Since Wednesday marks the one-year anniversary of the Affordable Care Act, President Obama’s voluminous health reform law, two Los Angeles Democratic Congresspersons, Henry Waxman and Karen Bass, are scheduled to headline a self-congratulatory program this morning at Cedars-Sinai.
Tomorrow, from 11 to 4 at St. John’s Well Child and Family Center, 5701 S. Hoover St., another caravan of political figures will reprise today’s program.
They will include Lt. Gov. Gavin Newsome, Mayor Villaraigosa, Dave Regan, an SEIU vice president, Herb Schultz, regional director of Health and Human Services, based in San Francisco, Dr. Fernando Torres-Gil, a board member of The California Endowment and Jim Mangia, President-CEO of St. John’s.
Here is a closer look at the controversial law that detractors refer to as Obamacare.
[Editor’s Note: The following data and opinions on the health care act were provided by the regional office in San Francisco of the U.S. Centers for Medicare and Medicaid Services.]
Covering Children with Pre-Existing Conditions
Most insurance companies are now banned from denying coverage to children because of a pre-existing condition. An estimated 2.2 million kids with a pre-existing condition in California will be protected because of this provision. In 2014, insurers are banned from discriminating against anyone with a pre-existing condition.
Removing Lifetime Limits on Health Benefits
The law bans insurance companies from imposing lifetime dollar limits on health benefits – freeing cancer patients and individuals suffering from other chronic diseases from having to worry about going without treatment because of their lifetime limits. The law also restricts the use of annual limits and bans them completely in 2014. This will protect 19.8 million California residents with private insurance coverage from these limits.
Making it Illegal for an Insurance Company to Drop Coverage
When You Get Sick The law bans insurance companies from dropping coverage when an individual gets sick because of simple mistake on an application. This will protect 2.5 million California residents who buy coverage on the individual market from losing their coverage when they need it the most.
Increasing the Value of Health Insurance
Under the law, insurance companies must provide consumers greater value by spending at least 80 percent of premium dollars on health care and quality improvements instead of overhead, executive salaries or marketing. If they don’t, they must provide consumers a rebate or reduce premiums. This means that 19.8 million California residents with private insurance coverage will receive greater value for their premium dollars.
Scrutinizing Unreasonable Premium Increases
New rules in the law require insurers to publicly justify unreasonable premium increases, and strengthen states’ abilities to crack down on premium hikes.
Strengthening Economic Growth in California
Since the President signed the Affordable Care Act into law last March, the economy has created nearly 1.4 million private sector jobs, and has grown at an average annual rate of 2.7 percent. Experts predict that the Affordable Care Act will create anywhere from 250,000 – 400,000 jobs each year.
Lowering Early Retiree Coverage Costs
An estimated 430,000 people from California retired before they were eligible for Medicare and have health coverage through their former employers. Unfortunately, the number of firms that provide health coverage to their retirees has decreased over time. But thanks to the creation of the Early Retiree Reinsurance Program in the Affordable Care Act, 518 employers in California have been approved to receive support to firms that continue to provide health coverage to their early retirees—lowering their total health care costs. In 2010, employers in California received $64.9 million in payments.
Creating New Coverage Options for Individuals with Pre-Existing Conditions
Residents of California who have been locked out of the coverage system because of a pre-existing condition are now eligible for coverage through a new Pre-Existing Condition Insurance Plan that was created under the law. To learn more about the plan available in California go here: https://www.pcip.gov/StatePlans.html.
Increasing Support for Community Health Centers
The Affordable Care Act increases the funding available to the more than 1,100 community health centers in all 50 States, including the 1,073 existing Community Health Centers in California in rural communities and inner cities, enabling them to double the number of patients they serve from 19 million to nearly 40 million by 2015. This builds on a $2 billion investment in Community Health Centers in the American Recovery and Reinvestment Act, which has provided an unprecedented opportunity to serve more patients, create new jobs, and meet the significant increase in demand for primary health care services.
Reducing the Health Care Workforce Shortage
Nearly 9 percent of California residents live in an under-served area. The law includes new resources to boost the number of doctors, nurses and health care providers in communities where they are needed most. These resources include grants, scholarships, loan repayment programs, as well as increased support for educational institutions that provide training for a range of health care careers.
One Year Later: The Benefits of the Affordable Care Act for California
Thanks to the Affordable Care Act, passed by Congress and signed into law by President Obama on March 23, 2010, California residents have more freedom and control over their health care choices. All Americans now have the freedom from worrying about losing their insurance, or having it capped unexpectedly if someone is in an accident or becomes sick. They no longer have to live in fear of double-digit premium increases from their insurance companies without recourse or accountability. The law reduces costs for families and businesses and has already made it illegal for insurance companies to deny care to children because of a pre-existing condition. And it includes substantial new benefits and freedoms for California residents.
Specifically, the Affordable Care Act is already helping the people of California by:
Providing New Benefits and Lowering Costs for Medicare Beneficiaries
Nearly all 44 million beneficiaries who have Medicare, including 4.3 million in California, can now receive free preventive services – like mammograms and colonoscopies – as well as a free annual wellness visit with their doctor. Also, more than 328,159 California residents who hit the Medicare prescription drug coverage gap known as the “donut hole” received $250 tax-free rebates, and will receive a 50% discount on brand name prescription drugs when they hit the donut hole this year. By 2020, the law will close the donut hole completely. Taken together, the changes in the law will save seniors enrolled in traditional Medicare more than $3,500 over the next 10 years.
Lowering Taxes for Small Businesses
The law provides $40 billion of tax credits to up to 4 million small businesses, including up to 502,923 in California to help offset the costs of purchasing coverage for their employees and makes premiums more affordable.
Providing Greater Resources for California The law gives governors millions of dollars in Federal support for their work to hold down insurance premiums, build competitive insurance marketplaces, provide insurance to early retirees, and strengthen their public health and prevention efforts. So far, California has received $436.7 million from the Affordable Care Act. Grants to California include:
• $4.2 million to support a consumer assistance program
• $1 million to plan for a Health Insurance Exchange
• $1 million to crack down on unreasonable insurance premium increases
• $91.5 million to support capital development in community health centers
• $42.7 million from the Prevention and Public Health Fund
• $278.1 million in Therapeutic Discovery Project Program Tax Credits and Grants
• $1.5 million for Medicare improvements for patients and providers
• $5 million for demonstration projects to address health professions workforce needs
• $510,082 for aging and disability resource centers
• $0 for Nursing and Home Health Aides Training Programs
• $749,960 for the Personal and Home Care Aide state training program
• $8.4 million for Maternal, Infant and Childhood Home Visiting
• $2 million for Pregnancy Assistance Fund programs
Providing New Coverage Options for Young Adults
Insurance companies are now required to allow parents to keep their children up to age 26 without job-based coverage on their insurance plans. An estimated 177,000 young adults in California could gain insurance coverage as a result of the law.
By the Numbers: The Affordable Care Act Nationwide
Coverage for Young Adults. Up to 1.2 million young adults will be eligible to be covered under their parents’ health insurance plan until their 26th birthday.
Stronger Medicare and Savings for Seniors. Seniors enrolled in traditional Medicare will save more than $3,500 over the next 10 years thanks to the new law. The law makes preventive care like mammograms and colonoscopies free for seniors on Medicare and shrinks the size of the prescription drug coverage gap known as the “donut hole” until it is eliminated in 2020. More than 3.5 million Americans who have hit the prescription drug coverage gap known as the donut hole have already received $250 rebate checks to help support the cost of their prescription drugs. This year, seniors who hit the donut hole will receive a 50 percent discount on their brand name prescription drugs.
Support for Small Businesses. Up to four million small businesses nationwide may be eligible for small business tax credit this year that will make it easier for them to provide insurance to their workers. These tax credits will provide a total of $40 billion in relief for small firms over the next 10 years and are already helping cover more Americans. The tax credits are already having an impact. For example, in Kansas City, Blue Cross Blue Shield has enrolled over 9,000 new members who work for over 400 new employers—38 percent of whom did not previously offer insurance.
Free Preventive Care. Up to 88 million people in new insurance plans will receive preventive services like mammograms, colonoscopies, immunizations, pre-natal and new baby care without being charged a deductible, co-payment or co-insurance.
Ban on Discriminating Against Children with Pre-Existing Conditions. New insurance plans will be prohibited from denying coverage to children with pre-existing conditions, which will allow an estimated 51,000 uninsured children to gain coverage. Additionally, up to 90,000 children will no longer have specific benefits denied because of a pre-existing condition.
Ban on Lifetime Limits. Before reform, cancer patients and individuals suffering from other serious and chronic diseases were too often forced to limit or go without treatment because of an insurer’s lifetime limit on their coverage. Insurance companies are now banned from placing lifetime limits on coverage. Up to 20,400 people who typically hit their lifetime limits along with nearly 102 million enrollees in plans with lifetime limits can live with the security of knowing that their coverage will be there when they need it most.
Ban on Rescissions. Approximately 10,700 people whose coverage is dropped each year because they get sick and made an unintentional mistake on their application will not have their coverage rescinded.
Restrictions on Annual Limits. Annual limits on the amount of care an insurance company may provide can often prevent Americans with serious illnesses like cancer from getting the care they need. The ban on the use of low annual limits will protect care for up to 3,500 people each year who would have hit their annual limit. Eighteen million people are in plans with annual limits today, and these limits will be eliminated completely in 2014.
No Restrictions on Emergency Room Care. Before the Affordable Care Act was enacted, insurance companies could limit which emergency room you could go to or charge you more if you went to an emergency room outside of your insurance company’s network. Now, new insurance plans cannot charge more for emergency services obtained outside of their network. Up to 88 million people will benefit from this new rule.
Fostering Innovation. The $1 billion Therapeutic Discovery Tax Credit will support 2,923 small biotechnology companies that are working on projects that show significant potential to produce new therapies, address unmet medical needs, reduce health care costs or advance the goal of curing cancer within the next 30 years. Companies in 47 states and the District of Columbia received the tax credits.
Protecting Health Care for Early Retirees. More than 5,400 employers that provide coverage, including 245 Fortune 500 companies, all of the major unions, and state or local governments from all 50 states are participating in the law’s Early Retiree Reinsurance Program. The program provides much-needed financial relief for employers and have helped benefit more than 4.5 million Americans.
Strengthening Community Health Centers. For more than 40 years, community health centers have delivered comprehensive, high-quality preventive and primary health care to patients regardless of their ability to pay. The Affordable Care Act provides $11 billion to bolster and expand community health centers over the next five years. Some 143 community health centers in 40 states and the District of Columbia have already received $716 million to expand access to quality health care thanks to the Affordable Care Act. The new funds will help these health centers serve nearly 20 million more patients.
Better Value for Premium Dollars. Insurance plans are required to spend at least 80 percent of the premiums they collect from consumers on medical care, rather than on executive salaries and administrative costs. If they don’t, they must provide a rebate to their customers. Up to 9 million Americans could be eligible for rebates starting in 2012 that are worth up to $1.4 billion. Average rebates per person could total $164 in the individual market.
Crackdown on Unreasonable Premium Increases. The Affordable Care Act provides $250 million to help States improve how they review proposed health insurance premium increases and hold insurance companies accountable. Already, $46 million in grants have been awarded to 45 states and the District of Columbia to strengthen their premium review process. We know premium review works. The state of Connecticut rejected Anthem Blue Cross and Blue Shield’s plan to raise insurance premiums by 20 percent, an increase that would have raised rates for 48,000 consumers. Premium review has also held down rate hikes in California, Massachusetts and Maine. In fact, in Massachusetts, health insurance premiums for individuals and small businesses during the second quarter of 2011 will be limited to an average increase of less than 10 percent.
Choice of Physician. Up to 88 million people who enroll in new plans will be guaranteed their choice of any available primary care and pediatric doctor in their plan’s network of providers and women will have the right to see an OB/GYN without having to obtain a referral first.
More Benefits in the Years Ahead
Exchanges Offering Affordable, Quality Coverage Options. In 2014, consumers will have access to new competitive insurance marketplaces called Exchanges that will make it easier for consumers to compare benefits and costs. More than 24 million Americans could use the exchanges to purchase private, affordable, quality health insurance. Exchanges will be state-based and states have substantial flexibility to dictate the design and operation of their exchange. States may choose not to operate an exchange, in which case, their residents will be eligible to purchase affordable private insurance through a federally managed exchange.
Tax Credits to Make Health Care More Affordable. In 2014, new tax credits will help middle class families afford health insurance. Tax credits will be available for Americans with incomes up to 400 percent of poverty (up to about $88,200/year for a family of four) to purchase coverage through the Exchanges. The Congressional Budget Office estimates that approximately 19 million Americans will receive tax credits. When the impact of new premium tax credits are taken into account, many people in the individual market could see their premiums drop by up to 60 percent compared to their current premiums.
Expanding Coverage. In 2014, states will be given new funding to expand Medicaid to cover individuals with incomes of up to $14,000, or $29,000 for a family of four. The Congressional Budget Office estimates that 16 million people will gain coverage through this expansion. The federal government will cover 96 percent of the costs of expansion, and overall, states’ share of each Medicaid enrollee’s health care expenses will decrease by 4.5 percent from today’s levels. As more Americans gain coverage, states and local governments are estimated to save approximately $70 to 80 billion in uncompensated care, which exceeds new costs to states of expanding Medicaid.
Reducing the Deficit. The Congressional Budget Office projects that the Affordable Care Act will reduce the deficit by more than $210 billion over the next ten years and more than $1 trillion in the decade after that.
