Haas, Sheila A

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Debunking Myths Regarding Provisions of the Affordable Care Act

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Loyola University ChicagoLoyola eCommonsSchool of Nursing: Faculty Publications and OtherWorks Faculty Publications2013Debunking Myths Regarding Provisions of theAffordable Care ActSheila A. HaasLoyola University Chicago, shaas@luc.eduThis Article is brought to you for free and open access by the Faculty Publications at Loyola eCommons. It has been accepted for inclusion in School ofNursing: Faculty Publications and Other Works by an authorized administrator of Loyola eCommons. For more information, please contactecommons@luc.edu.This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.© American Academy of Ambulatory Care Nursing, 2013.Recommended CitationHaas, S. "Debunking Myths Regarding Provisions of the Affordable Care Act." ViewPoint, March/April 2013.6 ViewPoint   MARCH/APRIL 2013Sheila A. HaasWith President Obama’s reelection, the PatientProtection and Affordable Care Act (PPACA) and healthcare reform are here to stay. However, the hard foughtcampaign, as well as the write-ups around the U.S.Supreme Court decision on the Individual Mandate thispast summer, have generated quite a few myths and mis-understandings about the PPACA provisions and what theymean for many Americans. Patients, as well as providers,are struggling to figure out how to comply with provisionsand tap into the benefits offered in the PPACA. To help sen-ior citizens become more comfortable with provisions inthe PPACA, a recent issue of AARP’s The Magazine offered asuccinct article (Howard, 2012) for readers where healthcare experts provided concise commentaries to assist indebunking the most common myths.To debunk the myths, it is important to remember thatthe PPACA is first and foremost a bill designed to makemuch needed health insurance reform, so most Americanscan have timely, affordable access to health care. Second,the PPACA is designed to enhance quality and decreasecosts of health care. The provisions for insurance reform inthe PPACA were modeled on the Massachusetts health careinsurance plan and also the Bismarck Model (PublicBroadcasting Service [PBS], 2008), which is used in industri-alized European countries such as Germany, France, andSwitzerland. This model allows private insurance companiesto compete for sales of insurance in the market while at thesame time limits profits and does not permit denial for pre-existing conditions or denial for high expenditures due tocatastrophic illnesses. Citizens in Germany and Switzerlanddo not go bankrupt due to medical expenses. With 50-60%of U.S. workers getting health insurance through employersand the uninsured able to purchase private insurancethrough state insurance exchanges, the U.S. will not have“Universal” government-run health care, but Americans willhave universal access to health care insurance.Medicare and Continuation of CoverageIn the AARP article (Howard, 2012), the first mythfocuses on the belief that PPACA cuts Medicare benefits,when in fact, it prohibits cuts to Medicare and providesincentives to cut soaring Medicare costs. These savings willcome from decreasing unreasonable payments toproviders, taxing high-premium plans (beginning in 2018)and decreasing fraud and waste (Howard, 2012). There areactually added benefits such as free annual wellness exams,screenings, vaccines, and care coordination for personswith complex chronic diseases. Another myth is that per-sons on Medicare will have to get more or different insur-ance. This idea stems from confusion about the rhetoricaround the PPACA’s individual mandate. In actuality, if aperson is on Medicare or has employer-based insurance, heor she can stay on those plans and no additional insuranceis mandated. A third myth involves the belief that MedicareAdvantage will be taken away; again, this is not true.Privately administered Medicare Advantage actually coststaxpayers about 14% more per enrollee per year. ThePPACA aims to bring these costs down and provide incen-tives for higher quality care in Medicare Advantage plans.As we move toward 2014, when the PPACA provisionsthat insurance companies cannot deny coverage for preex-isting conditions in adults and state insurance exchangesare open for business, providers and health systems aregearing up for the anticipated increase of insured patientsand the requirements for wellness, prevention, and primarycare through establishment of Patient-Centered MedicalView health care reform resources online at:www.aaacn.org/health-care-reformDebunking Myths Regarding Provisions of the Affordable Care ActUpdated cover-to-cover with:The new Core Curriculum for Ambulatory Care Nursing, ThirdEdition, Candia Baker Laughlin, MS, RN-BC, EditorA comprehensive administrative and clinical guide to ambulatory careAdvance your practicePrepare for certificationImprove patient careCore Curriculum forAmbulatoryCare NursingThird EditionCandia Baker Laughlin, MS, RN-BCEditor• Content from the new ANCC TestContent Outline for theAmbulatory Care NursingCertification Exam• Expanded focus on clinical careand telehealth practice• New chapters includeperioperative care,complementary and alternativetherapies, and transition care3 Easy Ways To Order• ONLINE www.aaacn.org• FAX with credit card information to 856-218-0557• MAIL completed form with payment to:American Academy of Ambulatory Care NursingEast Holly Avenue/Box 56Pitman, NJ 08071-0056Download order form for fax or mail at www.aaacn.orgProduct #P020V2012 (530 pages)Member Price: $79 • Regular Price: $99WWW.AAACN.ORG   7Homes (PCMHs) and Accountable Care Organizations(ACOs). With PPACA pay-for-performance incentives, thereshould be enhanced access to quality care. However,patients have bought into the myth that they either won’tbe able to see “their doctors” or a doctor at all. There willbe no change for persons who stay in their current plansand whether or not those plans allow them to choose theirdoctors. The PPACA actually has provisions to attract morephysicians into primary care, as well as prepare moreadvanced practice nurses as primary care providers.Taxes and FinesThe U.S. Supreme Court’s decision regarding the indi-vidual mandate has spawned several myths such as, “If Ican’t afford to buy health insurance, I’ll be taxed or worse.”Those who cannot afford the cheapest health insuranceplan (where the cost exceeds 8% of income) will beexempt from penalty. If they do not meet the 8% test andhave to pay a penalty, the penalty in the first year is $95and will reach its maximum of $695 in 2017 (Howard,2012). Even if the tax penalty is levied, there are no provi-sions for criminal prosecution or property liens on peoplewho ignore the tax. The need for all to be insured is ameans to have people seek care when they need it, ratherthan wait until their conditions are so extreme that theymust use emergency care. The second myth about finesinvolves the PPACA provision that small businesses will befined if they do not provide health insurance for employ-?????????????????????????????????????????????????????????? ????????????????? ??????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? ???????????? ?????????????????????????????????????????????????????????????????????????????????? ??????????????????????? ?????????????????? ???????????????????????????????? ?????????????????????????????????????????? ????????????????????????????????????????????????????????????????????? ?????????????????????? ???????????????????????????????? ????????????????????????????????? ????????????????????????????????????????????????????????-???-?????????????????????????????-??????????????????????? ?????????????????? ees. In reality, the PPACA penalties are only for companieswith over 50 employees, and through 2013, eligibleemployers will receive a business credit for up to 35% oftheir contribution toward employee’s premiums. For 2014and beyond, the tax credit rises to as much as 50%. Thesecredits apply to companies with fewer than 25 full-timeemployees whose average annual salaries are less than$50,000. Companies with more than 50 workers thatdon’t provide coverage will be subject to a fine of $2,000-3,000 per employee per year (Howard, 2012).National DeficitAnother myth that was touted during the presidentialcampaign was the idea that the PPACA raids Medicare of$716 billion. This number came from the CongressionalBudget Office (CBO) estimate of $716 billion in reducedspending between 2013 and 2022 that would accrue toMedicare due to provisions in the PPACA. The provisions thatwould create these savings come from changes to providerpayments and correcting overpayments to insurance com-panies that offer Medicare plans (Howard, 2012). These sav-ings will be used to close the donut hole in the Medicare pre-scription drug plan and pay for preventive care andincreased coverage for the uninsured. In fact, all guaranteedMedicare payments were protected in the PPACA (Howard,2012). A follow-up myth is the idea that the PPACA willcontinued on page 11WWW.AAACN.ORG   11bankrupt America. This again is simply not true; ignoring theneed to reform health care would actually bankruptAmerica. According to the CBO and Joint Committee onTaxation, the PPACA will reduce the deficit by $210 billionbetween 2012 and 2021 by decreasing subsidies to privateinsurance companies and cracking down on fraud, abuse,and waste, as well as reining in profits (Howard, 2012). Afinal myth states that the PPACA will drive up premiums. Thisis not so because as the young adults who are mostly healthycome into plans, their premiums will help subsidize care forless healthy persons (Brownlee, 2012). This, along with thePPACA’s “medical loss ratio requirement,” which dictatesthat 80-85% of premiums be spent on medical costs, willkeep premiums down (Howard, 2012). In 2011, there were$1.1 billion in rebates from insurance companies that didnot meet this provision.ConclusionFinally, as has been discussed in prior ViewPointcolumns, some states have put off setting up insuranceexchanges leading to the myth that, “If my state doesn’tset up an insurance exchange, I can’t get health coverage.”Again, this is not true. If a state does not set up one ormore exchanges, then the federal government, throughthe Department of Health and Human Services (DHHS),will set up an exchange in that state or partner with them.Misinformation and myths will continue to confusepatients and providers. There is valuable information ongovernment Web sites, but many do not know this orknow how to access the sites. There are federal sites, suchas HealthCare.gov (n.d.) and the Department of Labor(n.d.) site, which offer valuable information to consumers.There are also state sites that offer information on stateinsurance exchanges, such as the State of Illinois Web site(Illinois.gov, n.d.). It is essential that health care providers(especially those in ambulatory care) be knowledgeableabout PPACA myths that exist and be able to respond topatient questions with simple answers and refer them totrustworthy resources to gain further information.ReferencesHoward, B. (2012, September). 11 myths about health care reform[Electronic version]. AARP The Magazine, 65(6C), 66-69. Retrievedfrom http://www.aarp.org/health/health-insurance/info-09-2012/medicare-and-health-care-reform-myths.htmlDepartment of Labor. (n.d.). Consumer information on health plans. Retrievedfrom http://www.dol.gov/ebsa/consumer_info_health.htmlHealthCare.gov. (n.d.). HealthCare.gov home page. Retrieved fromhttp://www.healthcare.govIllinois.gov. (n.d.). Illinois Department of Insurance. Retrieved fromhttp://insurance.illinois.gov/hiricPublic Broadcasting Service (PBS). (2008). Healthcare systems – The fourbasic models. Retrieved from http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/models.htmlSheila A. Haas, PhD, RN, FAAN, is a Professor, Niehoff School ofNursing, Loyola University of Chicago, Chicago, IL. She can be con-tacted at shaas@luc.eduHealth Care Reformcontinued from page 7When you reply to a call for volunteers, be sure toinclude why you want to be considered for the position,the number of years you have been a member of AAACN,and any involvement you have had being a volunteer withAAACN or any other professional groups. These involve-ments include: serving on a workgroup or SIG activity, pre-senting at the annual conference, publishing an article inViewPoint or in the Nursing Economic$ “Perspectives inAmbulatory Care” column, contributing to anotherAAACN publication (such as the Core Curriculum forAmbulatory Care Nursing), serving as a AAACN representa-tive to a special project or initiative, or holding an electedposition within the association.Don’t give up! We may have the perfect project, work-group, or other opportunity for you just around the corner.There are new initiatives being presented to the Board ofDirectors all the time. Watch your email for one that maybe just right for you.Linda Brixey, RN, is Program Manager of Clinical Education,Immunizations, and Travel Medicine, Kelsey-Seybold Clinic,Houston, TX, and Immediate Past President of AAACN. She can becontacted at linda.brixey@kelsey-seybold.comMaximize Your Volunteering Potentialcontinued from page 1We took everything you need for your job search and put it all in one place. Welcome to the AAACN Career Center – your leading resource for an ideal position or effective recruitment. Job seekers can: ? Find the right nursing jobs. Quicker. ? Get job alerts. ? Receive targeted e-mails,    e-newsletter, and career    advice.And if you’re hiring, there’s something for you too. Because we’re connected to other disciplines’ career centers, your job posting is seen by more people every day.Connect today!www.healthecareers.com/AAACN ??????????????????????????????????????????American Academy ofAmbulatory Care NursingMany settings.  Multiple roles.  One unifying specialty.

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