Health Insurance Reform

Health Insurance Reform

On March 23, 2010, President Barack Obama signed off the Patient Protection and Affordable Care Act (PPACA, or ACA) as a law.  This was one of the most significant legislative moments of our nation’s history in the matter of health insurance reform.

The goal of this law is to provide working adults with quality health insurance that is affordable.  Coverage should also be guaranteed in the event a person changes jobs, becomes involuntarily unemployed, or
decides to become self-employed.

While some of these health insurance reform changes will not take place for the next couple of years, there are some aspects of the ACA that will go into effect in the coming year.

Protecting the Consumer

The new health law offers a large range of protections for individuals and small businesses with 50 or fewer employees. For some time, carriers cannot deny coverage to children that have pre-existing medical conditions. With this health insurance reform law in effect, consumers will gain access to resources that will allow them to appeal
an insurance carrier’s decision on a new application for coverage including denials.

Beginning in 2013, this health insurance reform law will help to phase out annual and lifetime caps on amounts paid by carriers to cover the insured’s health care expenses.  This will apply to new individual policyholders. Additionally, the federal government is taking action to control increasing insurance policy costs.  This is in the form of a grant that will be awarded to states that require insurance companies to explain increasing premiums.

People who utilize federal programs like Medicare, Medicaid, and Children’s Health Insurance Programs (CHIP) can expect to find increased efforts placed on anti-fraud and waste in these programs.

Expanded Coverage

The legislation is looking to deliver affordable health insurance to millions of Americans who were previously uninsured, or facing the possibility of not having insurance. In July, different states started to accept insurance applications for enrollment, which included coverage for high-risk groups like those with pre-existing medical conditions. Families receiving CHIP coverage were also relieved of previous state efforts that threatened to decrease enrollment, until state-based health insurance exchanges go into effect in 2014.

The PPACA provision will also help families with dependent children under age 27 by extending coverage. In addition, more small (fewer than 50 workers) businesses are eligible to receive tax credit incentives
that will help in providing coverage for employees.

Individuals and families who have their own private insurance by or after September 23 will receive free preventive healthcare services in addition to services covered on their policy.

Seniors and Retired Persons

This legislation will bring many changes to seniors and others receiving Medicare.  These began in 2010, when about 4 million seniors hit the “donut hole”, also known as the gap in coverage that is part of the Medicare prescription drug benefit.

This is only the beginning of many things to come, as Medicare reform will take place in numerous ways. Things like cost containment, federal program funding increases, the additional Medicare services covered, and support for primary care physicians.

There will also be more support for health care providers that work in rural or underserved areas

Beginning in 2010, incentives in the form of scholarships and loan repayment plans will be implemented as a way to increase the number of primary care physicians, nurses, and physician assistants that work in rural or underserved areas. This health insurance reform law will also include increased payments as an incentive to continue serving these communities.