Affordable Care Act bringing changes to health carecomment (1)
June 27, 2013
By Sondra Washington
First of Six in a Series
For many Americans, the new law is overwhelming and extremely confusing.
To help Alabama Baptists understand the parts most vital to their lives, The Alabama Baptist is publishing a six-part summer series continuing through July and August dedicated to explaining the basics of what needs to be understood in the Affordable Care Act. Deadlines for action and resources for making decisions also will be provided.
If you have specific questions or concerns about the changes coming to health care, please email those to firstname.lastname@example.org or call 1-800-803-5201, ext. 103. If your issue is not addressed in the series, then we will do our best to research the answer for you in the final part of the series. (TAB)
By Sondra Washington
On March 23, 2010, President Barack Obama signed into law America’s most recent health care reform, the Affordable Care Act. This action was hotly debated from the meeting rooms and voting floors of the U.S. House and Senate to the chambers of the country’s highest court.
It was not until June 28, 2012, that the U.S. Supreme Court ruled the new 954-page law constitutional, and some portions of the health care act are still being implemented.
As a comprehensive plan, the reforms affect several areas of health care including insurance, Medicaid, Medicare, chronic disease prevention, public health improvements, health care workers and students, transparency and program integrity among medical professionals as well as many other topics.
The following are some of the changes that have already been implemented.
- Tax credits for small businesses to help companies provide insurance benefits for their employees.
- Matching federal funds for states for covering additional low-income individuals and families under Medicaid. Alabama opted out of this option in 2012, but discussions continue about the advantages and disadvantages of increasing the state’s Medicaid funding to reach more people and receive the matching federal funds.
- One-time $250 rebate check and more affordable prescription drug coverage for senior adults. This program has been called the “donut hole” gap. To determine whether you are eligible to receive this benefit, call 1-800-MEDICARE (1-800-633-4227). TTY (text telephone) users can call 1-877-486-2048.
- New Medicare screening procedures to help reduce health care fraud.
- Expanded insurance coverage for early retirees through employment-based plans. This plan was put in place to serve as a bridge until the new “exchange” insurance plans are in place by early 2014, according to the healthcare.gov website. “The new law creates a $5 billion program to provide needed financial help for employment-based plans to continue to provide valuable coverage to people who retire between the ages of 55 and 65, as well as their spouses and dependents.”
- Access to insurance for uninsured Americans with pre-existing health conditions.
- Insurance coverage for adults age 26 and under with their parents’ plans.
- Prohibitions against insurance companies that wrongfully drop sick patients.
- Free preventive care services for senior adults and free mammograms and colonoscopies for others who need them, but it is not clear what makes one eligible for this category.
- Elimination of lifetime limits on essential insurance coverage including ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.
- Prohibition of insurance coverage denial of children based on pre-existing conditions.
- Restriction of unreasonable insurance premium hikes.
- Funding for scholarships and loan repayments for primary care doctors and nurses in underserved areas.
- $15 billion Prevention and Public Health Fund to encourage Americans to live healthier from smoking cessation to combating obesity.
- Funding to strengthen community health centers.
- Improved health care quality and efficiency under the Medicaid, Medicare and Children’s Health Insurance Program.
- Expanded authority to bundle payments to hospitals, doctors and providers.
Some of the upcoming reforms still to be implemented include the following changes:
1. A “health insurance marketplace” for individuals and small businesses allowing selection of affordable and qualified health benefit plans.
2. Requirement of basic health insurance coverage for individuals who can afford it. According to healthcare.gov, “Under the Affordable Care Act, starting in 2014, you must be enrolled in a health insurance plan that meets basic minimum standards. If you aren’t, you may be required to pay an assessment. You won’t have to pay an assessment if you have very low income and coverage is unaffordable to you, or for other reasons including your religious beliefs. You can also apply for a waiver asking not to pay an assessment if you don’t qualify automatically.”
3. Expanded Medicaid coverage for individuals and families below the poverty level.
4. Prohibition of insurance companies from dropping individuals participating in clinical trials including treatments for cancer and other life-threatening diseases.
5. Tax credits will be provided to help impoverished families who are not eligible for other affordable coverage.
6. Ban against insurance company discrimination due to pre-existing conditions or gender.
7. Paying physicians based on value not volume.
While The Alabama Baptist will explore this law more specifically with various experts in the upcoming weeks, a good resource for one’s own research is healthcare.gov — a website designed to explain the details of the law. It also describes the areas affected by the new act.