Health Insurance and the Affordable Care Act

This document provides a comprehensive guide on health insurance and the Affordable Care Act (ACA). It discusses factors to consider when choosing a health plan, such as lifetime renewability and coverage for pre-existing diseases. It also explores the advantages and disadvantages of ACA, including its impact on health insurance coverage and costs. Additionally, it highlights the Group and Corporate Health Insurance Plan by Pacific Prime as a suitable option for organizations with 50 or more employees.

Running Head: Health Insurance and the Affordable Care Act 1
Health Insurance and the Affordable Care Act

Health Insurance and the Affordable Care Act 2
Introduction:
A health insurance plan is to be undertaken for a small organization having an employee strength
of 50. It seems after careful consideration the owners decided to have the Group and Corporate
Health Insurance Plan by Pacific Prime. This particular organization is chosen as it provides
health coverage to the staff on their pre-existing diseases as well.
Factors considered while choosing a health plan for the staffs:
 Lifetime renewability – It would be wise for the organization to choose a health plan that
would include staff above the age of 50 years as the organization are supposed to consist
of senior employees as well.
 Pre-existing diseases – The company need to be aware of the insurance company’s
clause of allowing pre-existing diseases as there could be some of the staff having a
prolonged medical history or undergoing any sort of ailment currently (Field & Richard,
2007). So before finalizing a particular health plan, the company need to ensure that it
allows the provision for pre-existing ailments as in case of Pacific Prime.
 Dependency – The health insurance in question would be determined of the fact that it
would be able to provide coverage to the staff and the policy extendible to their spouse
and children as well.
 Day-care and OPD expenses – The unhealthy lifestyle of the younger generation tends
to have them diseases like diabetes and obesity which could be treated without admitting
in the hospital (Lewis, 2015). So the health insurance plan need to have provision for the
OPD expenses and day-care facilities for the staff as there are certain surgeries and
treatment that could be done even by not getting admitted in the hospital or clinics.

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So these are some of the factors that need to be considered while choosing a suitable health
insurance plan for the staff. In this scenario, the Group and Corporate Health Insurance Plan by
Pacific Prime would be suitable to address the requirements of the staffs in terms of coverage of
pre-exiting conditions, extending policies and deductible clause amongst others (Pacificprime,
2019).
Affordable Care Act:
Affordable Care Act (ACA) stands to be a comprehensive healthcare reform to make health
insurance plans affordable to a larger segment of people. This particular regulation provides
subsidies to the customers having domestic revenue between 100% - 400% of the federal poverty
level (HealthCare.gov, 2019). This is being done to extend the medical facilities for the
incumbents having domestic revenue below 138% of the federal poverty level. ACA apparently
supports medical care delivery practices keeping in mind the element of controlling the costs
related to healthcare practices.
Advantages of ACA:
 The advent of ACA in 2010 facilitated health insurance coverage to 16 million fellow
Americans most of which comprised the young adults of the country. This is because the
Act made health insurance policies affordable to most of the countrymen and the
companies currently spend 80% of the premium for healthcare practices (Purcărea,
Gheorghe, & Petrescu, 2013).
 The most important aspect of ACA has been the inclusion of the pre-existing medical
conditions along with no ceiling for treating the chronic health diseases like a heart
condition. It is due reference to the provision of the Act to have in its fold screening and

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preventing medical issues along with aiming for lowering the medicine costs (Melnyk, et
al., 2013). The phenomenon apparently saved around worth $15 billion in its 1st 5 years
of implementation.
Disadvantages of ACA:
 The implementation of ACA gives due stress on the public exchequer for funding the
medical devices and pharmacies for the needy people. So the wealthy Americans are
being taxed and it is often seen that people are being fined for not getting covered by a
health insurance plan owing to the regulation (Lewis, 2015).
 It is often seen amongst the small entrepreneurship that the organization are cutting off
the number of their staffs to avoid getting enrolled to ACA. This is because organizations
having 50 or more full-time staffs need to be covered under a competitive health
insurance plan as per ACA (HealthCare.gov, 2019). So in certain cases the employers are
limiting their staffs under the benchmark of 50 to avoid getting enrolled under ACA.
Conclusion:
The paper concludes that a competitive health insurance plan is to be adopted by organizations
having staffs numbering 50 or more. The Group and Corporate Health Insurance Plan by Pacific
Prime would definitely serve the purpose for the organization by providing adequate coverage to
the staffs noting their pre-exiting conditions and extending policies under ACA.

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References
Field, & Richard. (2007). Managing with Plans and Budgets in Health and Social Care. London:
Learning Matters Ltd.
HealthCare.gov. (2019, February 23). Affordable Care Act (ACA) - HealthCare.gov Glossary.
Retrieved from HealthCare.gov: https://www.healthcare.gov/glossary/affordable-care-act/
Lewis, S. (2015). Qualitative inquiry and research design: Choosing among five approaches.
Health promotion practice, 16(4), 473-475.
Melnyk, B., Jacobson, D., Kelly, S., Belyea, M., Shaibi, G., Small, L., . . . Marsiglia, F. (2013).
‘Promoting Healthy Lifestyles in High School Adolescents: A Randomized Controlled
Trial'. American Journal of Preventive Medicine, 45(4), 50-62.
Pacificprime. (2019, February 23). Group Health Coverage Plans | Corporate Health Insurance
Coverage. Retrieved from Pacificprime.com: https://www.pacificprime.com/health-
insurance-plans/group/
Purcărea, V., Gheorghe, I., & Petrescu, C. (2013). The assessment of perceived service quality of
public health care services in Romania using the SERVQUAL scale. Procedia
Economics and Finance, 6(2), 573-585.