· This bill strengthens the weaknesses between provider and patients allowing strong relationships.

· Another issue is that patients now have more choices when it comes to insurance, and they have to find an insurance plan that meets the needs for their care.

· Patients would be assigned doctors and medical providers.

· After reaching the age of an adult, children were not allowed to be covered through their parents’ insurance plan. They would need to receive their own coverage or stay uninsured.

· Children can now stay on their parents’ health insurance till the age of 26.

· Patients now have the right to choose their provider, as long as it is in code with the patients’ insurance.

· This measures the medical costs spent on clinical services and improvements.

· Medical Loss Ratio can hurt high – deductible plans due to the eighty percent only counting towards the medical costs paid from the insurance company.

· Traditional loss ratio included medical care claims and premiums, now the medical loss ratio includes medical care claims plus improvement expenses and regulatory fees.

· “The Medical Loss Ratio provision of the ACA requires most insurance companies that cover individuals and small businesses to spend at least 80% of their premium income on health care claims and quality improvement, leaving the remaining 20% for administration, marketing, and profit.” (Explaining Health Care Reform, 2014)

· States run the marketplace for their state in partnership with the federal marketplace.

· States run the marketplace based on their local needs and market conditions.

· States needed to find out what was the best way to implement and run the health insurance exchange.

· As the state based health insurance exchange becomes more common, the flexibility of the price plans became more of a competition due to the uncertainty of the marketplace itself.

· Allowed small and medium businesses shop with the larger businesses and save costs, they had a wide range of plans for employees.

· The marketplace offers competition with online comparisons and promotes competition through participation of the insurers.

· This would be consider a one stop place for consumer to stop the different type of coverage that are available

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· With the insurance the state can either accept or refuse.

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· What this is it helps any businesses or even small business find show for coverages.

In order for this to work it has to provide for low income providers

· PPACA, the state exchanges are not limited to government funded coverage and could evolve into a marketing channel for non-subsidized coverage.

· This also helps people register with health care “Consumer Assistance Programs have reached communities in rural and frontier areas that previously have not been served by health insurance consumer assistance advocates.” (CMS.gov)

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· They are also the front of the line people who may come with information with the insurance company

· They been around since 1990 what they do is help with and select private health insurance.

· Not only are the elderly are able to afford insurance it has even lower over the years as well

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· Everyone is able to afford different choices, the exchange. Even have pre-existing condition.

· High risks pool there were some waiting periods for a year of coverage a pre-existing condition.

· Different states can come up with their own high-risk for people. There have been some states who can choose have their HHS handle a PCIP program.

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· Now with the ACA no one can’t deny a patient to be insure with any pre existing condition.

· Annual limits are restricted under the Department of Health and Human Services (HHS) regulations. (CMS.gov Center for Medicare & Medicaid Services, 2017).

· Employers and insurers estimated that requiring mini-med plans to comply with the new rules could cause mini-med premiums to increase, forcing employers to drop coverage and leaving some workers without even the minimal insurance coverage. (CMS.gov Center for Medicare & Medicaid Services 2017).

· Plans that receive the waiver had to comply with all other provisions of the law and must alert consumers that the plan had a restrictive coverage and includes low annual limits. (CMS.gov Center for Medicare & Medicaid Services, 2017).

· On June 17, 2011, the Center for Medicare and Medicaid Services introduced a process for plans that have already received waivers and want to renew those waivers for plan or policy years beginning before January 1, 2014.

· A Health Reimbursement Arrangements (HRA) were subjected to the restricted annual limits, having apply individually for an annual limit waiver. (CMS.gov Center for Medicare & Medicaid Services, 2017).

· Most of these children may be eligible to join their parent’s health plan if that plan offers dependent coverage. (CMS.gov Center for Medicare & Medicaid Services, 2017).

· Nearly half of the uninsured young adults report problems paying medical bills.

· Young adults usually have an entry or part time job that does not offer health insurance. (CMS.gov Center for Medicare & Medicaid Services, 2017).

· Early implementation would avoid gaps in coverage for new college graduates and other young adults and save on insurance company cost for dis-enrolling and re-enrolling them between May 2010 and September 23, 2010. (CMS.gov Center for Medicare & Medicaid Services, 2017).

· Even if the child is married children qualify for this coverage.

· Children up to age 26 can stay on their parent’s employers plan even if they have their own coverage through their employer. (CMS.gov Center for Medicare & Medicaid Services, 2017).

· A plan could lose grandfather status if the insured chooses to make certain significant changes that reduce benefits or increase costs to consumers. (CMS.gov Center for Medicare & Medicaid Services, 2017).

· The original regulation only allowed self-funded plans to change third-party administrators without necessary losing their grandfathered plan status. (CMS.gov Center for Medicare & Medicaid Services, 2017).

· The grandfathered rule states that a group health plan would relinquish grandfathered status if it changed issuers or policies. (CMS.gov Center for Medicare & Medicaid Services, 2017).

· Offering the same level of coverage through a new issuer and remain grandfathered, as long as the change in issuer does not result in cost increases.

· Helps protect American’s ability to keep their current plan if they like it. (CMS.gov Center for Medicare & Medicaid Services, 2017).

· Conducted through annual check-ups which are done before a patient becomes symptomatic or shows any symptoms.

· Another concern is that is there enough physicians to take care of everyone properly? Not having enough doctors to review patient’s histories properly, can lead to many problems if they are overloaded with patients seeking care since they now have access to health insurance.

· Preventive services were not covered 100%, and patients were required to meet their deductible, or pay a coinsurance which could be extremely high before being able to receive these services that could be life-saving.

· Since the ACA was enacted there, have been national campaigns for preventative health measures, especially those to combat smoking, and childhood obesity.

· Different plans offer different levels of coverage based on what the participant chooses for themselves. All plans cover preventative health care, and it is the ACA’s responsibility to make sure that the laws are followed within the marketplace and reinforce them with the different plans.

· “ACA was structured to address the gaps and limitations of our public-private health insurance system. It builds on employer-based coverage, restructures the individual insurance market, and broadens access to and affordability of coverage by expanding Medicaid for the low-income population and extending tax subsidies for the purchase of private insurance to those with moderate incomes”(Tolbert, 2015, para. 2).

· Also, a lot of people were unable to get insurance before the ACA because they were unable to afford it, so they had to pay out of pocket for the care that they needed, or go without it.

· Most health care plans are showing that patients are receiving high-quality care, within the improvement, and public disclosures.

· If a student qualifies for a student health plan, they will become exempt from the tax penalty that some people face for not carrying health insurance.

· “An annual study put out by Beckley’s firm, Hodgkins Beckley Consulting, suggests that, in general, the ACA has pushed student premiums up slightly at schools which have historically offered good-quality plans”(Dame, 2014, para. 11).

· Prior to the ACA, student health plans had inconsistent coverage and tended to provide meager benefits to those that carried them.

· Many colleges and universities offer student plans that now cover ten vital benefits with no benefit maximums since the ACA was established.