Health Care

After much debate, many versions of the bill, and countless calls from constituents, the Affordable Care Act was signed into law on March 23, 2010. Thanks to all of you who raised your voices, told your own health-care stories, and contacted your Members of Congress. This long-needed bill will bar predatory insurance practices and expand coverage to 32 million Americans who are currently uninsured.

Implementation of the Affordable Care Act will come in stages, being fully implemented by 2015. But many benefits have been implemented already:

• A new insurance plan that will cover those with pre-existing conditions until 2014, when insurance companies will no longer be allowed to deny or rescind coverage because of a pre-existing condition;
• Children can no longer be denied coverage because of a pre-existing condition;
• Young adults can now stay on their parent’s plan until they turn 26 years old;
• Tax credits for small businesses to help them provide health insurance for their workers;
• End of the “doughnut-hole”, a gap in Medicare prescription coverage;
• Matching federal funds for states when they cover additional low-income families under Medicaid;
• 50% discount for seniors purchasing Medicare Part D covered brand-name prescription drugs;
• Seniors are able to receive certain free preventive services from Medicare;
• New resources and new screening procedures to avoid health care fraud;
• Coverage for early retirees through a $5 billion program to provide financial help to employment-based plans;
• All new insurance plans must provide certain free preventive services;
• Insurance companies cannot deny coverage because of a mistake in a customer’s application;
• Insurance companies can no longer place lifetime limits on health insurance coverage and their ability to impose limits to annual insurance coverage is restricted;
• Insurance companies are now required to justify increases in rates in order to be eligible for $250 million in new grants;
• A $15 billion fund for prevention and public-health programs that help keep Americans healthy;
• New funding to support the construction and strengthening of community health centers;
• Increased payments for rural health care providers;
• 85% of premium dollars from large employer plans must be directed towards health care services and health care quality improvements;
• New Center for Medicare & Medicaid Innovation that will begin testing new ways of delivering care to patients.

Several additional benefits will be added until January 1, 2015:

Effective in October 1, 2011:

• Creation of a Community First Choice Option that will allow States to offer home and community based services to disabled individuals through Medicaid rather than institutional care in nursing homes.

Effective in January 1, 2012

• Incentives for physicians to join together to form organizations that will better coordinate patient care and improve quality, help prevent disease and illness and reduce unnecessary hospital admissions.

Effective in March 2012

• Ongoing or new federal health programs must collect and report racial, ethnic and language data, in order to understand and reduce persistent health disparities;

Effective in October 1, 2012

• Creation of CLASS, a voluntary long-term care insurance program to provide cash benefits to adults who become disabled;
• Introduction of changes to standardize billing and require health plans to begin adopting and implementing rules for the secure, confidential, electronic exchange of health information;
• Establishment of a Value-Based Purchasing Program in Original Medicare, that will offer financial incentives to hospitals to improve the quality of care;

Effective January 1, 2013

• New funding for Medicaid programs that cover preventive services for patients at little or no cost;
• The federal government will fund an increase in State payments to primary care physicians, so that they receive no less than 100% of Medicare payment rates in 2013 and 2014;
• National pilot program to encourage hospitals, doctors and other providers to work together to improve the coordination and quality of patient care;

Effective in October 1, 2013

• States will receive two more years of funding to continue coverage for children not eligible for Medicaid;

Effective in January 1, 2014

• Establishment of Health Insurance Exchanges that will allow individuals and small businesses to purchase insurance directly in a marketplace;
• New requirement that all individuals who can afford it purchase basic health insurance coverage or pay fee to upset the costs of caring for uninsured Americans. If affordable coverage is not available to an individual, he or she will be eligible for an exemption;
• Individuals who earn less than 133 percent of the poverty level will be eligible to enroll in Medicaid. States will receive complete federal funding for the first three years to support this extended coverage;
• Tax credit that will make health insurance more affordable for those with income between 100 percent and 400 percent of the poverty line who are not eligible for other affordable programs;
• Insurers will no longer be allowed to drop or limit coverage because an individual chooses to participate in a clinical trial;
• Annual limits on insurance coverage will be prohibited for all new plans and existing group plans;
• Strong reforms will come into effect that prohibit insurance companies from refusing to sell coverage or renew policies because of an individual’s pre-existing condition. In the individual and small group market, these regulations will also prohibit insurance companies from charging higher rates due to gender or health status.
• The second phase of the small business health insurance will come into effect, guaranteeing up to 50% of the employer’s contribution to provide health insurance for employees

Effective in January 1, 2015

• A new provision will tie physician payments to the quality of care they provide.

The Mikulski Amendment

An amendment proposed by Senator Barbara Mikulski guarantees that women are able to receive certain free preventive screenings, as defined by experts. These procedures include mammograms and cervical cancer screenings. The law only requires that insurance companies offer these services for free.

The Fight for Affordable Health Care is not Over

The fight to guarantee decent health care for Americans is not yet over. Elected under a banner of job creation, the 2011 Congress decided to start the year by proposing the repeal of the Affordable Care Act, though their attempt failed in the Senate. Moreover, the act is also being challenged in the courts. It is important that we continue defending the law and the benefits it has brought to American individuals and families.

Source:

www.healthcare.gov

More Information:

Map of the uninsured across America: http://www.npr.org/templates/story/story.php?storyId=113042669