Reading the Affordable Care Act

OK, so here's a project I've started. It's not related to Peace Corps. Several weeks ago, I decided I wanted to read the Affordable Care Act. I'm writing as I go, reflecting on what I read and trying to understand it. I'll probably embarrass myself with my lack of understanding, but what the hell?

If anyone reads this, I might give it a blog of its own. 

Here goes nothing. This was Day One:

July 13, 2014

I’m going to read the Patient Protection and Affordable Care Act.

I’m not a doctor, a politician or a policy wonk. I have a master’s of science in public health, but I’m mostly a normal person (and journalist). I’m probably going to misunderstand a lot of it, but I’m going to do my best.

I remember hearing pundits talk about how so many politicians haven’t read the act. It is long. The version I downloaded, with amendments, is 2,409 pages. I imagine the proper way to read it is to read the actual act and then return to the top and read the amendments. I’m not going to do that. I’m just going to read it all the way through. That might muddle my understanding of the document, but I think I’ll manage to get the gist.

Or maybe it makes more sense to read the amendments first, rather than reading a version that was later updated. I haven’t even scrolled through to see whether amended sections are struck through.

Also, I’m in a hut in Swaziland in southern Africa, a month away from finishing a two-year stint as a volunteer. I have a lot of down time. I will use this time to read the Affordable Care Act and to write about it here. I am not speaking on behalf of anyone but myself. Also, I don’t have great Internet access in my hut, so chances are that I won’t always be able to look up things that confuse me. I’d appreciate it if you’d cut me a break if I muse over something I could have just Googled.

If I misinterpret wording or if you disagree with me, please feel free to call me out. This is just an exercise in which a normal American Person tries to read and understand an important document produced by the American Government.

Let’s get started!

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I’m 11 pages in, and I’m still on the table of contents, with its titles and subtitles.

Stuff I’m interested in learning more about:

-       Public health initiatives such as data collection about health disparities

-       Community transformation grants

-       Medicaid coverage for freestanding birth center services

-       School-based health centers

-       Reasonable break time for nursing mothers

-       Scholarships for health professionals

-       Spending for Federally Qualified Health Centers (FQHCs)

-       Limitation of excessive remuneration paid by certain health insurance providers

-       Additional hospital insurance tax on high-income taxpayers

-       Excise tax on elective cosmetic medical procedures

-       Indian health care improvement

Stuff that gives me pause:

-       Termination of provider participation under Medicaid if terminated under Medicare or other state plan (If a state dumps Planned Parenthood, for example, the federal plan must also do so for Medicaid recipients?)

-       Inclusion of cost of employer-sponsored health coverage on W-2 (My health care costs are considered income, which could mean I’m taxed at a higher rate?)

-       Additional requirements for charitable hospitals (This is under revenue offset provisions. What does it mean?)

Part of the ACA requires summaries of benefits and coverage to be presented in a uniform format that’s four pages or less and printed in at least 12-point font. I assume they talked to insurers about whether this was feasible. I think it’s awesome. I sure as hell can’t remember ever reading more than four pages of a document about my insurance benefits. But I’ve been lucky (read: healthy or lazy) enough to not need to read the fine print.

UCR fees = usual, customary and reasonable fees

The ACA requires every hospital to publicly release the cost of standard charges for items and services. TRANSPARENCY FTW.

Every state has to have an ombudsman. Love me some ombudsmen. This is who I’ll contact if I’m looking to get some health care when we return to America.

There’s a lot of talk of Internet websites. To the Internet website! I require informations!

Insurers have to submit justifications for “unreasonable premium increases” to the state and feds BEFORE they increase the premium. They also have to post it online (see Internet websites for details). I’m sure the ACA elaborates on “unreasonable” somewhere – in Section 2794. This section is called Ensuring That Consumers Get Value for Their Dollars, which I am all about. It also suggests that insurers who (this is America, so they get to be “who”) have a pattern of increasing premiums “unreasonably” could get booted from the exchange.

Subtitle B is “Immediate Actions to Preserve and Expand Coverage.” I’m going to read it, but since it’s irrelevant – I believe this is all the stopgap measures that were put in place between passage of the act and 2014 – I probably won’t have much to say about it.

Basically, if you were in a high-risk pool, you should have transitioned to coverage from a health exchange by Jan. 1 of this year. Did that happen? I hope so.

By Aug. 1 of this year, the Treasury Secretary should have notified any insurers that have been assessed a penalty (p. 77). I’m sure this is public information. Just, y’know, FYI. I suppose I’m not sure whether the government would update its Internet website to reflect this in real time.

Session one: pp 1 to 80, started with “December 24, 2009” and stopped at amendments to Subtitle C – Quality Health Insurance Coverage for All Americans