The Patient Protection and Affordable Care Act (PPACA or ACA)
By: Dr. Peter Ikre
The landmark legislation was signed into law on the 23rd of March, 2010 by the first black president of the U. S., Barack Hussein Obama. The event climaxed many years of efforts by previous administrations to establish a health insurance framework that took into consideration the interests of teeming millions of uninsured U. S. residents wishing to access the health care delivery system. If you are still wondering what the topic is all about- I am referring to the new health care reform law officially known as Patient Protection and Affordable Care Act (PPACA or ACA for short). To the man in the street, it is colloquially called ObamaCare just like the aborted HillaryCare during the Clinton era or the successful RomneyCare before it. Moreover, some of the cardinal or foundational principles of ObamaCare emanated from RomneyCare in Massachusetts. Recently, I discovered that RomneyCare was patterned after Israel’s 1995 National Health Insurance Law that required every resident to register as a member of one the sick funds or health insurance companies. Prior to this period, in 1973, the government enacted a law requiring every employer to pay a health tax to fund a portion of employees’ health insurance premiums. In essence, the graduated payment scheme of the sick funds and employer contributions (30% of health care expenditures) constitute the bulk of health care financing in Israel. The arrangement has given the Israeli population a sense of belonging, equity, and security with respect to health issues (Israel Ministry of Foreign Affairs, 2002). At this point, it is pertinent to state that every health plan must provide a set of basic health services to residents and remain non-discriminatory on the grounds of age or health status. It is obvious Obamacare took a cue from the Israeli health system. Furthermore, President Barack Obama should be commended for working tirelessly to extend health insurance to millions of uninsured individuals, especially to those in the immigrant communities and minority groups. Although the precise number of uninsured is unknown, Footracer (2009) estimated that there are 46 million people in the U. S. without any form of health insurance coverage. The number of uninsured within the immigrant community is growing, and the non-citizen group remains disproportionately represented in the uninsured population. In addition, a study comparing access to care between documented and undocumented Mexican immigrants revealed that the latter were more likely to face obstacles including financial, educational and cultural on the way to accessing health care (Urrutia, Marshall, Trevino, Lurie, & Minguia-Bayona, 2006). At this juncture, it is pertinent to state that Obamacare as presently constituted only applies to documented individuals with or without insurance. The non-possession of citizenship or residency makes one ineligible for Obamacare. To buttress this point, Sungkyu and Sunha (2009) declared that non-citizens of the United States were 1.6 times less likely to have access to regular care compared to their native-born counterparts. They attributed the disparity to several factors including: a) health insurance status, b) length of stay in the U. S., and c) level of English proficiency. The reason for the preamble is to provide a brief historical insight into the struggle to enhance accessibility to health care in the U. S.
Because of the significance of health care to the individual and the overall
economy (health care accounted for about 17.9% of the U. S. gross domestic product or GDP in 2011), this piece is only the beginning of a 5-part series aimed at familiarizing readers with the following: a) basic concepts enshrined in the law, b) mandate requiring legal residents/citizens to have health insurance or Individual Mandate, c) mandate requiring businesses to provide health insurance to employees or Employer Mandate, d) various assistance programs to help with enrollment, and e) obligations of the taxpayer. One thing is certain- anyone residing legally in the country must participate in the program except for a few exemptions. As the series progresses, more information will be made available regarding eligibility requirements, waivers, exemptions, fees, and penalties. Just as it is in other parts of the world with existing comprehensive/universal coverage such as Britain and Canada, success of Obamacare depends on adequate funding obtained through taxation. For now, financing of Obamacare will depend on a combination of insurance premiums, various co-paying arrangements, general taxes, and taxes disguised as penalties and fees. As the program becomes more comprehensive, the tax component may likely increase if the system is inundated with fewer young individuals and more sick/old people.
On a final note, the just concluded enrollment exercise for purchase of health insurance via the marketplace (from October 1, 2013 to March 31, 2014) was adjudged a success by the administration. The enrollment goal of 7 million sign-ups was met. Despite the March 31st deadline, enrollment continues for those unable to complete the process. Persons yet to commence the exercise must wait for the next enrollment exercise at the end of the year. The next registration exercise for the year 2015 starts on November 15, 2014 through February 15, 2015. The company I represent, Investigroup, is actively involved in the Obamacare Enrollment Program. The public is invited to register at our main offices in New Jersey and New York. As program director, I oversee the work of a group of well-trained, highly dedicated individuals (known as Certified Application Counselors or CACs) focused on ensuring that health insurance extends to those desiring the benefit.
Dr. Peter Ikre has more than 25 years experience in Healthcare, Accounting, Taxation, Business Management and Financial Consulting both locally and internationally. Dr. Ikre is currently a tax expert and loan modification specialist at Investigroup, Inc. You can reach him at 9083421160 (cell); 9083441806 (alt.); 9086884778 – office; email: email@example.com