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What healthcare reform means for Americans


As many people know, last year President Barack Obama signed into law the Affordable Healthcare Act promising millions of Americans better health coverage. From its creation there has been much debate about the law, and many are still unclear of how it affects them individually. Additionally, some Americans are unaware of the changes that have already been implemented.

The first wave of benefits that are a result of the Affordable Healthcare Act began on Sept. 23, 2010, and were directed at insurance companies. If individuals purchased or joined a new plan on or after that date insurance companies must:

* Cover recommended preventive services without charging out-of-pocket costs: Services like mammograms, colonoscopies, immunizations, prenatal and new-baby care are covered, and insurance companies are prohibited from charging deductibles, co-payments or co-insurance.

* Provide an opportunity to appeal coverage decisions: Consumers are guaranteed the right to appeal insurance-company decisions to an independent third party.

* Guarantee enrollees their choice of primary-care provider: Consumers will have their choice of provider within the plan’s network of doctors, including OB-GYNs and pediatricians, without a referral, as well as out-of-network emergency care.

These three provisions are expected to benefit up to 88 million people by 2013.

Before reform, cancer patients and individuals suffering from other serious and chronic diseases were often forced to limit or go without treatment because of an insurer’s lifetime limit on their coverage. Insurance companies can no longer put a lifetime limit on the amount of coverage enrollees receive, so families can live with the security of knowing that their coverage will be there when they need it most.

Other changes, including new benefits, protections and cost savings will be implemented between now and 2014. The Affordable Care Act builds a bridge to 2014 when a new competitive insurance marketplace will be established. The new marketplace will include state-run health insurance exchanges where millions of Americans and small businesses will be able to purchase affordable coverage, and have the same choices of insurance as members of Congress.
According to White House representatives, the Affordable Care Act will bring down costs, improve the quality of healthcare delivered to all Americans, and expand coverage to more than 32 million Americans.

Experts have found that the new law helps reduce costs for families and businesses, cuts the deficit and strengthens Medicare, adding years to the trust fund while maintaining seniors guaranteed benefits. The Congressional Budget Office said the Affordable Care Act would save more than $100 billion over the next 10 years, and more than $1 trillion in the following decade.

California Insurance Commissioner Dave Jones’ who is an avid supporter of healthcare reform, issued this statement: “My overarching goal is to make the California Department of Insurance the strongest consumer protection agency in the nation. I am determined to define my tenure as insurance commissioner by a single word: action.”

The law is believed to be strengthening the healthcare system. Additional provisions of the law that have already been implemented include:

Important consumer protections and a new Patient’s Bill of Rights that end some of the worst insurance company abuses.

The establishment of the Pre-Existing Condition Insurance Plan to provide coverage to Americans who have been uninsured because of a pre-existing condition.

Launch of the Early Retiree Reinsurance Program to make it easier for businesses to provide coverage to retirees who are not eligible for Medicare.

So what does this mean for young adults?

Through the new law young adults will be able to remain on their parent’s plan until their 26th birthday. Up to 1.2 million young adults could gain coverage through this provision of the new law.

Small Businesses?
In this year alone, up to 4 million small businesses may be eligible for tax credits, making it easier for them to provide coverage to their workers.

The law ensures that the U.S. continues to protect seniors’ guaranteed Medicare benefits, while taking important steps to fight waste, fraud and abuse. The new law will close the prescription drug coverage gap known as the “donut hole” completely by 2020. In 2010, 4 million people with Medicare who fell into the donut hole received $250 rebate checks. In 2011, people with Medicare in the donut hole receive a 50 percent discount on their covered brand name prescription drugs. In addition, people with Medicare are eligible for an annual wellness visit and free preventive services, such as mammograms and colonoscopies.

Aside from the many provisions that the law has already put into place, 2014 is the year when the remaining aspects of the plan come to fruition. At that time health plans must accept every employer and every individual that applies for coverage. Health plans will no longer be allowed to require individuals to take a health questionnaire or deny them coverage because of their health condition.

Individuals and families will be able to  receive subsidies, based on their income, to help buy coverage from their state’s health insurance exchange. Also, income-based caps on out-of-pocket medical expenses take effect. People under age 30 can purchase a comprehensive coverage plan or a plan designed just for their age group. Small businesses can purchase insurance for themselves and their employees through the health insurance exchange. Their tax credit will increase to 50 percent of premiums and last for two years. The tax credits are available to employers with fewer than 25 workers and average wages below $40,000 a year.

For more information on healthcare reform and for detailed timelines on the progress of the Affordable Healthcare Act visit I, which contributed to the material in this article.