DNP – 825: Week 1 DQ 1

            Patient Protection and Affordable Care Act (ACA) 2010 has significant potential effects on public and private insurance options. Individuals may be confused on the right insurance options for them between public health insurance and private health insurance. Private health insurance is provided by private entities including private insurance companies and employers. Majority of Americans currently receive their health coverage via private health insurance plans. The employer-sponsored health insurance plans are provided by employers as a benefit of employment in the form of group health insurance or group coverage (Smith, 2018). On the other hand, public health insurance plans are provided by the government. Public health insurance plans are available for low-income populations, families, individuals, special groups, and the elderly. Under public health insurance, Medicare is a federally-funded insurance program for people aged 65 years and over, individuals who have been diagnosed with end-stage renal disease, and the disabled young people. Likewise, Medicaid is co-funded by the state and federal government and available for low-income families, and individuals with certain form of disabilities, pregnant women, and other qualified persons (Feldman et al., 2015).  Other public insurance plans for special groups include Tricare for military personnel and their families, Veteran Affairs for military veterans and retired military members, and the Children’s Health Insurance Program for uninsured children and teenagers who are ineligible for medical assistance (ACA, 2010). 

            The impact of ACA 2010 on public and private insurance options can have significant implications on population-based nursing. ACA 2010 requires all employers who have more than 50 employees on full-time basis be provide affordable health coverage to their employees or else face tax penalties. Alternatively, individuals and families can opt for individual health insurance plans since they are less costly than group insurance plans. The advantage of private health insurance plans is that individuals can choose their own physicians, one can enjoy a wider network of healthcare providers to choose from, and more plan options are available. However, it is associated with demerits such as payment of mandatory monthly premiums, it is more expensive than public health insurance plans, and that more flexibility and better coverage implies more payments.  The advantage of public health insurance plans is that it is more affordable compared to the private insurance plans, no deductibles or co-payments, and individuals may qualify for assistance with associated payments. However, the public insurance plans are less flexible in terms of choice of providers, limitations in covered treatments, and that some providers may object government-sponsored health insurance plans (Smith, 2018).

References

Feldman, H.M., Buysse, C.A., Hubner, L.M., Huffman, L.C., & Loe, I.M. (2015). Patient Protection and Affordable Care Act of 2010 and children and youth with special health care needs. J Dev Behav Pediatr., 36(3), 207-217. DOI: 10.1097/DBP.0000000000000151. 

Patient Protection and Affordable Care Act 2010. (2010). Patient Protection and Affordable Care Act 2010.  Retrieved on Jan 04, 2019 from, https://democrats.senate.gov/pdfs/reform/patient-protection-affordable-care-act-as-passed.pdf

Smith, A. (2018). Private health insurance vs. public health insurance. Retrieved on Jan 04, 2019 from, https://www.firstquotehealth.com/health-insurance-news/private-vs-public-health