Under the Affordable Care Act, for the first time ever, women will now have access to life-saving preventive care, such as mammograms and contraception, without paying any more out of their own pockets.
Today, we move yet another step closer to giving women control over their health care. In addition to the benefits for women already included in the Affordable Care Act, beginning the first plan year after August 1, 2012, most private health insurance plans will cover additional women’s preventive services without requiring women to pay an extra penny out of their pockets. These services include:
- Well-woman visits
- Screening for gestational diabetes, which help protect the mother and her child from one of the most serious pregnancy-related diseases
- Breastfeeding support, supplies and counseling
- Screening and counseling for interpersonal and domestic violence
- Contraception and contraceptive counseling
- HPV DNA testing
- STI counseling
- HIV screening and counseling
These services are based on recommendations from the Institute of Medicine, which relied on advice from independent physicians, nurses, scientists, and other experts, as well as evidence-based research, to develop its recommendations. And insurance companies know these services help prevent disease and illness, which can save them money in the long run.
By eliminating barriers like copays, co-insurance, and deductibles, secure, affordable coverage is quickly becoming a reality for millions of American women and families.
President Obama recalled his mother telling him, “You can tell how far a society is going to go by how it treats its women and girls. And if they’re doing well, then the society is going to do well; and if they’re not, then they won’t be.”
A final summary of the major changes under the Patient Protection and Affordable Care Act (PPACA) (aka Obamacare):
- Kids can continue to be covered by their parents’ health insurance until they’re 26.
- Insurers cannot impose an unreasonable premium increase without justification (generally anything less than 10% is ok).
- Insurers have to tell customers what they’re spending money on, (instead of just “administrative fee”, they have to be more specific) and those expenditures are required to follow the 80/20 rule:
- No more than 20% can be spent on administrative costs, minimum of 80% must go directly to patient care.
- A new website is made to give people insurance and health information – healthcare.gov
- Any new health plans must provide preventive care (mammograms, colonoscopies, etc.) without requiring any sort of co-pay or charge.
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If you can afford insurance but do not get it, you will be charged a fee. This is the “mandate” that people are talking about. Basically, it’s a trade-off for the “pre-existing conditions” bit, saying that since insurers now have to cover you regardless of what you have, you can’t just wait to buy insurance until you get sick. Otherwise no one would buy insurance until they needed it. You can opt not to get insurance, but you’ll have to pay the fee instead, unless of course you’re not buying insurance because you just can’t afford it.
*Note: On 6/28/12, the Supreme Court ruled that this is Constitutional.
More details from Kaiser Health News:
Q: I don’t have health insurance. Will I have to get it, and what happens if I don’t?
A: Under the legislation, most Americans will have to have insurance by 2014 or pay a penalty. The penalty would start at $95, or up to 1 percent of income, whichever is greater, and rise to $695, or 2.5 percent of income, by 2016. This is the individual limit; families have a limit of $2,085 or 2.5 percent of household income, whichever is greater. Some people can be exempted from the insurance requirement, called an individual mandate, because of financial hardship or religious beliefs or if they are American Indians, for example.
Q: I want health insurance, but I can’t afford it. What do I do?
A: Depending on your income, you might be eligible for Medicaid, the state-federal program for the poor and disabled, which will be expanded sharply beginning in 2014. Low-income adults, including those without children, will be eligible, as long as their incomes didn’t exceed 133 percent of the federal poverty level, or $14,404 for individuals and $29,326 for a family of four, according to current poverty guidelines.
Q: What if I make too much for Medicaid but still can’t afford coverage?
A: You might be eligible for government subsidies to help you pay for private insurance that would be sold in the new state-based insurance marketplaces, called exchanges, slated to begin operation in 2014.
Premium subsidies will be available for individuals and families with incomes between 133 percent and 400 percent of the poverty level, or $14,404 to $43,320 for individuals and $29,326 to $88,200 for a family of four.
The subsidies will be on a sliding scale. For example, a family of four earning 150 percent of the poverty level, or $33,075 a year, will have to pay 4 percent of its income, or $1,323, on premiums. A family with income of 400 percent of the poverty level will have to pay 9.5 percent, or $8,379.
In addition, if your income is below 400 percent of the poverty level, your out-of-pocket health expenses will be limited.
Medicaid is the largest health insurance program in the United States. Presently, Medicaid provides health and long-term care coverage to 59 million individuals.
Under the PPACA (Patient Protection and Affordable Care Act), Medicaid is set to expand its eligibility for coverage to include persons with income levels at or below 133 percent of the federal poverty level. Best estimates place the increase in additional enrollees at 16 million to 18 million.
The purpose behind the expansion of Medicaid under the PPACA is to reduce the number of uninsured in the U.S., an estimated 46 million. Using analyses provided during the debate leading up to passage of the PPACA, 32 million of the 46 million will gain access to insurance under the new law, half of which will do so via Medicaid.
Assuming a somewhat equal replacement trend (those that fall off Medicaid due to death or change in economic status are replaced by approximately the same number of new eligible enrollees) over the phase-in period set for Medicaid expansion (by 2014), Medicaid will ultimately cover nearly 70 million people. Per the Congressional Budget Office, the cost of expansion between 2010 and 2019 to the federal government is $434 billion with an additional $20 billion allocable as states’ costs.
With an additional 16-18 million people on Medicaid, cost becomes a big issue. Estimates have the total cost of the whole bill (Medicare, Medicaid, etc.) at $828 billion. Take away from that $575 billion in savings from Medicare, and a bevy of new taxes.
Including higher taxes for those making more than $200K, taxes on luxury medical plans, on drugs, on high-cost medical equipment, on indoor tanning salons, and an annual fee to all insurance providers.
Added all together and the Congressional Budget Office estimates a reduction in the Federal Budget deficit, meaning that the PPACA and its increased Medicaid coverage pays for itself and saves money.
Of course, these are all estimates and subject to endless debate.
*Note: Medicare is for the elderly and Medicaid is for the poor. Most of the controversy and supreme court discussion is around Medicaid, not the below Medicare.
Nearly 50 million older Americans and Americans with disabilities rely on Medicare each year, and the new health care law makes Medicare stronger by adding new benefits, fighting fraud, and improving care for patients. The life of the Medicare Trust Fund will be extended to at least 2024 as a result of reducing waste, fraud, and abuse, and slowing cost growth in Medicare. And, over the next ten years, the law will save the average person in Medicare $4,200. People with Medicare who have the prescription drug costs that hit the so-called donut hole will save an average of over $16,000.
Lower Cost Prescription Drugs: In the past, as many as one in four seniors went without a prescription every year because they couldn’t afford it. To help these seniors, the law provides relief for people in the donut hole – the ones with the highest prescription drug costs. As a first step, in 2010, nearly four million people in the donut hole received a $250 check to help with their costs. In 2011, 3.6 million people with Medicare received a 50 percent discount worth a total of $2.1 billion, or an average of $604 per person, on their brand name prescription drugs when they hit the donut hole. Seniors will see additional savings on covered brand-name and generic drugs while in the coverage gap until the gap is closed in 2020.
Free Preventive Services: Under the new law, seniors can receive recommended preventive services such as flu shots, diabetes screenings, as well as a new Annual Wellness Visit, free of charge. So far, more than 32.5 million seniors have already received one or more free preventive services, including the new Annual Wellness Visit.
Fighting Fraud: The health care law helps stop fraud with tougher screening procedures, stronger penalties, and new technology. Thanks in part to these efforts, we recovered $4.1 billion in taxpayer dollars in 2011, the second year recoveries hit this record-breaking level. Total recoveries over the last three years were $10.7 billion. Prosecutions are way up, too: the number of individuals charged with fraud increased from 821 in fiscal year 2008 to 1,430 in fiscal year 2011 – nearly a 75 percent increase.
Improving Care Coordination and Quality: Through the newly established Center for Medicare and Medicaid Innovation, this Administration is testing and supporting innovative new health care models that can reduce costs and strengthen the quality of health care. So far, it has introduced 16 initiatives involving over 50,000 health care providers that will touch the lives of Medicare and Medicaid beneficiaries in all 50 states.
Providing Choices while Lowering Costs: The number of seniors who joined Medicare Advantage plans increased by 17 percent between 2010 and 2012 while the premiums for such plans dropped by 16 percent – and seniors across the nation have a choice of health plans.
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