Sept. 23, 2010, was a milestone date in the history of healthcare delivery in this nation. This date not only marked six months since the passage of the Patient Protection and Affordable Care Act; it also heralded the delivery of a new and important series of reforms that the act scheduled for early implementation.
The provisions of law effective on Sept. 23 will give consumers new opportunities to purchase insurance and will extend important rights and protections to millions of consumers who already have insurance. We can look forward to major improvements scheduled for 2014, but we can celebrate today the significant progress that will be made this year to take us down the path toward access to quality, affordable healthcare.
When the legislation was signed, HHS moved quickly to put into place programs that will help millions of Americans. The healthcare reform act is already providing financial relief to millions of seniors and people with disabilities on Medicare.
Help is already being delivered to Medicare beneficiaries in the “doughnut hole”—the $3,610 coverage gap in the Medicare Part D prescription drug benefit. Anyone who falls into the doughnut hole in 2010 will receive a $250 rebate. Starting in 2011, they will also receive 50% discounts on their brand-name drugs while they are still in the doughnut hole, with the doughnut hole closing more each year until it is totally eliminated by 2020. Additionally, the act eliminates all cost-sharing for preventive care in Medicare. Some of those services currently have a 20% copayment.
The Affordable Care Act is already helping small businesses. Effective for the 2010 tax year, small businesses with fewer than 25 employees are eligible for new tax credits of up to 35% of their contribution toward employees' premiums.
The reform law is already helping early retirees age 55 to 65. Private firms, government entities and labor unions across the country are participating in a new program that offers reinsurance to employer health plans that provide coverage for early retirees. This helps to protect coverage while reducing premiums for employers, their current workers and these early retirees.
The Affordable Care Act will also end discrimination against people with pre-existing conditions. The prohibition on pre-existing condition exclusions for children under the age of 19 also starts on Sept. 23. For adults, starting in 2014, insurance companies will no longer be able to turn away people or charge sky-high premiums because they have a pre-existing condition. (A recent Families USA report found that more than 57 million people—22.4% of those under the age of 65—have a pre-existing condition that can lead to a denial of coverage.)
Because Congress and the White House recognized that people need help now, a bridge program began on July 1 called the Pre-Existing Condition Insurance Plan. It enables people with pre-existing conditions to obtain coverage through new and expanded insurance pools, and the premiums can't be higher than the standard premium for everyone else in a state.
Other big changes effective on Sept. 23 are also significant:
Health plans are required to allow young people to remain on their parents' insurance policy until they turn 26. Young adults need not be financially dependent on their parents or in school and can be married or live in another state. Millions of young adults moving from school to their first jobs or internships can benefit from this new insurance option.
All new health plans are required to cover recommended preventive services with no copayments and to exempt preventive services from deductibles—in other words, recommended preventive services will be free under new health plans.
All health plans are banned from dropping people when they get sick just because they did not—in good faith—fill out an insurance application properly.
All health plans are prohibited from placing lifetime caps on coverage. All employer plans and new plans in the individual market have tight restrictions on the use of annual limits. Protections against these limits are especially important for anyone who faces a serious illness or chronic condition that can run up very high medical bills in a short time.
All new plans are required to comply with new rules about independent external appeals that give consumers a fair opportunity to contest decisions made by insurance companies that deny legitimate claims or prevent consumers from getting coverage for the care they need.
In 2014, every American will have access to quality, affordable health coverage, many through new “exchanges”—regulated marketplaces where consumers can pick from a range of plans that will meet their needs and that offer better value for their premiums dollars. Equally important, more than 28 million consumers will be eligible for new premium tax credits that will significantly reduce the cost of insurance. These new tax credits, worth thousands of dollars, are available to middle-income families with annual incomes that could be as high as $90,000.
For many who before had few or no coverage options due to their employment status, income or health status—the self-employed, early retirees, people with pre-existing conditions, and others—the Affordable Care Act will finally make coverage available and affordable.
Ron Pollack is executive director of Families USA, a healthcare consumer advocacy group.
