Many observers claim that we do not have a true “healthcare system” in the United States. Instead we have fragmentation across multiple dimensions resulting in unsustainable cost increases, compromised quality, and growing inequity. Streams of public, private, and individual funding for health care – each with their own rules, requirements, and information needs – are further complicated by unsynchronized provider organizations in hundreds of cities and thousands of communities across the country. This byzantine approach has also created a cottage industry of specialists whose sole job is to navigate these requirements and make sure that patients know their health insurance options, can enroll in coverage, and get access to the services that they are entitled to.
The Affordable Care Act (ACA) addresses this complexity in a number of important ways. For example, the expansion of Medicaid to all individuals with incomes under 138 percent of the federal poverty level greatly simplifies the enrollment criteria for low-income individuals. The ACA also provides clarity on the calculation of income, penalties, types and sources of required documentation, and clearly outlines the reconciliation process for eligibility and subsidies.
While enrollment has not yet been reduced to a single mouse click or finger swipe, there is considerable uniformity across the country. Under the ACA, a family of four living in the Coachella Valley of California will follow a largely similar enrollment process to a family of four in Cambridge, Maryland. Though their choices on plans and providers will differ, the process of calculating their eligibility and enrolling in Medicaid or a health plan through an Exchange should be similar.
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