|Health-related Bill Name||Patient Protection and Affordable Care Enhancement Act
|Bill Number||HR 1425|
|Description||The bill was introduced to the House of Representatives in June 22, 2020. The bill is intended to strengthen and improve the capabilities of the Affordable Care Act (ACA) through the enhancement of the Medicaid programs and cost improvement of the prescribed drugs (Congress.gov, 2020). The bill is meant to improve access to market places and provide cost effective measures for healthcare services and the products. Some of the areas of the ACA that are meant to become enhanced by the new bill include; the creation of more affordable premium tax credits (PTCs), diversification of subsidies from the ACA to include people from different socio-economic classes, alter the state waver in section 1332 which was introduced by the Trump government, funding of the state to cover projects for improving health coverage, funding all insurance programs meant to improve population outreach on matters concerning health, and elimination of the family gap between the rich and poor communities (Congress.gov, 2020). Most of the components of the bill are included in the ACA prior legislation and are a part of the former Vice President’s Joe Biden’s health care campaign protocols. HR 1425 includes the incentives of 14 states that have not yet expanded their Medicaid programs through considering the eligibility of Medicaid, CHIP, and post-partum Medicaid programs for 12months instead of 60days as it is normally used (Congress.gov, 2020). The bill will ensure an improvement in the payment rates for primary health care providers under the Medicaid programs and CHIP act.|
|Federal or State?||The Patient Protection and Affordable Care Enhancement Act is a federal bill. It is similar to the bill introduced by the Democratic leaders in March 2019. As a federal program, the bill is well defined in paragraph 3 section C of the Medicaid related program. According to the Compacts of Free Association, the bill covers all individuals lawfully residing in one of the 50 states. It is inhibited for all people living in the District of Columbia and it applies to the federal law in relation with the Compacts of Free Association between the United States Government and the Federal Governments of the States of Micronesia, Republic of Palau, and the Republic of Marshall Islands. However, the bill is legal for all people who lawfully reside in Puerto Rico, African Samoa, Guam, and Northern Marian Islands as stipulated by the Secretary of the Health and Human Services in writing. Various compacts have been developed to aid in health coverage for all American citizens who reside in other states besides their home state.|
|Legislative Intent||HR 1425 is meant to expand the availability of PTCs to individuals who are eligible with an income of 400% of the federal poverty level (FPL). It would make the PTCs more favorable by reducing amount of contribution made towards their health insurance premiums. The bill will also extend access to those who are not eligible due to their family glitch. According to the current federal health status, the PTCs are only available to individuals with an income of 100 to 400% of the FPL, approximately $ 12,000 to $ 51,000. Being available on a sliding scale, the subsidies are generous to the people of lower incomes. The ACA created a subsidy cliff through eradication of eligibility at 400% for individuals earning above the 400% level (United State Senate, 2018). Lack of subsidies attributes to greater challenges for middle income levels due to coverage losses. For the unsubsidized population, the middle class older adults get the highest level of premium coverage. The main aim of the bill is to eradicate the ACA subsidy cliff through authorization of PTCs for incomes above 400% FPL (United State Senate, 2018). By removing the upper limit, the act will enable access to PTCs for the middle income and upper income persons who purchase their own covers. Elimination of the subsidy cliff is also covered in the Biden healthcare plan. The main aim of the bill is to reduce the amount income that individuals have to contribute|
|Proponents/ Opponents||Proponents: House of representatives: yeas-nays, 234-179 on passage
House Energy and Commerce committee
Representative Craig and Rep Peters.
|Opponents: house of representatives failed the motion on instruction to retransmit by 187-223 (yeas to nays).|
|Target Population||The goal of HR 1425 is to provide $10billion annually to states to enable the establishment of reinsurance to various states and enable them use the funds for financial assistance in the reduction of premium costs and out-of pocket costs for individuals enrolled in care plans. The target population for the bill was the middle class individuals who were limited by the 400% FPL (United State Senate, 2018). Additionally, the program is focused to the states that do not apply for state funding even though they have Medicare and Medicaid programs. Most states have demonstrated the intention to transform healthcare programs from government to state based market places. Through provision of the $10billion, the states are meant to use the funds through: reducing the premiums for out-pockets costs for marketplace enrollees and establish personal insurance programs that are meant to cover health insurance coverage for students and old grandfathers with the inability to cover premiums (Mulcahy et al., 2018). Based on the bill, some states would choose to use enhanced ACA subsidies such as the state of California whereas others preferred to use the federal funds on reinsurance. Through the Department of Health and Human Services (HHS) all states have to apply for the funds and they are automatically qualified unless the HHS deems it otherwise.|
|Status of the bill (Is it in hearings or committees?)||The bill is under review by the senate committee. The bill passed the house of congress but still waiting final approval by the house of senate.|
|The bill is a good proposal meant to improve the health of the American community. It is meant to cover a cost of $100billion within 10yrs which will be used to cover medical insurance for people enrolled in various coverage programs such as the qualified health plans (QHPs) and the Patient Protection and Affordable Care Act (PPACA). The bill will focus on narrow networks which is a frequent shortcoming for the ACA. Through the HHS well developed plans will be enacted that will become used in state-based market places which will apply in the year of 2022. It alienates the differences between Obama’s administration and Trump’s. Obama’s administration required quantitative network adequacy standards up to 2017 which was disrupted by Trump’s market stabilization rule which was implemented in 2018 resulting to the HHS differing to state network adequacy standards. Through the bill, levels of un-justification, unfair discrimination, and unnecessary rebates are meant to be eliminated as customers’ access health coverage. The implementation of the changes will become enforced through civil monetary penalties imposed by the HHS. Unreasonable increases in the grandfathered health plans are expected to be addressed.|
Part 2: Legislation Testimony/Advocacy Statement
I support the passing of the Patient Protection and Affordable Care Enhancement Act to law due to the associated benefits. The bill is meant to benefit the people from middle and even low level income households. Through the $200 provided to the federal grants annually, all states are expected to transform their health care delivery systems (McGeeham et al., 2017). Some of the ways through which states can improve health delivery include; conducting a feasibility study to develop a plan for increasing enrollment, exploring various ways of improving customer enrollment to the care coverage programs through experimenting with auto-enrollment, investing in technology to improve data collection and distribution, and implementation of a state level individual mandate.
Besides improving the federal market place, the bill is expected to improve the educational opportunities for all nurses and other healthcare workers. Additionally, involved members ought to have better knowledge and understanding on the common conditions that affect their immediate populations and the best modes of prevention. The enrollment of the program is expected to be conducted in health disparity areas thus leading to better integration (Hall et al., 2017). Matters of culture and diversity are also issues to be addressed in outreach as it helps bridge the gap between the medical insured and those without medical covers. The program is aimed at eliminating organizations in the market places that act brokers and instead empower the navigators to register new members in the Medicaid and CHIP programs. Thus, through the bill, many members of the American population are meant to better understand the coverage programs and join as members.
One of the objectives meant to be achieved by the PPACA is accountability in health services disbursement. The HHS is expected to submit biweekly public reports on the performance of the government healthcare programs and enrollment on the various coverage programs. It is expected to establish annual enrollment targets that have to be assessed every three months. Normally, the HHS has always provided reports on the enrollment to the congress (Crowley & Bornstein, 2019). However through the new bill, they are supposed to provide more detailed reports involving information such as enrollment levels directly through the web brokers and insurers as well as navigator performance activities. HHS will be expected to provide information related to the ACA marketing and outreach programs.
Proper handling of the opponents is best done through effective education. Once the bill is introduced, it is important to conduct research on the knowledge levels among the congress, senate, and general public. A demonstration of low understanding should become covered by conducting outreach programs for the public and in house sessions for congress and senate members. Most importantly, the financial impact of integrating the bill into law should be very clear so as to facilitate better understanding among the lawmakers (Mulcahy et al., 2018). A good example is printing pamphlets that are distributed during sessions with information on the bill and some of the ACA and CHIP aspects that it is meant to improve.
Congress.gov. (n.d.). Retrieved September 20, 2018, from https://www.congress.gov
Crowley, R. A., & Bornstein, S. S. (2019). Improving the Patient Protection and Affordable Care Act’s Insurance Coverage Provisions: A Position Paper From the American College of Physicians. Annals of internal medicine, 170(9), 651-653.
Hall, K. S., Kottke, M., Dalton, V. K., & Hogue, C. R. (2017). Ongoing implementation challenges to the Patient Protection and Affordable Care Act’s contraceptive mandate. American journal of preventive medicine, 52(5), 667-670.
McGeehan, M., DeMaria, R., Charney, P., & Batavia, A. S. (2017). Insurance enrollment at a student-run free clinic after the patient protection and affordable care act. Journal of Community Health, 42(4), 785-790.
Mulcahy, A. W., Gracner, T., & Finegold, K. (2018). Associations between the Patient Protection and Affordable Care Act Medicaid primary care payment increase and physician participation in Medicaid. JAMA internal medicine, 178(8), 1042-1048.
United States House of Representatives. (n.d.). Retrieved September 20, 2018, from https://www.house.gov/
United States Senate. (n.d.). Senate organization chart for the 115th Congress. Retrieved September 20, 2018, from https://www.senate.gov/reference/org_chart.htm
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Assignment: Legislation Grid and Testimony/Advocacy Statement
As a nurse, how often have you thought to yourself, If I had anything to do about it, things would work a little differently? Increasingly, nurses are beginning to realize that they do, in fact, have a role and a voice.
Many nurses encounter daily experiences that motivate them to take on an advocacy role in hopes of impacting policies, laws, or regulations that impact healthcare issues of interest. Of course, doing so means entering the less familiar world of policy and politics. While many nurses do not initially feel prepared to operate in this space effectively, the reward is the opportunity to shape and influence future health policy.
- Select a bill that has been proposed (not one that has been enacted) using the congressional websites provided in the Learning Resources.
The Assignment: (1- to 2-page Legislation Grid; 1-page Legislation Testimony/Advocacy Statement)
Part 1: Legislation Grid
Based on the health-related bill (proposed, not enacted) you selected, complete the Legislation Grid Template. Be sure to address the following:
- Determine the legislative intent of the bill you have reviewed.
- Identify the proponents/opponents of the bill.
- Identify the target populations addressed by the bill.
- Where in the process is the bill currently? Is it in hearings or committees?
Part 2: Legislation Testimony/Advocacy Statement
Based on the health-related bill you selected, develop a 1-page Legislation Testimony/Advocacy Statement that addresses the following:
- Advocate a position for the bill you selected and write testimony in support of your position.
- Describe how you would address the opponent to your position. Be specific and provide examples.
- At least 2 outside resources and 2-3 course specific resources are used.