The Affordable Care Act

Affordable Care Act __________________________________________

The Affordable Care Act was passed by Congress and then signed into law by President Obama on March 23, 2010. On June 28, 2012 the Supreme Court rendered a final decision to uphold the health care law.  The health care law was brought about to reform the entire American Health Care System The Key Changes made to American Health Care can be found below based on the year when the change became effective.

To read the full Act for yourself please click on the link http://housedocs.house.gov/energycommerce/ppacacon.pdf provided by The U.S. Department of Health and Human Services at http://www.hhs.gov/healthcare/rights/law/index.html

Some Key Changes to Healthcare in 2015

Paying for quality of care instead of quantity (value instead of amount); medical providers who provide higher value care will receive higher payments than those who provide lower quality care; this replaces the method of paying providers based on the number of services, tests, or procedures done to you

Some Key Changes to Healthcare in 2014

Prohibiting discrimination based on Pre-Existing Conditions, Health Status, and Gender; insurance companies will not be able to refuse to sell coverage or renew policies because of an individual’s pre-existing conditions; in the individual and small group market, insurance companies will not be allowed to charge higher rates due to gender or health status

Ending Yearly Dollar Limits on the amount of coverage an individual can receive on both new plans and existing group plans

Not allowing individuals to be dropped or have their insurance coverage limited because they choose to participate in a Clinical Trial; applies to all Clinical Trials that treat cancer or other life-threatening diseases

Making insurance more affordable through Tax Credits for those individuals/families between 100%-400% of the Federal Poverty Level; the tax credit is advanceable, so it can lower your premium payments each month, rather than making you wait for tax time; Please see Full 2013 Federal Poverty Level Table found on Families USA website http://www.familiesusa.org/resources/tools-for-advocates/guides/federal-poverty-guidelines.html Example: Household of 1 at 100% is $11,490 for the year; at 200% is $22,980 for the year; at 300% is $34,470; at 400% is $45,960

Establishing the Health Insurance Exchange or Marketplace where individuals/families and small businesses can shop, compare, and purchase(or qualify for) public and private plans; plans must meet certain benefits and cost standards; members of Congress will start getting their health care insurance through the Marketplace

Increasing Tax Credits for small businesses and non-profits; this is the second phase of this tax credit, up to 50% of the employer’s contribution to provide health insurance for employees, up to 35% for non-profits

Expanding access to Medicaid by allowing individuals earning between 101%-133% of the Federal Poverty Level to qualify; States will receive 100% federal funding for the first three years to support this expanded coverage, phasing to 90% federal funding in subsequent years; Please note: the State of Tennessee has chosen not to expand Medicaid, known in Tennessee as TennCare

Promoting individual and shared responsibility by requiring most individuals who can afford it to obtain basic health insurance coverage or pay a fee to help offset the costs; if affordable coverage is not available to an individual, he or she will be eligible for an exemption

Some Key Changes to Healthcare in 2013

Providing new funding to State Medicaid programs which choose to cover preventive services at little to no cost; Please note: the State of Tennessee has chosen not to expand Medicaid, known in Tennessee as TennCare

Encouraging “payment bundling” where hospitals, doctors, and other providers work together and are compensated as a team; they also share savings with Medicare

Increasing Medicaid payment rates for Primary Care Providers to equal at least 100% of Medicare rates

Opening the new Health Insurance Exchange or Marketplace where individuals/families and businesses can shop, compare, and purchase(or qualify for) public and private plans

Some Key Changes to Healthcare in 2012

Rewarding Hospitals who show improved Quality of Care for Medicare recipients (allows for the inclusion of the patient’s perception of the quality of care he/she received)

Giving Incentives for Health Care Providers to form Cooperating Groups (Accountable Care Organizations or ACOs)

Encouraging the use of Electronic Health Records rather than paper copies (the purpose is to make billing standard across different organizations, drive down costs, and reduce medical errors)

Requiring Federal Programs to Collect and Report information so unequal treatment can be detected and addressed (racial, ethnic, and language data)

Some Key Changes to Healthcare in 2011

Offering Medication Discounts for Seniors in the Medicare Gap (donut hole)  [50% for brand-name; 7% for generic]

Including Preventive Services for Seniors (wellness visits and personalized plans) at no additional cost

Allowing Home and Community Based Services for those with Disabilities through Medicaid (instead of these services having to be delivered in a facility such as a nursing home)

Setting Limits on how much of your Health Insurance Premium can be spent on non-related health costs (only 15-20% of your premium can be used on administrative, operations, and marketing or the company owes you a rebate)

Some Key Changes to Healthcare in 2010

Putting Information for Consumers Online so you can compare health insurance coverage options and make a decision

Not Allowing Children to be denied Coverage based on Pre-Existing Conditions when they are under the age of 19

Not Allowing Insurance Companies to Take Back their decision to provide Coverage due to an earlier technical error on your application

Ending Lifetime Dollar Limits on Insurance Coverage on essential benefits like hospital stays

Raising then Getting Rid of Yearly Dollar Limits on Insurance Coverage.  Specifically, the law says that none of these plans can set an annual dollar limit lower than $750,000 for a plan year or policy year starting on or after September 23, 2010 but before September 23, 2011; $1.25 million for a plan year or policy year starting on or after September 23, 2011 but before September 23, 2012; $2 million for a plan year or policy year starting on or after September 23, 2012 but before January 1, 2014; no annual dollar limits are allowed on most covered benefits beginning January 1, 2014.

Making sure You Have the Right to Appeal a Coverage Denial and have a Review Process outside of the insurance company

Providing Small Business Tax Credits so employers can find it easier to offer health insurance benefits to their employees.  If you have fewer than 25 employees and provide health insurance, you may qualify for a tax credit of up to 35% (up to 25% for non-profits) to offset the cost of your insurance. This credit will increase in 2014 to 50% (35% for non-profits).

Including Preventive Services without charging a deductible, co-payment, or co-insurance [Please see below for a List of Preventive Services]

Letting Young Adults stay on their Parents’ health insurance plans until they turn 26

Providing more funding so States can Increase the Number of People who qualify for Medicaid.  Please note: the State of Tennessee has chosen not to expand Medicaid, known in Tennessee as TennCare

Increasing payments to Rural Health Providers to attract and keep them in these communities

Constructing new Community Health Centers and expanding their services

List of Preventive Services

Preventive Services are screenings or exams that check you for problems before they happen or before they get worse. 

15 Preventive Services will be Covered for Adults

  1. Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked
  2. Alcohol Misuse screening and counseling
  3. Aspirin use for men and women of certain ages
  4. Blood Pressure screening for all adults
  5. Cholesterol screening for adults of certain ages or at higher risk
  6. Colorectal Cancer screening for adults over 50
  7. Depression screening for adults
  8. Type 2 Diabetes screening for adults with high blood pressure
  9. Diet counseling for adults at higher risk for chronic disease
  10. HIV screening for all adults at higher risk
  11. Immunization vaccines for adults
  12. Obesity screening and counseling for all adults
  13. Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk
  14. Tobacco Use screening for all adults and cessation interventions for tobacco users
  15. Syphilis screening for all adults at higher risk

22 Preventive Services which will be Covered for Women

  1. Anemia screening on a routine basis for pregnant women
  2. Bacteriuria urinary tract or other infection screening for pregnant women
  3. BRCA counseling about genetic testing for women at higher risk
  4. Breast Cancer Mammography screenings every 1 to 2 years for women over 40
  5. Breast Cancer Chemoprevention counseling for women at higher risk
  6. Breastfeeding comprehensive support and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women*
  7. Cervical Cancer screening for sexually active women
  8. Chlamydia Infection screening for younger women and other women at higher risk
  9. Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs*
  10. Domestic and interpersonal violence screening and counseling for all women*
  11. Folic Acid supplements for women who may become pregnant
  12. Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes*
  13. Gonorrhea screening for all women at higher risk
  14. Hepatitis B screening for pregnant women at their first prenatal visit
  15. Human Immunodeficiency Virus (HIV) screening and counseling for sexually active women*
  16. Human Papillomavirus (HPV) DNA Test: high risk HPV DNA testing every three years for women with normal cytology results who are 30 or older*
  17. Osteoporosis screening for women over age 60 depending on risk factors
  18. Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk
  19. Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users
  20. Sexually Transmitted Infections (STI) counseling for sexually active women*
  21. Syphilis screening for all pregnant women or other women at increased risk
  22. Well-woman visits to obtain recommended preventive services* *plan years starting on or after August 1, 2012

26 Preventive Services which will be Covered for Children

  1. Alcohol and Drug Use assessments for adolescents
  2. Autism screening for children at 18 and 24 months
  3. Behavioral assessments for children of all ages Ages: 0 to 11 months1 to 4 years5 to 10 years11 to 14 years15 to 17 years.
  4. Blood Pressure screening for children Ages: 0 to 11 months1 to 4 years5 to 10 years11 to 14 years15 to 17 years.
  5. Cervical Dysplasia screening for sexually active females
  6. Congenital Hypothyroidism screening for newborns
  7. Depression screening for adolescents
  8. Developmental screening for children under age 3, and surveillance throughout childhood
  9. Dyslipidemia screening for children at higher risk of lipid disorders Ages: 1 to 4 years5 to 10 years11 to 14 years15 to 17 years.
  10. Fluoride Chemoprevention supplements for children without fluoride in their water source
  11. Gonorrhea preventive medication for the eyes of all newborns
  12. Hearing screening for all newborns
  13. Height, Weight and Body Mass Index measurements for children Ages: 0 to 11 months1 to 4 years5 to 10 years11 to 14 years15 to 17 years.
  14. Hematocrit or Hemoglobin screening for children
  15. Hemoglobinopathies or sickle cell screening for newborns
  16. HIV screening for adolescents at higher risk
  17. Immunization vaccines for children from birth to age 18
  18. Iron supplements for children ages 6 to 12 months at risk for anemia
  19. Lead screening for children at risk of exposure
  20. Medical History for all children throughout development Ages: 0 to 11 months1 to 4 years5 to 10 years11 to 14 years15 to 17 years.
  21. Obesity screening and counseling
  22. Oral Health risk assessment for young children Ages: 0 to 11 months1 to 4 years5 to 10 years.
  23. Phenylketonuria (PKU) screening for this genetic disorder in newborns
  24. Sexually Transmitted Infection (STI) prevention counseling and screening for adolescents at higher risk
  25. Tuberculin testing for children at higher risk of tuberculosis Ages: 0 to 11 months1 to 4 years5 to 10 years11 to 14 years15 to 17 years.
  26. Vision screening for all children