The Supreme Court has ruled that, with the exception of one provision, the Affordable Care Act (or Obamacare) is constitutional. Despite that, Mitt Romney and the Republicans in Congress have vowed to repeal the legislation. I believe that it’s important to understand what the American people will lose if that happens.
Critics claim that Obamacare is a bill that’s much too long and complicated for us to read and understand. But you don’t have to go through the agonizing, mind numbing experience of reading the bill to learn what the key provisions are. A website has been created to help people understand the key provisions of the legislation. The website includes a timeline feature which tells when the key provisions will be enacted, and links to additional information about those key provisions. Here’s a link to that timeline:
Here are some of those key provisions found in that timeline. Keep in mind that the provisions from 2010 and 2011 are in place and have been implemented. Some of the provisions in 2012 may not have been implemented yet.
*The health care law includes new rules to prevent insurance companies from denying coverage to children under the age of 19.
*The health care law makes illegal the practice of rescinding, or denying coverage to applicants because of an error or other technical mistake on the application form.
*Insurance companies are prohibited from placing annual dollar limits on the amount of insurance coverage a patient may receive.
*The law established a process for external review in customers’ appeal of an insurance company’s determination on a claim. In the past the appeal could only be made to the insurance company that denied the claim.
The law also provides several provisions for improving the quality of care and lowering the cost of health care:
*The law provides small businesses with tax credits to help them provide insurance benefits for their employees.
*Obamacare provides relief for senior citizens who will reach the gap in Medicare prescription drug coverage (or doughnut hole) during the year in the form of a one-time $250 rebate check.
*All new plans are required to provide certain preventative services such as mammograms or colonoscopies without charging a deductible, co-pay or co-insurance.
*A new $15-billion Prevention and Public Health Fund was created to provide funding for proven prevention and public health plans that help keep Americans healthy.
*Obamacare provides new funding and resources to find and prosecute fraud in Medicare, Medicaid and CHIP programs.
*The law created a new Pre-Existing Insurance Plan to provide new coverage options to people who have been uninsured for at least 6 months because of a pre-existing condition.
*Young adults are allowed to remain on their parents’ insurance plan until they reach the age of 26. Remember the recent TV ad which featured a woman who aged before our eyes, telling how she voted for Obama but was so disappointed in his performance that she no longer supports him? A major source of her disappointment was the fact that her two children had not been able to find a job after graduating from college and had moved back in with her. Had one of her children hurt themselves while playing basketball in the driveway, their trip to the emergency room would have been paid for by their mother’s insurance under this provision.
*The law created an Early Retiree Reinsurance Program which provides financial help for employment based insurance plans to help them provide coverage for workers who retire early, before reaching the age of eligibility for Social Security and Medicare, as well as their spouses and dependents.
*Obamacare provides new incentives to expand the numbers of primary care doctors, nurses, and physician assistants.
*The law allows states that have or plan to implement measures requiring insurance companies to justify their premium increases to be eligible for $250-million in new grants.
*The law provides the funding to allow more people to enroll in Medicaid.
*Obamacare provides new funding to help rural health care providers and community health centers provide medical care for the under-served segments of the American population.
Among the provisions of Obamacare taking place in 2011 are these provisions:
*Senior citizens who reach the coverage gap in their prescription drug plan will receive a 50% discount on the price of their medications. This provision calls for seniors to receive additional savings on their medications until the coverage gap is closed in 2020.
*The law provides certain free preventative services such as annual wellness visits and personalized prevention plans for seniors on Medicare.
*Obamacare creates a new Center for Medicare and Medicaid Innovation that will test new ways of delivering care to patients. These new methods are expected to improve the quality of care and reduce the rate of growth in health care costs for Medicare, Medicaid, and the Children’s Health Insurance Program.
*Also crated under Obamacare is the Community Care Transitions Program which will help high risk Medicare beneficiaries who are hospitalized avoid costly, unnecessary re-admissions by coordinating care and connecting patients to services in their community.
*The law created the Independent Payment Advisory Board to develop and submit proposals to Congress and the President aimed at extending the life of the Medicare Trust Fund
*Obamacare also increases access to services at home and in the community by creating the Community First Choice Option, which allows states to offer home and community based services to disabled individuals through Medicaid rather than warehousing them in institutional care.
*To ensure that premium dollars are spent primarily on health care, the law generally requires that at least 85% of all premium dollars collected by insurance companies for large employers health care plan are spent on health care services and health care quality improvement. For plans sold to small employers and individuals at least 80% of the premium dollars must be spent on benefits and quality improvement. If insurance companies fail to meet these goals because their administrative costs or profits are too high, they will be required to provide rebates for consumers.
*The health care law also eliminates a discrepancy in payments to Medicare Advantage plans. Before the reform law Medicare had been paying insurance companies that provide the Medicare Advantage services over $1,000 more per person than is spent per person in traditional Medicare. This results in increased premiums for all Medicare beneficiaries, including the 77% of Medicare beneficiaries who have chosen to be served by traditional Medicare rather than a Medicare Advantage plan. Under the law the overpayment is gradually eliminated without denying the Medicare Advantage beneficiaries the benefits they have been guaranteed. This is the provision that the Republicans have portrayed as a Medicare cut. The truth is all that’s being cut are over-payments to Medicare Advantage plans. Beneficiaries in those plans will not see a reduction in services.
*On or after October 1 of this year a Value-Based Purchasing program goes into effect for traditional Medicare. This program offers financial incentives to hospitals to improve the quality of care in those hospitals. Hospital performance is required to be publicly reported, beginning with measures relating to heart attacks, heart failure, pneumonia, surgical care, health care associated infections, and patient’s evaluation of the care they received.
*Also going into effect on or after October 1 is a series of changes to standardize billing, and implement secure, confidential electronic exchange of health information. Electronic health records will reduce paperwork and administrative burdens, cut costs, reduce medical errors and improve the quality of health care.
*To help understand and fight health disparities, the law requires any ongoing new federal health program to collect and report racial, ethnic, and language data.
*Obamacare provides incentives for doctors to join together to form Accountable Care Organizations; groups that allow doctors to better coordinate patient care and provide higher quality care, help prevent disease and illness, and reduce the number of unnecessary hospital admissions. If an ACO provides high quality care and reduces costs to the health care systems they will be allowed to keep some of the money they have helped save.
*Next year Obamacare will provide new funding to Medicaid programs to cover preventative health care services for patients at little or no cost.
*The law establishes a national pilot program to encourage doctors and other health care providers to work together to improve the coordination and quality of patient care to Medicare beneficiaries. The program involves “bundling” of payments. Under the current system a Medicare patient who undergoes a surgical procedure would generate bills for service from all of the providers on the surgical team. Under the bundling established with this provision, the entire team is compensated with a bundled payment that provides incentives to deliver health care services more efficiently while maintaining or improving quality of care.
*The health care reform law will require states to pay primary care providers no less than 100% of Medicare payment rates in 2013 and 2014 for primary care services, with the increase fully funded by the federal government.
*Obamacare provides additional funding for the states’ Children’s Health Insurance Program. The states will receive two more years of funding to continue this insurance for children who are not eligible for Medicaid.
In 2014 many of the most popular features will go into effect:
*The law implements reforms that prohibit insurance companies from refusing to sell coverage or renew a policy because of a pre-existing condition. Also included is the elimination of the ability of insurance companies serving the individual and small group markets to charge higher rates due to gender or health status.
*Obamacare will prohibit new plans and existing group plans from imposing annual dollar limits on the amount of coverage a person can receive.
*Insurers will be prohibited from dropping or limiting coverage because an individual chooses to participate in a clinical trial that treats cancer or other life-threatening illness.
*The health care reform law will establish advance-able tax credits to make it easier for the middle class to afford to buy health insurance.
*Starting in 2014 if your employer doesn’t offer health insurance as part of a benefit package you will be able to buy it directly in an Affordable Insurance Exchange, an online marketplace where insurance companies will be able to offer qualified health benefit plans for individuals and families.
*Also in 2014 the second phase of the small business tax credit for qualified small businesses and small non-profit organizations is implemented.
*Obamacare will increase access to Medicaid by expanding the number of people who can receive Medicaid. The federal government will pay 100% of the cost for the expansion for the first three years, with the states eventually assuming 10% of the cost in subsequent years.
*The controversial individual mandate kicks in at the start of the year. Most individuals who can afford it will be required to obtain basic health insurance coverage or pay a fee/tax to help offset the cost of caring for uninsured Americans. If affordable coverage is not available to an individual, he or she will be eligible for an exemption. It’s important to note that the “individual mandate” is more of an “optional mandate”. Individuals will be charged that fee/tax if they refuse to buy basic insurance, but the agency charged with collecting that fee/tax, the IRS, has no power to prosecute or seize the assets of the individual according to the health care reform law. That’s the part of this provision that neither the Obama administration nor the Republicans want you to understand. The Obama administration wants people in the dark about this so they will pay the tax/fee; and the Republican want to project the image of large numbers of Americans having to pay this new tax.
*Free choice is ensured by allowing workers meeting certain requirements who cannot afford the coverage provided by their employer to take whatever funds the employer might have contributed to their insurance and use those funds to purchase a more affordable plan in the new health insurance exchange in their state.
There is one more provision scheduled to take effect in 2015. A new provision will tie physician payments to the quality of care they provide rather than the number of patients they see. Payments will be modified so that doctors who provide higher quality care will receive higher payments than those who provide lower quality of care.
I admit that I have not been a big fan of Obamacare. When it was signed into law I saw it as just a gift to the insurance companies, giving them 25-million or so new customers. I would much rather see a single-payer system like Medicare for all. But after looking at all of the key provisions in the law, I see a lot of good in the health care reform law.
What I see when I look at the key provisions of Obamacare are provisions that help all segments of America. There are provisions to help provide insurance coverage for children, young adults, individuals, families, and senior citizens. There are tax credits for businesses and individuals to help them provide or afford to buy insurance. There are incentives for health care providers to provide higher quality health care. There are provisions which will make our health care system more efficient, as well as funds for educating more health care practitioners to serve our aging population.
Since 2010 when the Affordable Care Act was signed into law, the right has derisively called the health care reform law “Obamacare”. For the last couple of years, “Obamacare” has been a demeaning term. Well, my friends, it’s time for us to take control of the word. It’s time for us to refer to the Affordable Care Act as Obamacare with pride. Obamacare is not perfect, but it is a great start.
And it’s a start that will be undone if Mitt Romney wins the White House and the Republicans gain control of both houses of Congress. They have promised to repeal Obamacare and replace it with a plan they have yet to reveal. Go back to the start of this post and look through the key provisions, thinking about the ones which will benefit you. Are you ready to kiss them goodbye?
If you see things in Obamacare that will help you, it’s time to take action. It’s time to spread the word about this website and the provisions in Obamacare that will benefit you. Too many people have formed negative opinions of Obamacare because they don’t know what’s in it. Help open their eyes to the benefits Obamacare will bring to all of us.