Running head: HEALTH INSURANCE AND THE AFFORDABLE CARE ACT 1

Health Insurance and the Affordable Care Act

By halljameswriter@gmail.com

HSA 405: Healthcare Policy and Law

Prof

Date
 HEALTH INSURANCE AND THE AFFORDABLE CARE ACT 2

Assignment 4: Health Insurance and the Affordable Care Act

Health insurance is vital to everyone, and as for my organisation, I would purchase a

Preferred Provider Organization (PPO). This kind of health insurance contracts with medical

providers, for instance, hospitals and physicians, to create a network of contributing providers. In

this health plan, an individuals’ pay less if they use providers that belong to their network.

However, in this plan, one can use health providers outside of the network but for an additional

cost. I would prefer a PPO plan as it would allow my employees to make a choice regarding who

gives them treatment as they can go to specialists, hospitals, and doctors that aren’t part of the

network provider. Also, I think that the PPO would be appropriate because it often covers

prescription drugs and one doesn’t also have to choose a primary care physician. An individual

doesn’t have to get a referral to consult a specialist in case of a complication that needs one to

seek care outside the provider’s network (Medicare.gov).

The lifestyle choices impact the health of individuals, and it’s an important factor to

consider while making a decision of health insurance plan. In the contemporary society,

extensive changes have occurred in individuals’ life. For instance, unhealthy diet, alcohol

consumption, stress, obesity, smoking, and drug abuse impacts the life insurance and premiums.

In choosing the PPO as a health plan for my organisation, these lifestyle choices would factor in

as it affects the amount of premiums remitted to the provider. The cost of health coverage takes

into account the medical history, height, weight, age, occupation and personal habits like alcohol

consumption and smoking. For example, substance abuse such as smoking and excessive alcohol

results in cancer, cardiovascular disease, asthma, the likelihood of accidents and other risks as
 HEALTH INSURANCE AND THE AFFORDABLE CARE ACT 3

the health-related problems lead to premature deaths. Maintaining a healthy lifestyle and

practising good health habits while seeking regular medical attention can be fundamental in

lowering the health insurance costs (Medicare.gov).

The Affordable Care Act (ACA) does not necessitate the employers to provide their

employees with health insurance plans. However, for those employers who deem it necessary,

can have their employees covered through employer-insurance coverage. While offering my

employees with health coverage, I would consider the ACA implications and requirements, for

instance, Blumberg (2013) notes that ACA exempts employer-sponsored coverage for fewer than

fifty employees from any penalties associated with health plan coverage. Employer-based health

coverage is perceived expensive, however being a guaranteed issue, it is beneficial to workers.

Another advantage is that part of the premium is paid by the employer who makes it convenient

as compared to individualised health insurance.

The shortcoming of employer-based health insurance is that the employer researches the

available health plans and chooses the insurance firm for the employees; hence there is minimal

flexibility. The other disadvantage is that when the worker leaves the company, the health

insurance coverage comes to an end. As opposed to having employees receive government health

insurance, it is advantageous for employers to purchase health coverage for their workers as

those who offer this service attract the most competent and qualified workers and its possible to

retain them since health benefits are among aspects considered by workers when seeking

employment. These employees will also be more productive since they are motivated and healthy

and the business gets tax advantage of deducting health plan contributions as business costs. But,

providing health insurance to employees is also faced with challenges of the rising health
 HEALTH INSURANCE AND THE AFFORDABLE CARE ACT 4

insurance costs which makes it expensive as it translates to high administrative overheads. There

are also concerns about legal compliance translating to legal fees.

References

Blumberg, L. J. (2013). The Implications of the Affordable Care Act for Employers.

Medicare.gov. Retrieved from https://www.medicare.gov/sign-up-change-plans/medicare-health-

plans/medicare-advantage-plans/preferred-provider-organization-plans.html