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ACA: Basics

12 Days of “Gifts” from the Affordable Care Act – Gift Twelve: Expanding the Possibilities

In the spirit of this holiday season, the Wisconsin Alliance for Women’s Health invited you to share in a series of blog posts, each containing a special “gift” from health care reform. Some have already been implemented and some are gifts still to come; but all are very important improvements to our healthcare system.

 

Gift Twelve: Expanding the Possibilities

 

Over the past 12 days, we have discussed a variety of key changes to our health care system. Women have faced many barriers to accessing care: they are more likely to be dependents under their insurance plan (making them more prone to losing coverage), they are less likely to get their coverage through work, they are disproportionately lower-income compared to men, and they have historically been discriminated against based on their gender in the health care system. All of the gifts we discussed will lead us to the ultimate gift: expanding the possibilities of expanded access and coverage for women, men and families.

Just in case you missed any, here is a summary of our “12 Days of Gifts from the Affordable Care Act”:

 

Gift One: Building a Bridge to Ending Pre-Existing Condition and Gender Discrimination

Phase One: Development of a Pre-Existing Condition Insurance Plan (PCIP) by July 1, 2010

Phase Two: Banning the denial of coverage to kids (under 19) based on pre-existing conditionseffective September 23, 2010 for new and existing group plans

Phase Three: Banning discrimination due to pre-existing conditions or gender for all ageseffective January 1, 2014

Gift Two: Expanding Coverage for Young Adults

Allows young adults to stay on their parent’s health insurance until they are 26, and  has already resulted in 2.5 million more young adults having health insurance.

 

Gift Three: FREE Preventative Care

Free preventative services – such as mammograms – without copays, coinsurance or deductibles.

Gift Four: Increased ACCOUNTABILITY in the Health Care System

The law increases the accountability of insurance companies by regulating their profit and administrative margins, relative to actual patient-care costs. It also stops companies from dropping people from coverage when they get sick.

Gift Five: More Increased ACCOUNTABILITY in the Health Care System

By 2014, plans will no longer be able to have annual limits on coverage. In the meantime, these plans cannot set an annual 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.

 

Gift Six: Doing More by Expanding Medicaid and Increasing Benefits for Older Adults

Expands Medicaid, closes the “Donut Hole”, creates new early retiree eligibility, and provides free preventative care for older adults under Medicare.

 

Gift Seven: Helping Families in Rural Areas and Strengthening Community Health Centers

Increases compensation and incentives for rural providers and expands capacity for community health centers.

Gift Eight: Increased Quality and Coordination of Care

Such as the creation of “Accountable Care Organizations”

 

Gift Nine: Understanding and Reducing Racial and Ethnic Disparities in Health Care

Requires any ongoing or new federal health program to collect and report racial, ethnic and language data – which will then be used to fight racial and ethnic disparities in health care.

Gift Ten: Exchanges and Tax Credits

Creates affordable, easily accessible, and quality care health care marketplaces (Exchanges) to help people find coverage that fits individual needs and budgets. Provides tax credits to qualifying women and families to help pay premiums.

 

Gift Eleven: Benefits for Small Businesses

Phase one: Provides a credit worth up to 35% of the employer’s contribution to the employees’ health insurance. Small non-profit organizations may receive up to a 25% credit.

Phase two: Provides a credit is up to 50% of the employer’s contribution to provide health insurance for employees.  There is also up to a 35% credit for small non-profit organizations.

Each gift offers women and families more protection and possibilities when deciding on their coverage plan. We thank all of you, and hope you have enjoyed our series of blog posts. Keep checking our blog to remain informed and engaged on health care reform issues and “gifts” that impact women’s lives.

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