|Type of paper:||Essay|
|Categories:||Medicine Healthcare policy|
The pre-existing conditions are the health issues which an individual had before the start of the new medical care coverage. Due to the establishment of the Obamacare affordable act, the insurers do not request for more costs or deny the coverage of the people with these pre-existing conditions. Also, the insurers are unable to limit the benefits or deny paying for the treatment of the pre-existing condition because of this act. The denial of the health coverage to those with pre-existing conditions before the start of Obamacare had effects to 50 million individuals which included 17 million children. Most people who tended to seek coverage from the private insurers were either denied coverage; their condition removed from the insurance or was charged higher premiums. The people with this condition ended up in the emergency rooms since they could not access or afford the treatment. The medical bills were paid by the Medicaid thus making medical care costs to heighten. Therefore, Obamacare act stated that every individual was to buy insurance which could help them in accessing the health care services whenever they fall sick.
What tends to qualify as a pre-existing condition?
The insurance organizations consider any preventive measures, diagnosis or the test to be pre-existing conditions. These companies categorize this to be pre-existing conditions as it helps in minimizing the risks. The diseases which are termed to belong to this category are Alzheimer's which is the typical type of dementia, AIDS where one individual out of the six are aware that they the disease, cancer, and diabetes. Also, alcoholism is among the pre-existing condition since some people are addicts thus being dependent and abuses alcohol. Some children live in households in which one or both of the parents are dependent and abuse the alcohol. Families who are affected by alcoholism might have a family background which is linked to addiction hence making it a pre-existing condition. The alcoholic individuals tend to be affected by the fatty liver diseases which are believed to result from obesity, malnutrition, high cholesterol, and diabetes. Besides, people tend to have drug addiction where some use the prescription drugs without any medical reasons (Haney, Kinsella & Morey, 2014). Other diseases that are categorized as the pre-existing conditions are the kidney failure that results due to high blood pressure, stroke, Crohn's disease, and rheumatoid arthritis.
On the other hand, healthy individuals who had been denied the health coverage since they had acquired the coverage from private insurance as a pre-existing condition. Other conditions which were categorized as these conditions were; pregnancy since the women had to wait for a year to be covered for pregnancy after acquiring the insurance cover, denial for coverage due to the mental illnesses, intellectual disability and the obesity cases where people suffering from it were either charged highly or denied coverage (Haney et al., 2014). After the Obamacare act, those suffering from these conditions were accepted to take medical coverage since this act allowed every individual to buy an insurance cover.
Ways in which the insurance companies get around the affordable care act
The companies tend to place the price of drugs which are required by the high-cost patients on an expensive tier thus making the patients divert to other medical plans that are typical to charge fewer costs. Some of these companies require the patients to pay a given amount of money from their pockets making the acquisition of the medical coverage expensive. Also, some of these companies are substituting the lower-priced generics thus not covering for particular drugs. The affordable care act carries out an appeal whenever the doctors require the patients to have a name brand prescription and the insurance companies are unable to provide coverage for the medicine (Kocher, Emanuel & DeParle, 2010). Therefore, people are advised to check the formulary of the insurance companies before signing for a given premium since when one purchases prescriptions that are not on the formulary the insurance company does not provide coverage for them.
How one benefit from the Obamacare act
The individuals with the pre-existing conditions are covered by this act thus ensuring there is affordability of the medical services by every person. People cannot stay on the jobs which they feel uncomfortable due to the benefits of this act. Also, persons who do not have the interests of the pre-existing conditions tend to access medical services at an affordable cost. People who had no insurance cover to obtain preventive care rather than waiting for a crisis or medical issues to occur and send them to emergency rooms (Diaz, 2015). The persons who use the emergency rooms contribute to a given percentage of its costs hence treating patients at low prices in doctors' offices would have helped in minimizing the expenses for the medical care to every person.
Advantages of Obamacare act
The act required the insurance plans to provide coverage for the ten critical medical benefits. The treatments which are ensured by this act are the chronic diseases, mental health, and the addictions. If the insurance companies do not provide the services, patients will end up being taken to the emergency rooms whenever a crisis arises. Ensuring that there is coverage for every person by these companies, the cost of accessing medical services has reduced and made affordable for every individual (Tanner, 2015). Therefore, patients end up receiving treatment before requiring the high-cost services from the emergency rooms.
The act helped in eliminating the limits which were set by the insurance companies for the annual and lifetime coverage. The companies set limits which made the individuals who exceeded it to pay for extra costs thus earning more from them. Also, these companies are unable to deny people coverage due to the emergence of these conditions as this act protects them. The insurance cannot hike their premiums or reduce them whenever one of their beneficiaries falls sick. Besides, the law ensures the children stay on the medical insurance plans of their parents until they hit the age of twenty-six (Tanner, 2015). The addition of the uninsured individuals to the insurance plan led to the increment of the insurance profits, therefore, making the children acquire more premiums than healthy persons.
Obamacare helped in minimizing the medical care cost which is provided by the government since every individual in the state have registered for these premiums. Also, the budget deficit is promised by raising the taxes which are given out by these business organizations thus improving the family's income generation. The act helps in shifting the burdens of medical costs to the pharmaceutical organizations and the providers of medical care. The business organization which possesses at least fifty employees tends to offer their workers with the insurance covers since they acquire the tax credits which help them in paying the costs. On the other hand, individuals who are termed to be in the middle class are given the tax credits on their premium plans (Tanner, 2015). Therefore, this action helps in expanding Medicaid through the provision of coverage to the adults who do not have children.
Disadvantages of Obamacare
The insurance companies whose premium plans did not cover the ten benefits of the Affordable Care act were canceled thus making them to experience losses. Beneficiaries who had acquired the premium plans from these companies were forced to register again making the replacement costs expensive. Besides, the Affordable Care Act tends to require some services which are not needed for a lot of people such as maternity care (Rosenbaum, 2011). Due to the cancellation of these plans, workers lost their employment medical insurances thus making the small businesses to acquire the improved plans via the exchanges for the state-run.
Furthermore, the increment of the medical coverage to people led to an increase in the cost of healthcare within a shorter time. The price increased since individuals were receiving the testing and preventive care for the first time thus making it expensive in offering treatment to the illnesses which had been ignored (Tanner, 2015). Also, people who did not buy the medical covers were taxed, but some swayed from it through the expanding exemption list.
Obamacare has proofed to be of importance to the citizens of the United States since they can receive medical coverage after buying the insurances. The patients who were being taken to the emergency rooms after the crisis has occurred has reduced hence reducing over congestion and appropriate delivery of medical services. The government promoted the accessibility of the medical services by every citizen thus making it affordable. Those who had the pre-existing conditions which were not being treated started receiving health care which promoted their health.
Diaz, F. G. (2015). How Obamacare will affect you: An editorial. Neurosurgery, 62(CN_suppl_1), 81-91. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4571845/
Haney, N. M., Kinsella, S. D., & Morey, J. M. (2014). United States medical school graduate interest in radiology residency programs as depicted by online search tools. Journal of the American College of Radiology, 11(2), 193-197. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24120904
Kocher, R., Emanuel, E. J., & DeParle, N. A. M. (2010). The Affordable Care Act and the future of clinical medicine: the opportunities and challenges. Annals of internal medicine, 153(8), 536-539. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/20733178
Rosenbaum, S. (2011). The Patient Protection and Affordable Care Act: implications for public health policy and practice. Public health reports, 126(1), 130-135. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001814/
Tanner, M. (2015). The pros and cons of a guaranteed national income. Washington, DC: Cato Institute. Retrieved from https://object.cato.org/sites/cato.org/files/pubs/pdf/pa773.pdf
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