March 23, 2012 marked the two-year anniversary of the enactment of the Affordable Care Act (ACA), passed by Congress and signed into law by President Obama. The ACA provides better health security by putting in place comprehensive health insurance reforms that hold insurance companies accountable, lower health care costs, guarantee more choice, and enhance the quality of care for all Americans.
Because the ACA encompasses significant regulatory reforms, all of its provisions could not be implemented all at once. Portions of the law have already taken effect like provisions that implement a new Patient’s Bill of Rights that put an end to some of the worst insurance company practices, such as canceling your policy, denying you coverage, or charging women differently than men.
I agree with President Obama that you should not have to fear going bankrupt because you get sick or somebody in your family gets sick. In Congress, I will continue to fight any efforts to turn back the clock and repeal the ACA. Health care reform has been long overdue in this country, and now is the time we must see it through to completion so that healthcare in Florida and the rest of the nation is accessible and more affordable to all.
If you have any questions about provisions in the Affordable Care Act, please visit www.healthcare.gov or feel free to contact my office.
WHAT THE AFFORDABLE CARE ACT HAS DONE FOR YOU SINCE 2010:
Protection from discrimination against children with pre-existing conditions: Under the ACA, insurance plans that cover children can no longer exclude, limit or deny coverage to your child under age 19 solely based on a health problem or disability that your child developed before you applied for coverage.
In District 17, up to 41,000 children with preexisting health conditions can no longer be denied coverage by health insurers.
New Coverage Options for Individuals with a Pre-Existing Condition: A Pre-Existing Condition Insurance Plan (PCIP) provides new coverage options to individuals who have been uninsured for at least six months because of a pre-existing condition.
Protection for women: Under ACA, you can no longer be dropped by your insurance company if you become pregnant or become sick. New plans now offer free coverage for important, life-saving preventive services, such as mammograms and colonoscopies. Additionally, older women with chronic conditions receive improved care due to incentives provided for more coordinated care efforts under Medicare.
Protection for seniors: Seniors who reach the “donut hole” will receive a 50 percent discount when buying Medicare Part D covered brand-name prescription drugs.
4,200 seniors in the district received prescription drug discounts worth $2.5 million, an average discount of $590 per senior. By 2020, the law will close the donut hole.
Protection for young people and minority youth: Under the ACA, young adults can stay on their parents’ health insurance plan until the age of 26.
6,600 young adults in District 17 now have health insurance through their parents’ plans.
Free Preventive Care Services: Under the ACA, health plans must cover certain preventive services such as mammograms and colonoscopies without charging a deductible, co-pay or coinsurance. Seniors also receive a free Annual Wellness Visit under Medicare.
62,000 seniors in the district received Medicare preventive services without paying any co-pays, coinsurance, or deductibles.
80,000 residents in District 17 have benefited from this change, including 19,000 children, 31,000 women, and 69,000 residents who are African American, Latino, or a part of other minority groups for whom preventative care can reduce health disparities.
Protection from unreasonable cost increases and lifetime limits: If you have private insurance, you will not have unreasonable premium increases, lifetime limits or lose your insurance when you or a family member gets sick.
Before the ACA, 105 million Americans were in health insurance plans that had lifetime limits. The U.S. Department of Health and Human Services estimates that 70 million people in large employer plans, 25 million people in small employer plans and 10 million people with individually-purchased health insurance had lifetime limits on their health benefits prior to the enactment of the ACA.
In District 17 alone, 270,000 residents with private health insurance coverage are now protected from rescission of their health coverage if they get sick; and 150,000 people in health care plans no longer have lifetime limits imposed on them.
Additionally, your insurance company must now spend at least 80 percent of your premium covering medical services – rather than CEO pay, profits, and administrative costs. As of this summer, if your insurer fails the test, you get a rebate.
The ACA protects individuals from soaring health insurance costs by requiring insurers to post and justify proposed rate increases of 10 percent or more. It also limits the amount that insurance companies can spend on administrative expenses and profits. 110,000 residents who have individual coverage or employer coverage are benefiting from these provisions.
Protection for small businesses: Your small business can take advantage of tax breaks to provide quality, affordable health insurance for your employees.
The first phase of this provision provides a credit worth up to 35 percent of the employer’s contribution to their employees’ health insurance. Small non-profit organizations may receive up to a 25 percent credit.
720 small businesses in District 17 received tax credits to help maintain or expand health care coverage for their employees.
Improving community health: Financial support is provided to improve the health of communities.
$1 million in public health grants have been given to community health centers, hospitals, doctors, and other healthcare providers in the district to improve the community’s health.
WHAT THE AFFORDABLE CARE ACT WILL DO FOR YOU IN THE FUTURE:
Easy-to-understand summary of benefits: Policies must provide an easy- to-understand summary of benefits of coverage to consumers, including a standardized “coverage examples” section that uses a format modeled on the nutrition facts label for food.
Insurance exchanges: Starting in 2014, you will be able to shop for insurance through an exchange that allows you to compare private health plans, determine if you are eligible for health programs or tax credits, and enroll in a program that meets your needs. For small employers, the exchange would also be a place where you have a better choice of plans and insurers at a lower cost, like larger employers do.
Protection for women: In 2014, being a woman can no longer be treated as a “pre-existing condition” by insurance companies, meaning women cannot be charged substantially higher premiums than men for the same coverage.
Encouraging Integrated Health Systems: The ACA will provide incentives for physicians to join together to form “Accountable Care Organizations.” In these groups, doctors can better coordinate patient care and improve quality, help prevent disease and illness, and reduce unnecessary hospital admissions. If Accountable Care Organizations provide high quality care and reduce costs to the health care system, they can keep some of the money that they have helped save.
Additional funding for important social services: Important programs like Medicaid and the Children’s Health Insurance Program (CHIP)will receive additional funding.
Protection from discrimination against all patients with pre-existing conditions: Health insurers will be prohibited from discriminating against all adults and children with pre-existing conditions, which will protect the 100,000 to 280,000 individuals in the district with a pre-existing health condition.
*The U.S. Department of Health and Human Services provided the Florida statewide data for the Affordable Care Act. The factsheet can be found on www.healthcare.gov here: https://www.healthcare.gov/law/resources/fl.html
*The data sources on the Affordable Care Act's impact on District 17 can be found here:https://democrats.energycommerce.house.gov/sites/default/files/image_uploads/DistrictbyDistrictHCRReports_DataSources_March2012.pdf