010. President Obama stated, "This act represents the most significant government expansion and regulatory overhaul of the U.S. health care system since the passage of Medicare and Medicaid in 1965." (2) PPACA is aimed at increasing the rate of health insurance coverage for Americans and reducing the overall cost of health care. It provides a number of mechanisms--including mandates, subsidies and tax credits--to employers and individuals to increase the coverage rate. Additional reforms aim to improve health care outcomes and streamline the delivery of health care.

In the beginning of the planning phases of PPACA, the Congressional Budget Office projected that the act will lower both future deficits and Medicare spending. However, as of May 2013, their estimates determined that the overall cost of PPACA will result in a $40 billion dollar cost to the American public after 12 years. (3)

On June 28, 2012, the U.S. Supreme Court upheld the constitutionality of most of PPACA in National Federation of Independent Business v. Sebelius. This very pragmatic and close ruling (a 5-4 vote) upheld the requirement that certain individuals pay a financial penalty for not obtaining health insurance, and that this penalty may reasonably be characterized as a tax. However, the court rejected the mandate in the law that would have expanded Medicaid. In a 7-2 vote, it ruled that the law exceeded its constitutional authority to require Medicaid expansion at the risk of losing existing federal payments. …