It seems highly appropriate that I received Thursday’s news about the Supreme Court ruling on health reform while driving through Vermont, a state with a very inclusive, high quality, affordable health care system, en route from Canada, a country where everyone receives free health services under a single payer system. Of course, the news was delivered on my smartphone – a device that will play an increasingly important role in managing and tracking patient care.
While Republicans predictably responded with a knee-jerk reaction to repeal the law, the reality is that many provisions are either already in place, or in late-stage planning. More specific components are slated to become effective in 2013 and 2014; ones which will help cover an additional 50 million Americans, set up a system for them to obtain affordable insurance (including government subsidies if needed), and make sure that insurance companies provide coverage when it’s most needed.
Here are some key highlights:
Expansion of Medicaid to cover nearly all people under age 65 with household incomes at or below 133% of the federal poverty level, effective 2014. An estimated 17 million people are eligible for this coverage. While states face denial of additional funding if they refuse to participate, the Court said they cannot lose existing funding if they opt out.
Tax subsidies will make insurance more affordable for roughly 50 million people – who are among those that will pay penalties or fines if they don’t buy coverage or get it through an employer.
If an employer does not provide insurance to its workers, insurance exchanges will offer a range of insurance options on a sliding income scale – as income increases, subsidies decrease.
Insurers cannot deny coverage for pre-existing conditions – good news if you change jobs or have to purchase your own plan. Insurance companies also have maximum limits on what they can charge different age groups, smokers, or other higher-risk individuals.
Insurers can no longer put “lifetime limits” – the maximum amount paid for any service or treatment. They will also need to justify any unusually large premium increases to government regulators.
Maternity care will be required coverage in all new insurance plans, starting in 2014.
Young adults up to age 26 can remain on their parent’s plans.
Preventive care without co-pays. According to CBS News, some 54 million Americans now receive at least one preventive service like mammograms, since the law was enacted in 2010.
Health Information Technology is increasingly important in controlling costs, delivering more efficient care, helping providers and patients optimize disease management, improving knowledge, and tracking data. Coordinating care through Health Information Exchanges helps to eliminate duplication of services and ensures that all clinicians have access to a patient’s health history.
The Kaiser Family Foundation website has a comprehensive timeline of the provisions and when they go into effect.
I don’t really understand why anyone can be opposed to people having affordable health insurance, access to more preventive care, not forfeiting insurance if they lose their jobs, or going bankrupt if hit by serious illness. Insurance means incentive to get those preventive screenings. More preventive care means illnesses are caught and treated earlier – saving lives, and saving money. The ability of physicians and other providers to “talk” to each other electronically and access a patient’s medical record will cut costs, save time, and ensure better care.
Justice Roberts did the right thing by closely examining the law on its merits, not by focusing on politics. It’s high time the rest of the U.S. has the type of quality health care that Vermonters enjoy. It’s not perfect, but it’s a heck of an improvement for millions of Americans.
for more on this issue, see my blog post at The Center for Health, Media and Policy.
Thank you, Liz, for printing this comprehensive list of benefits under the Affordable Care Act. I am dumbfounded by the number of people who hate this act because “it’s a mandate.” Perhaps your article will inform some who have questions about how insurance works.