MATRIX GRID hcs 455 week 2

Topics: Health insurance, Health care, Insurance Pages: 8 (2468 words) Published: November 10, 2014
University of Phoenix Material
Health Care Reform Matrix
With your learning team, complete the Health Care Reform matrix below. Listed in this matrix are some of the topics addressed by the Patient Protection and Affordable Care Act policy. You are required to describe the issue, in your own words, and list 2-3 points about each topic under each heading in the matrix.

Describe the issue:
Key concerns regarding the issue:
How is this issue addressed in the current health care environment? How will this issue be addressed by the Patient Protection and Affordable Care Act? Patient Bill of Rights
A newly implemented set of protections that apply to health coverage starting on or after September 23, 2010. The patient bill of rights was implemented to end common insurance abuses such as discrimination against children with preexisting conditions, ban on insurance companies dropping or limiting coverage for individuals in their utmost time of need, and coverage for preventive care. In the past insurance companies were known to deny coverage for people with preexisting conditions including children. Also in the past insurance companies were allowed to deny coverage for preventive treatments. Currently in the health care environment insurance companies are no longer allowed to discriminate against children with preexisting conditions and are not allowed to deny or limit coverage. Individuals are now entitled to coverage regardless of their health status. The affordable care act has implemented the patient bill of rights which makes it mandatory for insurance companies to accept individuals and provide coverage regardless of their health status and regulates coverage for certain preventive testing mandatory such as cancer screening, immunizations and hearing and vision test for children and newborns Medical Loss Ratio

Medical loss ratios are defined as when an insurance company spend a substantial portion of consumer premium dollars on administrative costs and profits including executive salaries and marketing. Lawmakers have raised some concerns about the MLR

provisions, including the issue that insurers are not allowed to deduct insurance agent, broker and salary bonuses and commissions from their medical loss ratio expenses The ACA requires certain health

insurers to provide consumer rebates if they do not meet a set financial target known as a medical loss ratio (MLR)
Beginning in 2011 all health insurers are required to publicly submit data reports detailing aggregated state level financial data as well as income from premiums and expenditures on health care claims quality improvement taxes licenses and regulatory fees under the ACA.

State-based Health Insurance Exchange
Online State Health Insurance comparison websites
A state can offer it’s own insurance or work with other states to establish regional insurance coverage exchanges People who are not able to obtain affordable insurance through their workplace, Medicaid or CHIP had the opportunity to purchase health insurance during open enrollment October 2013. 25 states out of the 50 united states have decided not to run an exchange for their specific state residents People who are not offered affordable insurance through their workplace must purchase coverage individually which can be quite expensive. Residents of states that do not offer specific insurance can explore coverage’s offered by regional exchanges The Act promises to give individuals health coverage by reforming the insurance markets and insurance. Individuals can compare and contrast coverage. Coverage will be of one of two packages, Family/Individual coverage and Small Business coverage. Federally-facilitated Insurance Exchange

Federal government will have to be aware of insurance laws that are state specific Federally Facilitated exchanges do not have the option to regulate which health plans are purchased through the exchanges like states do States are allowed to decide which health...

References: (2013). Retrieved from
CFDA, (N.D). Affordable Care Act (ACA) – Consumer Assistance Program Grants. Retrieved from: (2014). Retrieved from (2014). Retrieved from
Health Policy Briefs. (2013). Retrieved from
Kaiser Family foundation, (Feb, 29, 2012). Explaining Health Care Reform: Medical Loss Ratio (MLR). Retrieved from:
Marketplace insurance categories. (2014). Retrieved from
Medicaid Expansion Good for the States?. (2014). Retrieved from expansion-good-for-the-states
U.S Department of Labor. (2014). Retrieved from
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