Contents of "Obamacare" - Part I

CONTENTS OF THE AFFORDABLE CARE ACT From now until the election, I will be briefly summarizing the content of the Affordable Care Act (aka “Obamacare”) so that you may be informed about the act when you vote in November. The law is lengthy and complex so I shall be simplifying. Title I, Subpart A, of the act starts with improvements that were to take effect immediately upon the signing of the act. These include the removal of annual or lifetime limits for benefits; a prohibition disallowing insurers to rescind (“take back” or “cancel”) an existing health insurance policy unless the applicant has committed fraud in the application process; coverage of appropriate immunizations; preventive care for infants, children and adolescents; preventive care and screening for women such as mammograms and breast cancer screening; extension of coverage for dependents up to 26 years of age. Changes in wording and definitions: The act provides for standardization of wording and format for coverage documents and benefits plans to make them easier to understand and easier to cross-compare; the development of standard definitions for insurance related terms such as “deductibles’ “copayments”, “preferred provider”, “out-of-pocket” , etc.; the development of standard definitions for medical terms that are utilized in insurance plans, such as “durable medical equipment”, “hospitalization”, “hospice” so that individuals may more easily cross-compare and understand various plans; Equality of benefits. The act includes prohibitions preventing employers from discriminating against lower-paid full-time employers or providing better insurance for higher-paid full-time employees. Changes in health care delivery: the act provides incentives to encourage hospitals to avoid re-admissions for the same condition rather than putting a Band-Aid on the problem, stabilizing the patient, and discharging them; steps to reduce medical errors through “best clinical practices”; and incentives to include wellness and preventive care. <Wellness and preventive care: These are “smoking cessation”, “weight management”, “stress management”, “physical fitness”, “nutrition”, “heart disease prevention”, “health lifestyle support”, and “diabetes prevention.” Reporting by insurance plans: Insurers will be provided to report on a website the percentage of their premiums that they actually spend on health care and provide a refund to the insured if this is less than 80%. Standardization and reporting of charges for medical procedures: The act requires hospitals to publish in advance their standardize costs for procedures so that individuals may cross-compare. Minimal requirements for an appeals process: These include and internal appeals process, an understandable notice to individuals receiving denials about their rights and appeals, and the patient’s right to review their record and provide testimony. Health insurance consumer information: The law provides grants to the states, if they provide certain information in return, to establish contacts for consumer assistance in regards to health care insurance. Funding: The act funded all of the above activities for the first year with 30 million dollars. <b>Justification and Disclosure for Premium Increases: The state is required to monitor and review premium increases, and the law offers federal grants to states to achieve this. Immediate Actions to Preserve and Expand Coverage (Title 1, Subpart B): The law creates temporary high-risk pools to provide insurance for those with pre-existing conditions (this has already been done) and adds sanctions for the dumping of sick patients. Five billion dollars was appropriated each year for these claims. In 2014, the patients will be transferred to other plans. The act also provides funds to cover re-insurance for early retirees (those over 55 years of age), their spouses, their surviving spouses and dependents. Establishment of websites to allow patients to find coverage. HOLD YOUR BREATH. I AM ONLY THROUGH PAGE 60 OF A 2,409 PAGE ACT! MORE TO COME.