The American Rescue Plan Act to the Rescue

Unfortunately, it’s the patient who is left out in the cold.

The American Rescue Plan Act (ARPA) extends eligibility for health insurance subsidies to people buying their own health coverage through the Patient Protection and Affordable Care Act (PPACA) 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 PPACA coverage. This change will only last 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. 

First, let’s take 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 cover the $492 per month he had been paying for Eliquis for the last eight years. 

When Bob signed up through the Marketplace, he thought he would have to pay a deductible, but that 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 costs $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 his closest physician was who was part of his plan. He found the doctor’s office, 18 miles from where he lived. Considering traffic, that was around an hourlong drive. This is because, either intentionally or unintentionally, there are no participating primary care providers closer to Bob. It may make sense that it may be hard for a plan to cover all the bases with specialty care. But many PPACA plan beneficiaries can’t find primary care providers nearby. 

From a monetary position, if plans collect premiums and do not have to provide care, PPACA plans can become much more profitable. The plans benefit from forcing enrollees to pay for their own care. 

Patients enrolled in insurance plans are increasingly forgoing services because of the high deductible amounts. Insurance plans benefit by collecting premiums as patients forego services when they can’t afford deductibles. Providers are raking in cash when they get paid at full charges when patients have to pay high deductibles. It is the patient who is left out in the cold.

This is a terrible system. The worst of it is that patients are often foregoing lifesaving care they need because they can’t afford their deductibles and coinsurance amounts. Let’s change the system.

Programming Note: Listen to live reports from Timothy Powell every Tuesday on Talk Ten Tuesdays, 10 Eastern.

Facebook
Twitter
LinkedIn

Timothy Powell, CPA, CHCP

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 the RACmonitor editorial board and a national correspondent for Monitor Mondays.

Related Stories

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

I050825

Mastering ICD-10-CM Coding for Diabetes and it’s Complications: Avoiding Denials & Ensuring Compliance

Struggling with ICD-10-CM coding for diabetes and complications? This expert-led webcast clarifies complex combination codes, documentation gaps, and sequencing rules to reduce denials and ensure compliance. Dr. Angela Comfort will provide actionable strategies to accurately link diabetes to complications, improve provider documentation, and optimize reimbursement—helping coders, CDI specialists, and HIM leaders minimize audit risks and strengthen revenue integrity. Don’t miss this chance to master diabetes coding with real-world case studies, key takeaways, and live Q&A!

May 8, 2025

Trending News

Featured Webcasts

Navigating the 3-Day & 1-Day Payment Window: Compliance, Billing, and Revenue Protection

Navigating the 3-Day & 1-Day Payment Window: Compliance, Billing, and Revenue Protection

Struggling with CMS’s 3-Day Payment Window? Join compliance expert Michael G. Calahan, PA, MBA, CCO, to master billing restrictions for pre-admission and inter-facility services. Learn how to avoid audit risks, optimize revenue cycle workflows, and ensure compliance across departments. Critical for C-suite leaders, providers, coders, revenue cycle teams, and compliance teams—this webcast delivers actionable strategies to protect reimbursements and meet federal regulations.

May 15, 2025
Audit-Proof Your Wound Care Procedures: Expert Insights on Compliance and Risk Mitigation

Audit-Proof Your Wound Care Procedures: Expert Insights on Compliance and Risk Mitigation

Providers face increasing Medicare audits when using skin substitute grafts, leaving many unprepared for claim denials and financial liabilities. Join veteran healthcare attorney Andrew B. Wachler, Esq., in this essential webcast and master the Medicare audit process, learn best practices for compliant billing and documentation, and mitigate fraud and abuse risks. With actionable insights and a live Q&A session, you’ll gain the tools to defend your practice and ensure compliance in this rapidly evolving landscape.

April 17, 2025
Utilization Review Essentials: What Every Professional Needs to Know About Medicare

Utilization Review Essentials: What Every Professional Needs to Know About Medicare

Dr. Ronald Hirsch dives into the basics of Medicare for clinicians to be successful as utilization review professionals. He’ll break down what Medicare does and doesn’t pay for, what services it provides and how hospitals get paid for providing those services – including both inpatient and outpatient. Learn how claims are prepared and how much patients must pay for their care. By attending our webcast, you will gain a new understanding of these issues and be better equipped to talk to patients, to their medical staff, and to their administrative team.

March 20, 2025

Rethinking Observation Metrics: Standardizing Data for Better Outcomes

Hospitals face growing challenges in measuring observation metrics due to inconsistencies in classification, payer policies, and benchmarking practices. Join Tiffany Ferguson, LMSW, CMAC, ACM, and Anuja Mohla, DO, FACP, MBA, ACPA-C, CHCQM-PHYADV as they provide critical insights into refining observation metrics. This webcast will address key issues affecting observation data integrity and offer strategies for improving consistency in reporting. You will learn how to define meaningful metrics, clarify commonly misinterpreted terms, and apply best practices for benchmarking, and gain actionable strategies to enhance observation data reliability, mitigate financial risk, and drive better decision-making.

February 25, 2025

Trending News

Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →

CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24