By Roger Linnett
Many new aspects of the Patients Protection and Affordable Care Act, which the president signed on March 23, 2010, are now in effect and much more soon will be. The major features of the new law are:
- It makes insurance more affordable by providing the largest middle class tax cut for health care in history, reducing premium costs for tens of millions of families and small business owners who are priced out of coverage today.
- It helps 32 million Americans afford health care who do not get it today.
- Under the plan, 95% of Americans will be insured.
- It sets up a new competitive health insurance market giving millions of Americans the same choices of insurance that members of Congress have.
- It brings greater accountability to health care by enumerating practical rules to keep premiums down and preventing insurance industry abuses and denial of care.
- It will end discrimination against Americans with pre-existing conditions.
- It will reduce the deficit by somewhere between $30 billion and $100 billion over the next ten years – and by as much as $1 trillion over the second decade – by cutting government overspending and reining in waste, fraud and abuse.
Here is a breakdown of the new provisions in three areas; 1) Consumer Protections, 2) Improved Quality at Lower Costs and 3) Increased Access:
Consumer Protections
Effective March 23rd –
- An easy to use website comes online to compare health insurance coverage options and choose the the best plan for them, with ongoing improvements as data from insurance companies and public input make it more comprehensive.
Effective September 23rd –
- Insurance companies are prevented from denying coverage to children with pre-existing conditions. In 2014, this prohibition extends to everyone.
- Rescission, i.e., dropping people from coverage when they get sick is banned, except in cases of fraud.
- It will be illegal to use errors on applications or technical mistakes to deny coverage.
- Imposing lifetime dollar limits on essential benefits like hospital stays is prohibited.
- A sharp restriction of the use of annual dollar limits on patient coverage. In 2014, all annual limits will be prohibited.
- A simplified way to appeal (to either the insurer or to an outside board), if the company denies coverage or a claim is established.
Improved Quality at Lower Costs
Effective March 23rd –
- Small businesses are eligible for tax credits to help them provide insurance for their workers. The first phase provides a credit of up to a 35 percent of the employer’s contribution. In 2014, tax credits will cover 50 percent of premiums. Small, non-profit organizations may receive up to a 25 percent credit.
- Seniors, who this year fall into the gap in Medicare Part D prescription drug coverage known as the “donut hole”, will receive a $250 rebate. In 2011, a 50 percent discount on prescriptions begins.
- A new $15 billion Prevention and Public Health Fund will invest in such proven prevention programs as smoking cessation and decreasing obesity.
- Medicare investigators, who returned more than $2.5 billion to the Medicare Trust Fund in FY 2009, will receive additional resources to further reduce fraud and waste in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP).
Effective September 23rd –
- New and existing Medicare plans that make specified changes will cover preventive services, bringing relief to millions of seniors for whom preventive care means early identification of disease and greater opportunity for treatment and recovery. In 2011, Medicare eliminates all co-pays and deductibles for these services.
Increased Access
Effective March 23rd –
- Young people are allowed to remain on their parents’ insurance policy until their 26th birthday, unless offered insurance at their work. Most insurance companies already offer this.
- A transitional high-risk-pool program provides new coverage options to individuals who, because of a pre-existing condition, have been uninsured for at least six months. States have the option of running their own temporary high risk pool. If a state chooses not to do so, a National pool will be established by the Department of Health and Human Services.
- Funding to expand the number of primary care doctors, nurses and physician assistants, through scholarships and loan repayments for primary care doctors and nurses working in under-served areas. Doctors and nurses with student loans will also receive tax relief if they practice in communities with a shortage of health care providers.
- $250 million in new grants for states that have or plan to implement measures that require insurance companies to justify their premium increases. Insurance companies with excessive or unjustified premiums may be ineligible to participate in the new health insurance exchanges beginning in 2014.
- States will receive increased federal matching funds for covering low-income individuals and families on Medicaid.
- A $5 billion program to maintain affordable care has been created targeted at Americans who retire before they are eligible for Medicare( age 65) or are without employer-sponsored insurance, until more affordable coverage is available through the exchanges in 2014, Previously, many had seen their life savings disappear due to current exorbitant rates.
Effective January 1, 2011 –
- New funding will be allocated over the next 5 years to support the construction of, and expand services at, community health centers, allowing these centers to serve some 20 million new patients across the country.
Future legislation is working its way through Congress to extend and improve on the new law. For example, should the “public option” provision that allows Americans to join a national, single-payer program be enacted in the future, the savings in costs for both consumers and health care providers could be greatly improved, leading to further deficit reductions, while improving patient services.
Not waiting for a national program, many states are looking into starting their own single-payer programs. Congress is also in the process of creating legislation that will gradually lower the eligibility age for Medicare, which will further improve coverage and reduce patient’s expenses.
Data for this article was compiled from the following:
KaiserFamilyFoundation.org, ModernHealthcare.com and the SeniorCitizensJournal.org.