How Health Care Reform Affects You

I have long advocated for ensuring that all Americans have access to health care. That is why I have strongly supported the Affordable Care Act (ACA). The ACA set forth measures that will provide access to affordable, quality health care for millions of Americans, and protect consumers from abusive insurance company practices.

Below, my office has compiled information regarding the benefits of the ACA for the uninsured, seniors, children and young adults, veterans and businesses. For additional information, please visit the ACA's official website at www.healthcare.gov


 Facts About Health Care Reform

To date, millions of Americans have already benefitted from the ACA. This includes:

  • 105 million who no longer have a lifetime limit on their health coverage;
  • 54 million who have received free preventive services;
  • 17 million children with pre-existing conditions who can no longer be denied coverage;
  • 6.6 million young adults who have obtained coverage through their parents' plan; and
  • 5.3 million seniors in the 'donut hole' who have saved $3.7 billion on their prescription drugs.

Additionally, the implementation of the ACA has been ongoing since its passage in 2011, and the law will be fully phased in by 2014. The following aspects of the ACA are already in place:

  • Insurance companies are now required to cover a number of recommended preventive services, such as cancer, diabetes and blood pressure screenings, without additional cost-sharing such as copayments or deductibles;
  • Young adults who cannot get coverage through their employer can stay on their parents' plans until age 26;
  • The Medicare prescription drug “donut hole” in senior prescription coverage will close gradually over the next few years. Coverage currently ends at $2700, and then restarts only after a patient has spent $6700;
  • Insurance companies can no longer impose lifetime dollar limits on essential health benefits;

The following changes will be implemented in 2014: 

  • Insurance companies will no longer be able to deny coverage to anyone because of a pre-existing condition;
  • Insurance companies will no longer be able to drop your coverage when you get sick or because of a mistake made when applying for health insurance. 
  • The Health Insurance Marketplace will allow consumers to choose a private health insurance plan that fits their personal health needs. Each state is responsible for having their Marketplace ready to pay benefits by 2014.
  • Insurance companies will be required to spend at least 80 percent of your premium dollars on medical care and quality improvements rather than advertising and bonuses for executives. Millions of Americans have already received rebates because of this requirement.
  • Insurance companies will be required to publicly notify you when raising premiums and justify the reasons for doing so.
  • Small businesses will be able to receive tax credits to provide health insurance to their employees; and
  • The health care law helps stop fraud with tougher screening procedures, stronger penalties, and new technology.



The Individual Mandate and the Marketplace

The individual mandate will ensure that all Americans have access to health care coverage.  This is important because those without coverage are more likely to without care and end up in emergency rooms. On average, an American family pays and extra $1,017 each year for health insurance because of cost shifting from medical services provided to uninsured individuals.

Americans who currently do not have health insurance will be given the opportunity to buy affordable health insurance through the Marketplace beginning October 1, 2013. Coverage would be effective beginning January 1, 2014. The Marketplace will offer Qualified Health Plans; facilitate consumer assistance, shopping, and enrollment; and coordinate eligibility for financial assistance for those who qualify. Individuals, families, and small businesses required to purchase insurance through the mandate, but who cannot afford it, will receive a subsidy to help pay for it.

Florida residents can go to the Health Insurance Marketplace to research and purchase Qualified Health Insurance Plans. On August 15, 2013, the Center for Medicare and Medicaid services (CMS) awarded $67 million in Navigator Cooperative Agreements to facilitate State Partnership Marketplaces. Navigators will be available to aid consumers as they purchase health care, establish eligibility for financial aid and educate the public about the Marketplace.

Individuals who already have health insurance through their employers or are self-insured will keep their insurance. There is absolutely no provision within the ACA that would remove existing coverage from individuals and families. Furthermore, the law will make existing plans more secure and affordable. 


Seniors
 

Seniors will greatly benefit from changes resulting from the implementation of the ACA.  Many seniors are already benefiting from preventive services and lower Medicare prescription drug costs. 

Under the ACA, Medicare beneficiaries will save approximately $4,200 over the next decade from lower drug costs, free preventive services and reductions in the growth of health spending.  Enrollment in private Medicare Advantage (MA) increased by 17 percent between 2010 and 2012, and premiums fell by 16 percent during the same time.

Furthermore, because of the ACA, a free annual wellness visit is provided for seniors under Medicare, and key preventive services such as mammograms, colonoscopies, flu shots, as well as screenings for cancer, diabetes, and other chronic diseases are covered for free with no out-of pocket costs.

Since passage of the ACA, seniors have saved over 7 million dollars on prescription drugs - an average savings of $1,061 for the 6.6 million seniors in the Medicare Part D “donut hole” by 2020. Medicare beneficiaries who fall into the coverage gap known as the "donut hole" automatically receive a discount on prescription drugs, and each year, beneficiaries pay a reduced cost for brand name and generic drugs in the coverage gap.  In 2020, the donut hole will be closed completely.

Premium growth will also be slowed and deductibles lowered. Because Medicare has been made more efficient, the Medicare Part B premium for 2012 was $99.90, $6.70 lower than the amount projected. In addition, the Part B annual deductible decreased by $22 to $140, the first time in Medicare's history when the deductible was lower than the previous year.  

Lastly, the Medicare Trust fund has been extended by a decade. Medicare has been given enhanced authority to crack down on fraud, and in the last three years, the government has recovered over $14.9 billion from individuals and companies seeking fraudulent payments.


Expansion of Medicaid

The ACA also expanded the Medicaid program, which will ensure that individuals and families who cannot afford health insurance be covered under Medicaid. The program is expected to cover 17 million more people. Medicaid coverage will also become available to those with incomes below 133 percent of the poverty line.

Expanding Medicaid is at the discretion of each state nationwide. Because states will not be penalized for not expanding Medicaid, some states will likely opt out. I was disappointed to see that Florida Governor Rick Scott announced that Florida will not expand Medicaid in Florida. This expansion would have covered almost a million Floridians.

Children and Young Adults

The ACA implemented many reforms to benefit children and young adults and will provide an option for affordable healthcare for the 7 million children without any health insurance. For instance, children and young adults with pre-existing conditions can no longer be turned away by insurance companies or have their premiums raised based on health status. Young adults can now stay on their parents’ health plans up to their 26th birthday and can no longer be dropped by their insurance company because they get sick or have an accident.  As a group, young adults currently have the least health insurance coverage.

As of December 2011, 3.1 million young adults (ages 19-25) had gained coverage under the ACA. Furthermore, uninsured rates among men ages 19-25 dropped from 42% to 28% between September 2010 and December 2011.

Additionally, under the ACA, health care plans for children and young adults beginning on or after January 1, 2013 must cover pediatric services for children up to age 19, including pediatric dental and vision services. Furthermore, habilitation services for children and adolescents with developmental disorders and mental health and substance use disorder services, including behavioral health treatment (subject to federal parity requirements) will be covered. Please visit the Department of Health and Human Services page on Adolescent Resources Under the ACA for more information.


Veterans

The ACA improves and expands health benefits for American veterans.  Currently, of the total 22 million veterans in the U.S., 1.3 million are without health care insurance. Because of the individual mandate’s requirement that individuals maintain minimum essential coverage, the ACA expanded eligible health insurance plans to include those offered by the Department of Veterans Affairs (VA). The health care law does not change VA health benefits or Veterans’ out-of-pocket costs.

Additionally, the ACA provides supplemental coverage to those veterans already insured.  584,000 veterans are currently enrolled in Medicaid but without comprehensive coverage.  The ACA encourages these veterans to also enroll in health care plans offered by the VA to supplement health care plans that lack comprehensive coverage, which will lower total health care costs for all veterans. Tri-Care coverage is not affected by the ACA.

Please visit the U.S. Armed Forces webpage online for more information on health care coverage under the Civilian Health and Medical Program of the Department of Veterans Affairs as well as the VA website for reforms under the ACA.


Businesses

Businesses will see varying changes under the Affordable Care Act. Recently, President Obama postponed the business mandate until 2015, when certain businesses will be required to offer health insurance to employees.  However, not all businesses will be required to provide health insurance for employees, and the ACA will provide a number of financial benefits for businesses that offer insurance to employees.

Starting in October, self-employed individuals and small businesses will be able to access the health insurance market through the Marketplace and the Small Business Health Options Program (SHOP Marketplace). Many businesses will be eligible for tax credits and financial assistance. Businesses that do not employ 50 or more employees will not be required to provide insurance. Currently, 96% of businesses do not employ as many employees, and will therefore not be affected by the shared responsibility rules (commonly referred to as a tax for businesses that do not provide health insurance.)

If you are a business owner, are self-employed, or would like more information to help determine your coverage responsibilities under the ACA, please see the following resources from the Small Business Administration. These pages are organized for those who are Self-Employed, Employers with Fewer Than 25 Employees, Employers with Up to 50 Employees, and Employers with 50 or More Employees.