N108: Transition to the Registered Professional Nurse Role Study Guide • Improving access to innovative medical therapies • Community living assistance services and supports • Revenue provisions The Patient Protection and Affordable Care Act will accomplish a fundamental transformation of health insurance in the U.S. through shared responsibility. Systemic insurance market reform will eliminate discriminatory practices such as pre-existing condition exclusions. Achieving these reforms without increasing health insurance premiums will mean that all Americans must be part of the system and must have coverage. Tax credits for individuals and families will ensure that insurance is affordable for everyone. In June 2012, the Supreme Court decision that upheld the constitutionality of the Patient Protection and Affordable Care Act (PPACA) provided some guidance to states, insurers, employers, and consumers about what they were required to do by 2014, when much of the law came into force. Provisions in the act were designed to expand insurance coverage, control costs, and target prevention. One of the primary targets was adults aged 19 to 64, since their access to health care and use of health services deteriorated between 2000 and 2010, particularly among those who were uninsured. The act includes reforms such as prohibiting insurers from denying coverage for pre- existing conditions, expanding Medicaid eligibility, subsidizing insurance premiums, and providing incentives for businesses to provide health care benefits. 2.12 Healthcare Access and Availability of Services for the Uninsured Health plans in the U.S. are primarily linked to employment, except for those eligible for Medicare and Medicaid, because the cost of independent plans is prohibitive. Major incentives to pass the health reform act were to provide a mechanism for more individuals to be able to purchase insurance, stabilize those unable to afford insurance, and to reduce the effect of uncompensated care on healthcare providers. Many healthcare providers have struggled with the financial problem of uncompensated care. Uncompensated care is a particular concern for hospitals. Individuals arrive at emergency rooms, and laws require that they be assessed before they leave. If an acute problem is found they must be treated. If the patient has no insurance and is not able to pay privately, the provider is never compensated for the care given. Factors contributing to an increased number of uninsured and underinsured individuals in the U.S. include: • Welfare-reform initiatives that limit the ability of unemployed, low-income individuals to access Medicaid coverage. • Low-income individuals lack health insurance because they are unemployed, employers do not offer insurance as a benefit of employment, or because they cannot afford it. • Even people who are insured may find that their ability to access needed medical services is inhibited by a significant cost-sharing requirement.