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Front Page » September 19, 2013 » Carbon County News » Understanding the Affordable Care Act
Published 336 days ago

Understanding the Affordable Care Act


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By RICHARD SHAW
Sun Advocate publisher

While the speculation about the negatives and positives of the full implementation of the Affordable Health Care Act swirls throughout the media world and political circles, in the last three years a number of parts of the act have already been put in place. These pieces have tended to be the less controversial parts of the program, many that even most who oppose the program seem to like.

The original bill was signed in March 2010 by President Obama. With that signing a time line was created for the implementation of various parts of the act. Since that signing those provisions have come into place and in one way or another as various parts of the law will take effect through 2016.

Within the year after the signing of the bill changes began. Many of the changes are unseen by the individual. A lot of the laws provisions deal with health programs, improvement in health care, rules for insurance companies, etc. Because of those provisions the law has been hard for many to understand.

First came information, particularly information about comparisons between health insurance coverage. That kind of information was put on-line in July of 2010.

The next provision started in September of that year. After Sept. 23 insurance companies could no longer deny coverage to children under the age of 19 based on pre-existing conditions. This was controversial among insurance companies, but was a popular part of the bill with the public. At the same time it became illegal for health insurance companies to rescind insurance on someone just because of an error on an insurance application or some kind of technical mistake during their enrollment period. For many years some insurance companies had refused to pay claims on this basis, cutting services to many with deadly diseases.

Also in September of 2010 lifetime dollar limits were prohibited. Before that insurance companies would set a limit on what they would spend for any one person throughout their lifetime. The ability for those companies to do that was eliminated. An appeal process for consumers dealing with insurance companies and coverage determinations was also set up at that time.

All new insurance plans after Sept. 23 also had to cover certain preventive services such as mammograms and colonoscopies without charging a deductible, co-pay or coinsurance payment.

One of the most well known and popular provisions also took place in 2010. That was the ability of parents to keep their children on their plan until they are 26 years old.

Gradual introduction

In October of 2010 the law set up consumer assistance programs in states to address the needs of the citizens. These programs that have been put together help consumers file complaints and appeals, enroll in health coverage, and get educated about their rights and responsibilities in group health plans or individual health insurance policies. Data collection was also determined to be a part of this program so that trends and problems in the insurance industry could be tracked.

That year the government also mailed out $250 checks to seniors who reached the "donut hole" (a gap in medicare where prescriptions and other services were not provided) so they would have some relief.

In 2011 a lot of the provisions that came into affect impacted seniors. First came discounts on Medicare Part B brand-name prescription drugs. The law also brought into affect certain free preventative services for seniors as well as wellness visits and personalized prevention plans. The Community Care Transitions Program also went into force. This helps high risk Medicare beneficiaries who are hospitalized to avoid readmissions to hospitals by coordinating home care.

Another set of provisions that took affect in 2011 included holding health insurance companies accountable. One of the points of the law was for insurance companies to use premium dollars as much as possible for actual health care services. One part requires insurance companies to use 85 percent of the money they collect for health insurance premiums from large employer plans be used for actual health care improvement programs or for care itself. It also allowed for that 80 percent of receipts from individual and small employer plans must be used in the same way.

The year 2012 brought in more changes and innovations. Value-Based Purchasing came into affect, where hospitals have financial incentive through Medicate to improve their quality of care. In addition the performance of hospitals was required to be publicly reported. Reducing paperwork and heading toward a more electronic type of record keeping was also encouraged at all levels of health care.

Bundling services

This year has been a year of working on bundling services. In the past the health care system has been more fragmented with separate bills for many different services a patient receives. Now the law is working to have health care providers bundle all the services provided to a patient into one bill to Medicare to cut costs and administrative processes.

The act also provides for 100 percent of Medicare payments to doctors as they prepare to start seeing more patients in 2014.

On Oct. 1 individuals and small businesses can start to buy insurance through the competitive insurance marketplace. That is when enrollment begins for individuals who have no health insurance. Along with this, this year the program allows for tax credits for small businesses to provide health benefits to their employees. A regular business can get up to 35 percent of the their contribution to an employees health care in tax credits. Small non-profits can get up to a 25 percent.

270,000 eligible

It is important that eligible people sign up during the enrollment period. Around 270,000 Utahns are eligible to participate in the insurance marketplace. Those wishing to get federal insurance tax credits must fall within the zone of 100 to 400 percent of the federal poverty line (starting at $23,550 for a family of four and going to $94,200 at 400 percent). Four different plans will be offered at different price levels. Two of the plans have low deductibles, while the other two have higher co-pays and deductibles. The monthly cost for the lower deductible plans will be higher. As an example a family of four that signs up for a moderate plan and earns about $50,000 per year would have premiums of about $15,000 per year. However the federal tax credits would be around $11,500, leaving the family to pay around $3500 a year for their health insurance. This would break down to about $300 per month coming out of the family income. In this way families and individuals who have no insurance where they work can have various kinds of coverage depending on what they want to pay.

(This is the second in a series of three articles on the Affordable Care Act)

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