Questions on the Patient Protection and Affordable Care Act

Q 1. Provision #4 of the Patient Protection and Affordable Care Act.

Provision number four in the Patient Protection and Affordable Care Act commonly referred to as Obamacare is Health Insurance Exchanges (French et al 2016). This provision provides that if an individual has not acquired insurance through the employer or the government, then the individual can acquire the insurance via the given states exchange if it is available. If not, then the individual can purchase the insurance through the federal exchange. In the event that this takes place, then the premiums will go high because this will translate to an added layer of bureaucracy and expenses. In addition, the government will not have any profit to motivate her because there is less incentive to operate as efficiently as a private sector company. The Federal government is imposing hefty penalties to citizens who fail to acquire health insurance policies. The penalties range from as low as $2100. As a fact, families with the healthcare policy incur less in expenses as opposed to those fined for failing to acquire a health policy.

Q 2. Medical Malpractice and its Elements

Medical malpractice is any act or omission by a medical practitioner in the process of handling a patient that contravenes the universal norms of medical practices which may lead to an injury in the patient (Bal, 2009). Medical malpractice is enshrined in the Tort Law that concerns professional negligence. Tort Law is a body that that is tasked with creating and providing remedies for wrongs that are in one way or the other civil. Negligence refers to any conduct that goes against given standards. This standard according to the tort law is the so-called reasonable person. It is a legal creation by the law so as to have legal reference to protect people from any risk or harm.

The present medical malpractice law is based on the English common law set in the 19th century. The English common law encompasses England and wales legal systems and is the basis of jurisprudence in the United States. It is also applied in many commonwealth countries where it was borrowed during the British Empire Rule. Common Law is the law and systems of law that arise from decisions made by judges in the process of delivering rulings. Common law does not apply legislative statutes or decisions made by the executive. In a country like the Unite States of America, Medical malpractice law originates from specific individual states and its framework and rules governing its adoption and implementation come from lawsuit decisions that have been filed in the State courts. This therefore implies that state laws governing different states in the United States can vary but the principles in the law are the same. In the last 30 years, medical malpractice laws set in various states have significantly impacted on the governing principles of Medical malpractice law.

Thus, in the United States, any patient seeking a redress for medical malpractice must have a claim that satisfies four Elements or legal requirements for it to be considered. These Elements include: The doctor must have a legal obligation to provide medical care to the patient, the medical physician breaching this legal duty by failing to observe professional standards, a direct link between the legal breach and the harm caused to the patient and presence of damages arising from the harm that can be redressed by the laid down legal systems.

The first element applies as soon as a professional relationship is created between the medical practitioner and the patient. In a situation where a health provider treats a patient, he or she has a duty to do so observing professionalism in attending to the patient in all circumstances. This law is only limited when attending to indigent patients and when attending to accident victims. This law is exempted when health care is provided outside a hospital or clinic. In such a case, a relationship is established but the duty of reasonable care does not arise on the part of the medical practitioner. A medical practitioner has a duty to observe the provisions of Medical providers act and maintain the ethical issues enshrined therein (Crocker & Kahla 2015).

In the second element, the patient is required by law to demonstrate the concept of breaching the duty of standard care by the medical provider. Duty of standard care means care that is provided reasonably. This care must be proven beyond any reasonable doubt by expert witnesses to the jurist to be able to make a determination in a court. Expert witness is not required where the standard of care is egregious like wrong operation of a body part that is visibly evident (Jenny, 2016).

The third element requires one to show a direct relationship between the harm caused to the patient and the professional misconduct committed by the medical practitioner. The patient may also show a convincing illegality by a medical practitioner that indirectly caused harm to him or her.

The fourth element involves determination of damages to compensate the plaintiff who has successfully proven medical malpractice. The damages are calculated in monetary terms. It is rather rare for the jurist to award punitive damages in medical malpractice cases. In the event that a patient suffers harm in the hands of a medical practitioner and corrective measures are taken and the patient fully recovers, then no damages will be awarded (Rahmati, et al.,2017).

Q3: Medical Health Liability Initiatives and Outcomes in Florida.

In 2008, The Governor of Florida Charlie Crist set the Health of our people as one of his key priority. In conjunction with the Legislature, many of his healthcare reforms were achieved. These included the passing into law of the Cover Florida Health Care access Program act. This cover enables Floridians without any other medical insurance cover to access medication. This policy was signed into law on May 1, 2008 by Governor Crist. This policy was also aimed at expanding the healthcare options available for uninsured Floridians. It also provides coverage on basic and preventive medical services, inpatient cover as well as dealing with emergency operations (Kachalia & Mello 2011).

Another milestone in the medical field involves the Florida Health Choices Program which centralized the buying and selling of various products to enable clients to pay for healthcare. These plans include health insurance plans, health maintenance organization plans as well as flexible spending accounts (Hu, et al., 2016).

Lastly, there was the Florida Healthy Kids Program that had some sections amended to remove the part requiring full pay enrollment. The removal of this section enabled Florida kids to purchase health insurance through KidCare Program.

Q 4. Provision #7 of the Patient Protection and Affordable Care Act

Provision number 7 under the Patient Protection and Affordable Care Act is the Medicare Payment Reforms (French et al 2016). The current payments for medical treatments under Medicare are a fee-for-service payments. Under Obamacare, the payments will be collective. For example, in case of a surgery, the patient will get a bill from the hospital, the surgeon who operated on you, the anesthetist, etc. this means that with Obamacare, in a single bill, the patient will make payments to a medical facility accompanied by any physician group handling a certain procedure. The Patient Protection and Affordable Care Act is intended to improve the quality of healthcare based on pay- for performance strategy aimed at pressurizing the medical practitioners. This act lays down the procedures for reimbursement based on the patients satisfaction and the physician complying with quality procedures and professional ethics.

Q 5. Plans under the ACA Law.

The Affordable Care Act incorporates four new health insurance plans that have set the standard of care. They include the Bronze plan, Silver plan, Gold plan and the platinum plan (Kautter, et al., 2014). There is also another plan called the catastrophic plan offered to a given category of people. All the five plans are set to provide similar benefits of the Obama care. This does not limit other health providers and states to offer more benefits. It is important to note that the category of your medical plan does not mean the quality of care received by the patient. It means how an individual plans to split the cost of his or her healthcare.

Bronze plan category offers the lowest monthly premium payment. The insurance company caters for 60% of the expenses while the client pays 40%. If you want a low cost way to protect yourself from worst case medical complications arising from serious illnesses or injuries, then Bronze plan should be your choice. In this plan, the client pays low monthly premiums and the routine care expenses.

Silver plan offers moderate monthly premiums. The premiums are usually lower than those paid for Bronze plan. This plan is effective for a person who wants to get extra hundreds or thousands of dollars in savings annually. One can also pay slightly higher premiums if they want to be covered more.

Gold plan has a high monthly premium. The insurance company covers 60% while the client pays 20%. It is a low cost plan when one needs medical care. In this plan, the amount paid by the client is usually low before the provider covers the rest. This cover is good for people who want to part with more premiums in order to have more paid by their medical providers.

Platinum plan has the insurance covering 90% and the client 10%. It has the highest monthly premiums and the provider starts paying its share before other plans. This plan is essential to those who are willing to part with high monthly premiums as all their costs will be covered.

Lastly there is the Catastrophic health plan that has low monthly premiums and very high deductibles. It covers people under the age of thirty and people of any age with a hardship exemption or affordability exemption. In this plan, the amount the client pays before the plan provider starts paying are much high. It covers the same essential health benefits like other plans as well as a minimum of three primary care visits annually.

References

Jenny, L. M. (2016). Court ruling demonstrates ACA's power to reduce future medical expenses. Journal of Healthcare Risk Management, 35(4), 28-33.

Crocker, R. M., & Kahla, M. C. (2015). Management Challenge: Obamacare. Journal of the International Academy for Case Studies, 21(5), 59.French, M. T., Homer, J., Gumus, G., & Hickling, L. (2016). Key provisions of the Patient Protection and Affordable Care Act (ACA): a systematic review and presentation of early research findings. Health services research, 51(5), 1735-1771.

Hu, L., Kaestner, R., Mazumder, B., Miller, S., & Wong, A. (2016). The Effect of the Patient Protection and Affordable Care Act Medicaid Expansions on Financial Wellbeing (No. w22170). National Bureau of Economic Research.

Bal, B. S. (2009). An Introduction to Medical Malpractice in the United States. Clinical Orthopaedics and Related Research, 467(2), 339347. http://doi.org/10.1007/s11999-008-0636-2Rahmati, M. H., Hyman, D. A., Black, B. S., Liu, J., & Silver, C. (2017). Screening Plaintiffs and Selecting Defendants in Medical Malpractice Litigation: Evidence from Illinois and Indiana.

Kautter, J., Pope, G. C., Ingber, M., Freeman, S., Patterson, L., Cohen, M., & Keenan, P. (2014). The HHS-HCC risk adjustment model for individual and small group markets under the Affordable Care Act. Medicare & Medicaid research review, 4(3).

Kachalia, A., & Mello, M. M. (2011). New directions in medical liability reform.