Expand Access to Insurance Coverage
The aim of this provision is to extend health insurance coverage to approximately 32 million Americans who are currently uninsured by expanding both private and public insurance. Unless otherwise noted by January 1 2014 the following will be required.
- Employers must cover their workers or pay penalties with exceptions for small business employers.
- Providing tax credits to certain small businesses that cover specified costs of health insurance for their employers in the tax year 2010.
- With some exception such as financial hardship or religious belief all individuals will be required to have insurance.
- The creation of a state-based (or multi-state) insurance exchanges to help individuals and small businesses purchase insurance. Federal subsidies will limit premium costs to between 2 percent of income for those with income at 133 percent of federal poverty guidelines rising to 9.5 percent of income for those who earn between 300 percent and 400 percent of the poverty guidelines.
- Medicaid will be expanded to cover people with incomes below 133 percent of federal poverty guidelines.
- The creation of temporary high-risk pools for those who cannot purchase insurance on the private market due to preexisting health conditions beginning July 1 2010.
- Insurance plans must cover young adults on parents’ policies effective September 23 2010.
- A national voluntary long-term care insurance program must be established for “community living assistance services and supports” (CLASS) with regulations to be issued by October 1 2012.
- Consumer protections must be enacted to enable people to retain their insurance coverage.
Increase Consumer Insurance Protections
The ACA enacted several insurance reforms effective in 2010 to accomplish the following:
- Prohibit lifetime monetary caps on insurance coverage and limit the use of annual caps.
- Prohibit insurance plans from excluding coverage for children with preexisting conditions.
- Prohibit insurance plans from cancelling or rescinding coverage except in cases of fraud.
- Establish a state-based rate review system for insurance premium increases deemed unreasonable.
- Create an office of health insurance consumer assistance.
- Establish an appropriate share of premiums dedicated to medical services (minimum medical loss ratios).
Effective January 1 2014 additional reforms will include: prohibiting the majority of insurance plans from excluding people due to preexisting conditions discriminating based on health status and imposing annual monetary caps on coverage. Additional reforms will require guaranteed issue and renewal of policies premium rating rules nondiscrimination in benefits and mental health and substance abuse parity.
Emphasize Prevention and Wellness
Illness prevention is the primary goal of this provision with the following goals:
- Establishing a Prevention and Public Fund to provide grants to states for prevention activities such as disease screenings and immunizations.
- Creating the National Prevention Health Promotion and Public Health Council to coordinate federal prevention efforts including those necessary to address tobacco use physical activity and poor nutrition.
- Will require insurance plans issued after March 23 2010 to cover certain preventative care without cost-sharing such as immunizations; preventative care for children; and specified screening for particular adults with conditions such as high blood pressure high cholesterol diabetes and cancer.
- Increasing the federal share of Medicaid payments by 1 percentage point for certain preventative services for which states do not charge a co-payment effective January 1 2013.
- Increase Medicare payments for various preventative services effective January 1 2011.
- Establish a federal home-visiting initiative to help states foster health and well-being for children and families who live in at-risk communities.
- Require restaurant chains with 20 or more locations to label menus with calorie information and provide other information upon request including fat and sodium content etc.
- Require Medicaid programs to cover tobacco cessation services for enrolled expectant moms.
- Require federal public education campaign concerning oral health.
Improve Health Quality and System Performance
- Conduct research to study the effectiveness of various medical treatments.
- Establish demonstration projects to develop medical malpractice alternatives and reduce medical errors and payment mechanisms to improve efficiency and results.
- Increase investments in health information technology.
- Instigate improvements in care coordination between Medicare and Medicaid for patients who qualify for both.
- Create options for states to establish “health homes” for Medicaid enrollees with multiple chronic conditions to improve care.
- Collect data and reporting mechanisms to address health disparities among populations based on ethnicity geographic location gender disability status and language.
Promote Health Workforce Development
Through a number of provisions the ACA addresses workforce issues including reforms in graduate medical education training increases in health profession scholarship and loan programs support for training programs for nurses support for new primary care models such as medical homes and team management of chronic diseases increased funding for community health centers and the National Health Service Corps and support for school-based health centers and nurse-managed health clinics.
Curb Rising Health Costs
The ACA intends to address key provisions relating to rising health costs including providing more oversight of health insurance premiums and practices emphasizing prevention primary care and effective treatments reducing uncompensated care to prevent a shift onto insurance premium costs fostering comparison shopping in insurance exchanges to increase competition and price transparency implementing Medicare payment reforms and testing new delivery and payment system models in Medicaid and Medicare.
Although the ACA will not solve health care issues overnight it will attempt to take some positive steps forward toward reform. By making health coverage more affordable and accessible and therefore increasing the number of Americans with coverage and by funding community-based public health and prevention programs supporting research and tracking key health measures the ACA will begin to reduce disparities improve access to preventive care and reduce the nation’s health spending.
For more information on how the ACA may affect you or your business contact Lindemeyer to find out what changes might be in store for you.