STATE REPRESENTATIVE GARNET COLEMAN EXPLAINS HOW THE NEW HEALTH CARE LAW AFFECTS YOU!

Now that the Affordable Care Act (ACA) is unquestionably the law of the land, it is important to remember how the law affects you. By now everyone should be aware of the following beginning in 2014:

 

  • No one will be denied coverage due to a pre-existing condition,
  • Insurance companies will not be able to revoke your coverage once you get sick,
  • Every American will have access to affordable, high quality healthcare,
  • People will be able to shop for and compare private insurance plans on an easy-to-navigate website so that they can choose the best option for themselves and their family.

More specifically the ACA contains other benefits affecting certain populations:

Women
If you are female, regardless of your existing health insurance situation, then you are one of the primary winners of the Affordable Care Act.

  • End Of Gender Discrimination
  • As of right now, 30 states including Texas allow health insurance companies to charge a higher price for women than men. This will have to stop by 2014. Overall, women across the country pay $1 billion more a year than men do in health insurance premiums. It is time to stop treating women as if their gender is a pre-existing condition.

 

  • Wider Access To Contraception
  • Beginning in August, almost every health insurance plan will be required to cover all FDA-approved forms of contraception without charging copays or other out-of-pocket costs. This will greatly reduce the primary barrier to contraception (cost) and help prevent unwanted pregnancies.

 

  • Access To Preventive Care
  • All health insurance plans must cover a wide variety of preventive care, including pregnancy screenings, STI screenings, well-woman visits, domestic violence screenings, and counseling.

 

  • Maternity And Newborn Care
  • Insurance companies will have to provide care for pregnant women and mothers of newborns. They will receive breastfeeding support and supplies, access to smoking cessation programs, and other services that make it easier for mothers to have and raise their children.


Medicare

  • Access To Preventive Care
  • Already, the Affordable Care Act provides that seniors on Medicare be given access to preventive care – including mammograms for women and wellness visits for seniors – free of charge. 2,208,969 people with Medicare in Texas have benefitted from this provision.

 

  • Closing The Donut Hole
  • The ACA has started closing the infamous “donut hole” in prescription drug coverage. In the first year, 22,1395 people with Medicare in Texas received a $250 rebate to help cover the cost of their prescription drugs when they hit the donut hole in 2010.
    • Since the law was enacted, Texas residents with Medicare have saved a total of $223,382,540 on their prescription drugs.

 

  • In the first five months of 2012, 41,500 people with Medicare received a 50 percent discount on their covered brand-name prescription drugs when they hit the donut hole. This discount has resulted in an average savings of $629 per person, and a total savings of $26,119,155 in Texas. By 2020, the law will close the donut hole.

 

  • Cracking Down On Fraud and Abuse
  • $10.7 billion has been recovered by cracking down on waste, fraud, and abuse in Medicare all while securing and protecting the benefits seniors have earned.

The Uninsured

  • Reducing The Rate Of Uninsured People To Single Digits
  • Approximately 25 percent of all Texans, including a third of all Houstonians, are uninsured, giving Texas the highest uninsured rate in the country. After the main provisions of the ACA kick in in 2014, this will plummet to single digits. Nationally, the uninsured rate is expected to go from 18.9% to 8.7%.

The Middle Class

  • Tax Cut For The Middle Class
  • The ACA provides a significant tax cut averaging about $4,000 for more than 18 million middle class people and families—a tax cut Republicans in Washington are vowing to repeal, socking it to the middle class once again. Contrary to the Republicans, who are interested in cutting taxes for the wealthy even further, President Obama has cut taxes by $3,600 for the typical middle class family.  Republican plans will raise taxes on middle class families to give millionaires and billionaires a $250,000 tax cut.


Medicaid

  • Gives States The Option To Expand The Program
  • The one element of the Affordable Care Act that the Supreme Court limited is the national Medicaid expansion. The Court ruled that it is up to the states as to whether or not they wish to expand the program, so a state conceivably could decide to keep their program as is. This would be a  monumental mistake. The federal government will pay for 100% of the expansion for the first three years, and it will cover 90% of the costs after that. By expanding Medicaid eligibility, Texas would receive an estimated $13 billion a year in new federal funding to pay for the expansion. This would be a great deal for Texas; the federal government only pays around 60% of the state’s Medicaid costs currently.

Those Who Already Have Health Coverage
The Affordable Care Act is not just for those who lack coverage; it contains a number of regulations that will strengthen existing plans, make plans more affordable, and ensure that consumers are getting the most out of their premium dollars.

  • If You Like Your Current Plan, You Can Keep It
  • Nothing in the ACA requires you or your employer to drop your insurance plan.

 

  • Strengthening Your Existing Plans
  • Starting in August, private plans must begin to offer approved preventive care – such as annual physicals and blood screenings – without any out of pocket costs. The goal is to save money in the long term, since catching disease early is much more effective from both a health and financial standpoint than by waiting until the condition develops into something more serious.
  • Annual caps on benefits have been eliminated, and lifetime limits are soon to follow. Because of the law, 54 million Americans with private health insurance gained preventive service coverage with no cost-sharing, including 3,836,000 Texans. Also, all private plans must now spend at least 80% of all of your premium dollars on actual healthcare, not administrative costs such as salaries, marketing, overhead, or profits.

 

  • If your insurance carrier spends less than 80% of the premium on healthcare, they must refund to you the amount of money they overspent.     1,516,721 Texas residents with private insurance coverage will benefit from $166,975,840 in rebates from insurance companies this summer.
  • These rebates will average $187 for the 895,000 families in Texas covered by a policy.

 

  • Scrutinizing Unreasonable Rate Increases
  • Insurance companies are required to publicly justify their actions if they want to raise rates by 10 percent or more. Texas has received $1 million under the new law to help fight unreasonable premium increases.

 

  • Allowing Young Adults to Stay on their Parents’ Plan
  • Insurance companies must now allow parents to keep their children on their plans until the child reaches the age of 26.  As a result, 3.1 million young people have gained coverage nationwide, including 357,000 in Texas

Conclusion
The bottom line is that there is no more uncertainty over the law, so it is important to stop trying to re-fight the same battles. Instead, take the time to learn how the law affects you. The Affordable Care Act is and will continue to be the law of the land, and that is a good thing for all of us.