1. Running head: THE PATIENT PROTECTION AND AFFORDABLE CARE ACT 1
The Patient Protection and Affordable Care Act
Traci Waggoner
Southwest Florida College
Finance for Healthcare Managers
July 6, 2013

2. THE PATIENT PROTECTION AND AFFORDABLE CARE ACT 2
The Patient Protection and Affordable Care Act
In the United States the campaign for some form of government funded healthcare has
stretched over a century. On several occasions, supporters believed there was a strong possibility
of success, and each time they were defeated. Many Americans seem to be under the impression
that the crisis in our healthcare system recently emerged on the political itinerary, however the
first call for universal coverage came over a century ago. Teddy Roosevelt actually included
universal healthcare in his platform when running for president in 1912. Organized opposition to
reform has had a similarly long history (Cassanego, 2010).
The topic of universal coverage was supported by the people through the Great
Depression and World War II, as even then, concerns over the rising cost of healthcare fueled a
call for reform. In 1932, the Committee on the Costs of Medical Care released a report stating
that millions of Americans, although not considered poor by the government, faced financial ruin
if a family member became seriously ill. Despite this information, President Roosevelt never
publicly advocated for universal coverage. President Truman who is characterized as the first
great proponent of universal coverage, and who delivered a number of messages to Congress on
the very subject, calling for a transformation of the existing American health care system into
one where coverage would be compulsory for all people; he did not aggressively take his cause
before the American public. The creation of Medicare in 1965 was a major success in reform
efforts; however, the proposal for a universal healthcare system, once again, from the Clinton
administration never gained the support necessary to become a reality (Cassanego, 2010).
When we contemplate the history of these reform efforts and consider the current
political landscape; with its current legislative complexities, a more complex law making
environment, a broad partisan divide among political parties, and the peoples trust in the

3. THE PATIENT PROTECTION AND AFFORDABLE CARE ACT 3
government at an all - time low, the recent passage of the health care reform bill represents a
significant accomplishment for the Obama administration (Cassanego, 2010).
The debate over universal coverage will not end with the passing of Patient Protection
and Affordable Care Act (PPACA), it is imperative that the American people understand the
history of reform efforts, the complexities surrounding the success and failure of these attempts
and the unique moment in time we are facing. An issue as important as this cannot be evaluated
on limited information and half - truths.
The PPACA was first enacted on March 23, 2010, and the Health Care and
Reconciliation Act following on March 30th of that same year. The combined acts are referred to
as simply the Patient Protection and Affordable Care Act (PPACA) or the Affordable Care Act
(Chesser, 2010).
The major components of the PPACA include: the Creation of New Health Insurance
Marketplace Programs, Health Insurance Market Reforms, Coverage Mandates and Incentives,
Changes to Medicare, Medicaid and the CHIP programs, and Improvements in Quality of Care
and System Performance. An outline highlighting provisions within these components is listed
below (Chesser, 2010).
Creation of New Health Insurance Market Place Programs: Temporary high-risk
pools, early retiree insurance program, providing insurance coverage for retired individuals over
55 and not eligible for Medicare, Health Insurance Exchanges, State options for the creation of a
basic health plan for low income individuals, and voluntary long term care insurance (Chesser,
2010).
Health Insurance Market Reforms: Requirement of essential health benefits, Benefit
tiers, lifetime limits on coverage, recession of coverage, and the charging of higher premiums

4. THE PATIENT PROTECTION AND AFFORDABLE CARE ACT 4
due to gender, family history or occupation, and pre-existing condition exclusions prohibited.
Co-pays and preventative care deductibles are also prohibited under this provision – 2010 for
new plans, 2011 for Medicare, and all plans by 2018. Pre-authorization for emergencies, and
annual limits on coverage are also prohibited under the PPACA (Chesser, 2010).
Coverage Mandate and Individual Incentives: Individual penalties for non-
compliance, premium tax credits for individuals and families with incomes up to 400% of FPL,
cost-sharing subsidies to reduce out of pocket expenses, small business tax credits for employers
with < 25 employees and average annual wages < $50,000. Penalties for employers with > 50
employees that do not offer health insurance coverage and have at least 1 full time employee
receiving a federal subsidy (Chesser, 2010).
Changes to Medicare: No reduction in Medicare guaranteed benefits, reform to the
Part D coverage, eliminating the “donut hole” by 2020. Phasing out subsidies to private
insurance companies participating in Medicare Advantage and offering bonus payments for high
quality plans. Establishment of value based purchasing for hospitals, linking payment to
performance. Creation of the Independence at Home program, providing care for high need
Medicare beneficiaries at home. Providing a 10% bonus from 2011-2015 in Medicare
reimbursements for primary care physicians and general surgeons practicing in health shortage
areas (Chesser, 2010).
Changes to Medicaid and CHIP: Expansion of Medicaid to include adults with
incomes up to 133% of FPL and former foster care children up to 26 years of age. Increase
Medicaid drug rebates and Medicaid payments to primary care providers (Chesser, 2010).
Improving Quality and System Performance: Improvements in Mental Health and
Substance Abuse care, Long Term Care improvements. Establishing Workforce Training and

5. THE PATIENT PROTECTION AND AFFORDABLE CARE ACT 5
Development. Other improvements under this provision include establishment of Community
Based Collaborative Care Network program to support the coordination and integration of health
care services for low income uninsured and underinsured populations. Enhanced collection and
reporting of data on health disparities. Incentives for the creation of wellness programs by
employers and in the individual market. $11 billion increase in funding for community health
centers, to allow for a nearly doubling of the patients seen over the next 5 years. Establishing
new programs to support school-based health centers and nurse-managed health clinics (Chesser,
2010).
In 1993 President Clinton presented the Health Equity and Access Reform Act, a
universal health care coverage plan based on the idea of “managed competition” where private
insurers would compete in a tightly regulated market place. President Clintons plan also called
for all Americans, regardless of employment, to carry health insurance and to contribute to its
cost, government subsidies being provided for the poor. Individuals already covered under
existing government programs such as Medicare and Medicaid Department of Veteran’s Affairs,
etc. would simply continue coverage under those programs. Moreover, the plan also required
employers to bankroll 80% of all policy premium costs for employees and their families. The
Clinton plan also proposed to cover all services related to hospitalization, emergency care, office
visits, preventative care, mental health, substance abuse, prenatal care, hospice care, laboratory
and diagnostic tests, prescription drugs, medical equipment, rehabilitation, vision and hearing
care, preventative dental care for children, and health education classes (Government Run Health
Care in the United States, 2005).
The PPACA has many similarities to the health plan proposed by the Clinton
administration, but there are differences in the plan proposed in 1993 by President Clinton. One

6. THE PATIENT PROTECTION AND AFFORDABLE CARE ACT 6
significant difference is the PPACA builds on expanding the current system as opposed to
completely revamping it. Judith Feder, professor at Georgetown Public Policy Institute, has
pointed out that President Clinton’s plan was much more regulatory than the PPACA, and that
the PPACA is much more retention building on the system that currently exists. Although the
PPACA differs in language it requires, as the Clinton plan did, with the government providing
subsidies to individuals and businesses that cannot afford it (Kahn, 2009).
The Clinton plan was complex in structure, with close government involvement in the
health industry, packing public organization’s under the umbrella of health care alliances. The
PPACA includes a public option, a government run insurance plan that would compete with
private companies (Kahn, 2009)
The Clinton plan proposed incorporating Medicaid recipients into the mainstream health
care system, and enroll patients already on the plan into the mainstream. The PPACA focuses on
cutting costs in the Medicare and Medicaid programs by reducing inefficiencies, and at the same
time expanding coverage. Both the Clinton and the Obama administrations have argued that
reform would reduce inefficiencies in the current system, thereby cutting costs in the long term
(Kahn, 2009).
Overall, experts agree that the regulatory strategy proposed by President Clinton in his
health care reform plan is not present in the new plan. Rather, there is emphasis placed on
building on and improving the current system (Khan, 2009).

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References
Cassanego, S. (2010, January 30). The history of health care reform: where we've been and why
it matters. Retrieved July 7, 2013, from http://sites.duke.edu/sjpp/2010/the-history-of-
health-care-reform-where-weve-come-from-and-why-it-matters-2/
Chesswer, M. (2010, May 26). Overview of major components of federal health reform.
Retrieved July 7, 2013, from
http://services.dlas.virginia.gov/user_db/frmjchc.aspx?viewid=23
Government run health care in the United States. (2005). Retrieved July 7, 2013, from
http://www.discoverthenetworks.org/viewSubCategory.asp?id=615
Khan, H. (2009, September 28). Throwback to 1993? What’s new about democrat's health care
plans. Retrieved July 7, 2013, from http://abcnews.go.com/Politics/HealthCare/health-
care-reform-president-obama-path-bill-clinton/story?id=8675596#.UdnDUW2ebIV