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Before starting this assignment, please make sure to review the materials from the Reading Assignments folder,
In at least 300 of your own words, identify and discuss the impact of the Affordable Care Act on long-term care providers and consumers.

Make sure to cite your sources using the APA format.
Long-Term Care: Managing Across the Continuum, Fourth Edition
John R. Pratt

Introduction provides an overview of the Affordable Care Act was and its components.
The stated aim of the ACA was to increase the quality, affordability, and rate of health insurance coverage for Americans, and reduce the costs of health care for individuals and the government.
The act requires individuals to have insurance coverage and businesses to provide coverage or pay fines.
Health insurance exchanges will be set up in in each state to provide a marketplace where individuals and small businesses can buy insurance (with a government subsidy if eligible).
The law also requires insurance companies to cover all applicants within new minimum standards and offer the same rates regardless of pre-existing conditions or sex.
History/Passage of the Law
The bill passed without a single Republican vote and thirty-four Democrats also voted against it.
Republican attempts to filibuster the bill were defeated by Senate President Harry Reid (D-NV) who used a budgetary process called reconciliation to pass the bill with only 51 votes.
Various public polls at the time (and since) showed that more than 60% of Americans did not approve of the law.
Constitutionality of the Law
The constitutionality of the Act was challenged, specifically targeting one provision of the Act known as the individual mandate. That provision requires most individuals to purchase health insurance or pay a penalty.
On June 28, 2012, the United States Supreme Court upheld the constitutionality of the Affordable Care Act based on the argument that Congress has authority to impose the mandate under its power to tax and spend and that the individual mandate was, in fact, a tax.
The act was designed to be implemented over several years.
The administration chose to begin with some of the more popular portions (requiring policies to be issued regardless of any medical condition, allowing people under age 26 to be covered by their parents insurance, etc.). Those sections were implemented first.
Other more controversial regulations (increased taxes, expansion of Medicaid, etc.) were designed to be spread out over later years. Implementation of some sections have already been postponed by the Obama administration.
Various estimates are that the ACA has spawned anywhere from 10,000 to 30,000 pages of new regulations.
Only a portion of those regulations apply to long-term care.
Each section and provision of the law we cover has associated regulations.
Funding of the ACA
The ACA is funded by a combination of taxes and cost offsets (reductions).
Major taxes include a much-broadened Medicare tax on incomes over $200,000 for individuals and $250,000 for joint filers, an annual fee on insurance providers, and a 40% excise tax on Cadillac insurance policies.
Cuts in Medicare – to finance part of the new spending, spending and coverage cuts are made to Medicare, including:
Reduction in funding for Medicare Advantage policies
Reduction in Medicare home health care payments
Reduction in certain Medicare hospital payments.
Impact on Long-Term Care
The majority of provisions in the act, including many of the more controversial, are tangential to long-term care.
Originally, it was thought that long-term care would be a potential cost-saver because this type of coverage would not be needed immediately and the government could build up its reserves.
Many people are still unaware that long-term care is not included several years after passage of the ACCA.
Health Insurance Exchanges
The ACA included health insurance exchanges, online marketplaces for health insurance. Under this provision, people can use their state’s Insurance Exchange (marketplace) to obtain coverage from competing private health care providers.
Shifting Focus Away from Institutional Care
Much of the focus of the ACA is on redirecting long-term care consumers and services away from institutions such as nursing facilities and assisted living and toward less intensive home and community-based services, such as home health care, hospice, etc.
Considered by many the most important of these is the Community Living Assistance Services and Supports (CLASS) Act.
It would establish a national long term care insurance program.
. Its long-run sustainability came under scrutiny and it was suspended indefinitely on October 14, 2011.
Community First Choice Option
Option provides a six percent increase in federal Medicaid matching funds to states for providing community-based att


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