Update on the Affordable Care Act

from the inbox:

Secretary of Health and Human Services (HHS) Kathleen Sebelius provided an update today on progress made implementing the Affordable Care Act in the nine months since it was signed into law, highlighting the new benefits available to Americans across the country thanks to the legislation. She also took time to highlight new benefits coming in 2011.

“The Affordable Care Act has helped millions of Americans across the country gain more control over their insurance coverage, receive higher quality health care and start seeing some savings in their pocket,” said Secretary Sebelius. “And there is more in store for Americans under the new law in 2011, including scrutiny of large premium increases, free physicals for Medicare beneficiaries, and important new programs to improve patient safety. Still, some want to eliminate these benefits and put insurance companies back in charge. We won’t go back and we are committed to delivering the benefits of reform to the American people.”

"In Pennsylvania this year, thanks to the Affordable Care Act, approximately $79.6 million in grants for strengthening public health and consumer assistance have been awarded, over 148,000 Medicare beneficiaries have had their prescription drug costs lowered and 289 Pennsylvania employers have had their highest early retiree health insurance costs significantly reduced," said HHS Region 3 Director Joanne Grossi.

Some important benefits of the law that went into effect in the first nine months:

Patient’s Bill of Rights: On September 23, 2010, the Affordable Care Act’s Patient’s Bill of Rights took effect and began protecting consumers. The Patient’s Bill of Rights stops insurance companies from:

Denying coverage to children based on a pre-existing condition.

Dropping coverage when you get sick because you made a mistake on your application.

Putting lifetime caps on the dollar amount that they will spend on benefits. In the past, patients with cancer or other chronic diseases ran the risk of hitting a lifetime cap and losing access to care. The law also restricts most insurance companies’ use of low annual dollar limits on benefits. In 2014, annual limits will be eliminated.

Deny coverage or services without offering Americans in new insurance plans the chance to appeal the decision to an independent third party.

· Coverage for Young Adults: Young adults are able to remain on their parents’ health plan until they turn 26 if the plan covers dependent children and if coverage isn’t offered to them through their job.

Small Business Tax Credits: Starting January 1, 2010, up to 4 million small businesses became eligible for tax credits to help them provide insurance benefits to their workers, thanks to the Affordable Care Act. The first phase of this provision provides a credit worth up to 35 percent of the employer’s contribution to the employees’ health insurance. Small non-profit organizations may receive up to a 25 percent credit.

HealthCare.gov: On July 1, 2010, the Administration launched www.HealthCare.gov. A first-of-its-kind website, www.HealthCare.gov helps you make informed decisions about health care coverage by offering easy-to-understand information about what health plans are available in your state; how much they cost; what they cover, and lots more information tailored to your specific needs.

Insurer Oversight: The Affordable Care Act also provides new tools to help hold health insurers accountable to consumers. This includes new support for States for efforts to establish or strengthen consumer assistance programs. In 2011, insurance companies will be required to spend at least 80 percent of premium dollars on health care and quality improvements instead of overhead, salaries, or administrative expenses – or provide rebates to consumers.

· Prescription Drug Cost Relief: In 2010, eligible seniors who fell into the Medicare Part D prescription drug coverage “donut hole” received a tax-free $250 rebate check to help defray their out-of-pocket costs for their prescription drugs. Over 2.8 million seniors and persons living with disabilities have received this benefit to date to help them afford their medications.

Support for Early Retiree Coverage: The Early Retiree Reinsurance Program established under the Affordable Care Act provides much needed financial relief for employers so early retirees and their families can continue to have quality, affordable insurance. Already, more than 4,500 businesses, unions, States, local governments and non-profit organizations have been approved to take part in the program.

Pre-Existing Condition Insurance Plan: Thousands of uninsured Americans with pre-existing conditions who were shut out of the health insurance market were finally able to get the coverage and care they needed through the new Pre-Existing Condition Insurance Plan (PCIP) program.

Reducing Waste, Fraud and Abuse: Medicare has continued to take strong action to reduce payment errors, waste, fraud, and abuse. Current efforts to fight fraud returned more than $2.5 billion to the Medicare Trust Funds in FY 2009 alone. The President has made a commitment to reduce fraud in original Medicare by 50 percent by 2012. The Affordable Care Act makes an historic, ten-year, $350 million investment to build on these efforts to prevent, detect and fight fraud in Medicare, Medicaid and the Children’s Health Insurance Program, including new screening procedures for health care providers.

Strengthening the Health Care Workforce: The Affordable Care act provided $250 million in funding that, along with other funding in the American Recovery and Reinvestment Act, will train up to 16,000 primary care physicians, physician assistants and nurse practitioners over the next 5 years. In addition, the Administration allocated $250 million in funds from the 2010 Prevention and Public Health Fund to programs to support activities such as community initiatives and the development of the public health infrastructure that can help prevent disease and illness before it starts. Equally important, it awarded and made available over $1 billion in funding to strengthen community health centers.

“In 2011, Americans will continue to see new benefits under the Affordable Care Act,” said Sebelius. “Seniors and people on Medicare will have access to free preventive care and lower cost prescription drugs. Insurance companies will have to justify high premium increases and states will have new tools to keep premiums low. And we’ll continue our efforts to improve the quality of care for all Americans.”

Some Affordable Care Act benefits coming in 2011:

Value for Your Premium Dollar: Starting in 2011, the Affordable Care Act will help tackle rising health insurance premium costs by having insurers that spend less than 80 percent of premium dollars on health care and quality improvements, as opposed to administrative, overhead and marketing costs, to provide a rebate to enrollees. In addition, the new law will provides additional resources to help States crack down on unreasonable health insurance premium hikes.

· New Benefits for Medicare Beneficiaries: Thanks to the Affordable Care Act, starting on January 1, 2011, people with Medicare coverage can get an annual physical examination at no cost to them, and people new to Medicare will no longer have out-of-pocket costs for the “Welcome to Medicare” physical exam. Also starting on January 1, 2011, as the next step in closing the Medicare Part D coverage gap known as the “donut hole,” those reaching the coverage gap will automatically get a 50 percent discount on covered brand-name prescription drugs while in the gap.

· Safer Patients, Higher Quality Care: The Affordable Care Act provides a number of new policies and resources to help improve the quality of care Americans receive, and to keep patients safer.

Better Access to Primary Care: Too many communities suffer from a shortage of primary care doctors. To help ensure people on Medicare continue to have access to primary care providers, the Affordable Care Act is providing a 10 percent Medicare bonus payment for primary care services.

“Repealing the Affordable Care Act would eliminate these benefits, putting the insurance companies back in charge and making it harder to find a doctor,” said Sebelius. “We must not stop going forward. In 2011, Americans will continue to see new benefits under the Affordable Care Act.”

For more state-specific information about implementation of the Affordable Care Act, visit www.HealthCare.gov/center.