A Billed Proposed in the House by William F. Schaake, CIC, CRM
Health Care and Education Reconciliation Act of 2010 was signed by President Obama on March 30, 2010 as an amendment to the Patient Protection and Affordable Care Act. This second set of provisions including adjustment to health care inform while including the Student Aid and Fiscal Responsibility Act.
The magnitude and impact of PPACA will forever change the entire medical and health care industries, which accounts as the single largest sector of the US economy accounting for nearly 17% of our GDP. Ironically, most of the documents were allegedly drafted behind closed doors, heavily favored and endorsed by members of the democratic party during their brief control of all three branches of the federal government.
As many as 27 states have filed legal actions in federal court challenging the PPACA constitutionality, but three of the four appellate courts upheld the PPACA legality. The individual mandate, which will require most Americans to purchase health care coverage and in itself a requirement many consider unconstitutional, will be reviewed in by the Supreme Count and has scheduled over five hours of discussions in March of 2012
The key provisions of the Affordable Care Act by date.
March 23, 2010 President Barack Obama signs the PPACA into law.
Immediate Changes Starting September 23, 2010 (Source: whitehouse.gov)
2010
New Consumer Protections -
- No Discrimination Against Children With Pre-
Existing Conditions . The new law includes new rules to prevent insurance companies from denying coverage to children with pre-existing conditions. Effective for health plan years beginning on or after September 23.
- Prohibits Insurance Companies from Dropping Coverage. In the past, insurance companies could search for an error on a customer's application or other technical mistake and use this error to stop covering the person when he or she got sick. The new law makes this illegal and after media reports cited incidents of breast cancer patients losing coverage, insurance companies agreed to end this practice immediately. Effective for health plan years beginning on or after September 23. Click here to learn more.
- Eliminating Lifetime Limits on Insurance Coverage. Under the new law, insurance companies will be prohibited from imposing lifetime dollar limits on essential benefits, like hospital stays. Effective for health plan years beginning on or after September 23.
- Regulating Annual Limits on Insurance Coverage. Under the new law, insurance companies' use of annual dollar limits on the amount of insurance coverage a patient may receive is sharply restricted. In 2014, the use of annual dollar limits on essential benefits like hospital stays will be banned for new plans in the individual market and all group plans. Effective for health plan years beginning on or after September 23.
- Appealing Insurance Company Decisions. The law provides consumers with an easy way to appeal to their insurance company and to an outside board if the company denies coverage or a claim. Effective for health plan years beginning on or after September 23.
- Information for Consumers Online. The law creates an easy to use website where consumers can compare health insurance coverage options and pick the plan that works for them. Effective July 1, 2010. Click here to learn more.
Improving Quality and Lowering Costs
- Small Business Health Insurance Tax Credit. Up to 4 million small businesses are
eligible for tax credits to help them provide insurance benefits to their workers.
The first phase of this provision provides a credit worth up to 35 percent of the
employer's contribution to the employees' health insurance. Small non-
profit organizations may receive up to a 25 percent credit. Effective now. Click here to learn more.
- Relief for Four Million Seniors Who Hit the Medicare Prescription Drug "Donut Hole." An estimated four million seniors who hit the gap in Medicare prescription drug coverage known as the "donut hole" this year will receive a $250 rebate. First checks mailed in June, 2010, and will continue monthly throughout 2010 as seniors hit the coverage gap. Click here to learn more.
- Free Preventive Care. All new plans must cover certain preventive services such as
mammograms and colonoscopies without charging a deductible, co-
pay or coinsurance. Effective for health plan years beginning on or after September 23.
- Preventing Disease and Illness. A new $15 billion Prevention and Public Health Fund
will invest in proven prevention and public health programs that can help keep Americans
healthy -
- Funding begins in 2010.from smoking cessation to combating obesity.
- Cracking Down on Health Care Fraud. Current efforts to fight fraud have returned more than $2.5 billion to the Medicare Trust Fund in FY 2009 alone. The new law invests new resources and requires new screening procedures for health care providers to boost these efforts and reduce fraud and waste in Medicare, Medicaid, and CHIP. Many provisions effective now. Click here to learn more.
Increasing Access to Affordable Care
- Access to Insurance for Uninsured Americans with Pre-
Existing Conditions. A transitional high risk pool program will provide new coverage options to individuals who are uninsured because of a pre-existing condition for at least six months. States have the option of running their own temporary high risk pool. If a state chooses not to do so, a pool will be established by the Department of Health and Human Services. National pool e ffective July 1. Click here to learn more.
- Extending Coverage for Young Adults. Under the new law, young adults will be allowed to stay on their parents' plan until they turn 26 years old unless they are offered insurance at work. While the provision takes effect in September, most insurance companies have already implemented this new practice. Check with your insurance company or employer to see if you qualify. Effective for health plan years beginning on or after September 23. Click here to learn more.
- Coverage for Early Retirees. Too often, Americans who retire without employer-
sponsored insurance and before they are eligible for Medicare see their life savings disappear because of exorbitant rates in the individual market. To preserve employer coverage for early retirees until more affordable coverage is available through the exchanges in 2014, the new law creates a $5 billion program to help people who retire before age 65 maintain the affordable care they need. Applications for employers to participate in the program available June 1. Click here to learn more.
- Rebuilding the Primary Care Workforce. To strengthen the primary care workforce, new incentives in the law to expand the number of primary care doctors, nurses and physician assistants include funding for scholarships and loan repayments for primary care doctors and nurses working in underserved areas. Doctors and nurses with student loans will also receive tax relief if they practice in communities with a shortage of health care providers. Effective 2010.
- Holding Insurance Companies Accountable for Unreasonable Rate Hikes. The law allows states that have or plan to implement measures that require insurance companies to justify their premium increases will be eligible for $250 million in new grants and insurance companies with excessive or unjustified premium exchanges may not be able to participate in the new health insurance Exchanges in 2014. Grants will be awarded beginning in 2010.
- Allowing States to Cover More People on Medicaid. States will receive increased federal
matching funds for covering low-
income individuals and families on Medicaid. This will make it easier for states that choose to do so to cover more of their residents. Effective April 1, 2010.
- Payments for Rural Health Care Providers. Today, 68 percent of medically underserved communities across the nation are in rural areas, and these communities often have trouble attracting and retaining medical professionals. The law provides rural health care providers the payments they need and ensures they can continue to serve their communities. Effective 2010.
Health Care Reform Timeline & Summary
On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (PPACA) into law. This paved the way to control health care costs, expand coverage, and improve the health care delivery system, herein referred to as the Affordable Care Act or PPACA.
Tools from the Carriers
Oxford Health Plans -
The Road to Reform Oxford
Navigating Health Care Reform 2-
Navigating Health Care Reform 100+
Aetna
Empire -
Introduction to Health Care Reform Video
Health Care Reform Overview -
Navigating the Next Phase of Health Care Reform
Government Links
Whitehouse.gov
The Affordable Care Act -
Healthcare.gov
Department of Health & Human Services
Supreme Court of the United States
Disclaimer-
Affordable Care Act
Timeline
Barack Obama
Key provisions
Health Insurance
Tax Credit
Lifetime Limits
Annual Limits
Appeal
Pre-
Young Adult
Early Retiree
Medicaid
Health Care
Providers
Free Preventive Care
Health Care Fraud
Donut Hole
877-
Insurance & Employee Benefits
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