Affordable Health Care Act Alive and Well!

By Ruth Flower on 06/28/2012 @ 03:00 PM

Tags: Health Care

Amazing!

The Supreme Court upheld the Affordable Care Act. This is a huge step forward for the millions of people who will benefit directly from health care reform – that would be everyone who has health insurance and everyone who doesn’t.

The conflict before the Court was about what the federal government can require people to do. But one of the biggest stories – the one that will make a positive difference in millions of lives – is what the federal government can tell insurance companies to do (and not do):

• no denial of insurance for pre-existing conditions, or for using your insurance policy to pay for expensive care;
• no life-time limits and no annual limits on the cost of care;
• no higher premiums based on health status or gender;
• and a requirement that insurance companies spend 80 percent of the premiums they receive on actual care of patients (85 percent for group health insurance plans).

In exchange for opening up a massive market for the health care insurance industry, the Affordable Health Care Act (ACA) will restrict insurance companies in very important ways, when the law is fully implemented.

Employers with more than 50 employees will be required to offer a basic health insurance plan. Individuals will have help finding and affording health care insurance through “exchanges” which states may set up. These exchanges will also help small employers band together to purchase lower-cost group insurance plans for their employees.

The exchanges can also offer a multi-state public option – an option in which the financing of health care services is managed by a government entity (like Medicare).

Unfortunately, the Court rejected another key feature of the ACA: the expansion of Medicaid to cover all children and all adults up the age of 65, if their incomes are below 133 percent of the federal poverty line (which would be about $20,000 per year for a couple, or $30,600 for a family of four). Under the law, the federal government would have paid all of the cost of expansion for the first two years, gradually decreasing to 90 percent of the cost eight years from now. States protested, however, that the law put the funding for their historic Medicaid program at risk, if they did not agree to the expansion. The Court accepted the states' argument and invalidated this part of the law.

The Supreme Court’s opinion was, of course, complex and detailed. Further news on the particulars will come out in the coming days as lawyerly advocates have a chance to wade through the opinion. A good reference on the contents of the Affordable Care Act is available from the Kaiser Family Foundation., and a timeline for the implementation of all the provisions can be found here.

For now, I can know that my adult children will have health care, whether or not they have a job. We can know that that Medicare will be improved in important ways, and the silly “doughnut hole” in prescription coverage for seniors will be significantly reduced. We can be secure in our health care coverage, knowing that our car insurance might go up if we have a serious accident – but our health care coverage will be there for us. We can look forward to lower rates and more efficient practices, as insurance companies are required to spend more on our care and less on internal corporate business. States (and even local non-profits) will have an opportunity to exercise some creativity to design health plans that keep people healthy, and we’ll all know that we can get our periodic check-ups and screenings without co-pays.

There’s a lot to look forward to, and a lot to celebrate today!