The Affordable Care Act is helping people in every walk of life—even before it’s fully implemented. Here are a few examples.
A working mother now knows her children can’t be denied health insurance because of a pre-existing condition. In 2014, it will be illegal for anyone to be denied insurance because they have been sick before. The fact that she has been pregnant is no longer a reason to deny her coverage, and her friends can’t be turned away if they are cancer survivors. The Affordable Care Act also requires that important preventive services for her and her children—such as mammograms, new baby care and well-child visits—will be covered without co-pays. By catching health problems early, these prevention services saves pain and suffering as well as health care dollars.
The retiree will save thousands of dollars in prescription drug costs because Medicare’s coverage gap, known as the “donut hole,” is being phased out. Today, the retiree pays only 50 percent of the cost of medications in the donut hole. By 202, the donut hole coverage gap will be closed completely, so the retiree won’t have to pay for brand name and generic drugs. The retiree will have more choices in finding a new primary care practitioner because Medicare has begun paying 10 percent bonus payments to these providers. The retiree won’t have co-pays for annual check-ups or many preventive treatments such as screenings, diagnostic tests and vaccinations by the primary care practitioner. The retiree can count on better hospital care because of new policies that tie hospital payments to proven performance. In addition, premiums will be limited for employer-provided coverage for early retirees.
Once likely to be uninsured, a young adult now is entitled to stay on his or her parent’s health insurance plan up to the age of 26 unless he or she gets a job that offers insurance. Insurance companies now can’t refuse coverage to anyone up to age 19 because of a pre-existing condition. In 2014, young adults will have access to a greater number of affordable insurance choices. Large employers will have incentives to provide coverage to their employees. People working for small employers will have access to a new insurance marketplace (health care exchanges), will be eligible for government subsidies if they have low incomes and they will know insurance companies must cover essential services.
Over the past 10 years, premiums for family coverage have increased 108 percent, taking a huge chunk out of paychecks. Now, however, insurers are being pressured to roll back excessive premium increases. The companies must justify high premium increases to the U.S. Department of Health and Human Services. In addition, large insurers are required to spend 85 percent of the premium dollars they collect on health care (rather than pouring it into advertising and profits, for example). Insurers in the individual and small group markets must devote 80 percent of premium revenue to health care.