Updated on: June 22, 2021

The American Rescue Plan Act to the Rescue

Original story posted on: June 21, 2021

The U.S. Supreme Court has upheld the Patient Protection and Affordable Care Act (PPACA), commonly referred to as Obamacare, for the third time.

In March, the American Rescue Plan Act (ARPA) was passed. It extends eligibility for health insurance subsidies to people buying their own health coverage through Obamacare on the federal Marketplace who have incomes over 400 percent of the federal poverty level. It also increases the amount of financial assistance for people at lower incomes who were already eligible for Obamacare. This change only lasts two years, at a cost of around $62 billion. 

While extending benefits, it still does not solve the problems of high co-insurance amounts and lack of access to healthcare services. 

First, let’s consider some real-life examples of how high deductible amounts impact insurance coverage under the PPACA. Bob is a mechanic working in Florida. Like millions of Americans, Bob takes blood thinners for recurring blood clots. One of Bob’s reasons for signing up for healthcare coverage was to afford the $492 per month he had been paying for Elliquis for the last eight years. When Bob signed up through the Marketplace, he thought he would have to pay a deductible, but most of the cost of the drug would be covered by his policy. Bob was stunned when he went to the pharmacy only to be told that his prescription still cost $492 because the cost was being applied to his deductible of $6,000.

Bob had another painful surprise coming when he decided to go to the doctor for a persistent cough. He looked to see where the closest physician who was part of his plan was. He found the doctor’s office, 18 miles from where he lived. Considering traffic, that was around an hour-long drive.

There are opportunities to resolve these issues. 

One thing that could happen is that the Centers for Medicare & Medicaid Services (CMS) could convince counties that have created taxing districts to provide healthcare to the poor to move their taxing district plans into an Obamacare plan. In Florida, this would include Lee and Palm Beach counties.

Next, CMS could lift the current restriction preventing providers from paying the premiums and co-payments of patients. Similar to how providers pay the premiums of patients who qualify under COBRA, if providers can pay the Obamacare premium of patients admitted with a prognosis that portends a huge medical bill they simply can’t pay, it helps both the patient and the provider.      

Finally, CMS could require that all Obamacare plans provide a solid telehealth option that will enable patients to get medical care when the closest provider is far away, or when it is difficult for the patient to get an appointment that fits into their work or home schedule.

Programming Note: Listen to Tim Powell every Tuesday during Talk Ten Tuesdays, 10 Eastern.

Timothy Powell, CPA

Timothy Powell is a nationally recognized expert on regulatory matters, including the False Claims Act, Zone Program Integrity Contractor (ZPIC) audits, and U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) compliance. He is a member of both the RACmonitor and ICD10monitor editorial boards and a national correspondent for both Monitor Mondays and Talk Ten Tuesdays.

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