The Affordable Care Act (ACA) was signed into law in March 2010. You may have concerns about how ACA will affect you and your practice – your reimbursement, your independence, and the welfare of your patients. The first question is: why did we need the health care law? The answer is that we had a health insurance market that worked very well for big insurance companies, but not so well for patients and providers. Insurers premiums were skyrocketing even as insurers made record profits. Fifty million Americans were uninsured and tens of millions more had coverage that didn’t cover critical treatments and preventive care. Our health care system is full of barriers, roadblocks, and red-tape—ranging from the way we pay for health care services to a lack of usable, reliable information for patients and clinicians alike—that often keep health care professionals from practicing medicine in a collegial, evidence-based, and patient-centered manner.
The Act is already helping millions of Americans. It creates a new competitive private health insurance market for individuals and small businesses to buy affordable coverage. Starting in 2014, if your employer doesn’t offer health insurance, you canbuy it directly from a state Exchange.Under the ACA, young adults without other insurance will be able to stay on their parents’ plan until they turn 26. About 1.2 million young adults will gain insurance coverage as a result of the law. It bans insurers from denying coverage to children based on pre-existing conditions. In 2014, this ban extends to all Americans It bans lifetime dollar limits on coverage and annual limits. The law is also making unprecedented investments in prevention in the health & public health systems to benefit us far into the future.The ACA requires coverage of preventive services at no additional cost (no co-pays, co-insurance or deductible) to receive services, such as recommended screenings, vaccinations, and counseling. More on this later…A number of provisions in the ACA aim to enhance quality. One of these: ACA established a new Center for Medicare & Medicaid Innovation that is tasked with identifying and testing promising new models for delivering and paying for care. Recently at a CMS meeting to discuss possible strategies for an innovation center to improve perinatal outcomes.
The law replaces some of the worst excesses and abuses of the health insurance industry with strong consumer protections and administrative simplification provisions.It has the potential to bring considerable financial and clinical benefits for providers across the health care spectrum. The law enacts comprehensive reforms that will hold health insurance companies accountable, protect you and your patients, and guarantee choice and control.
The health care law will make an especially big difference for women. For years, women have gotten a bad deal in the health insurance market. Women are more likely to be uninsured or underinsured. They can pay up to 50 percent more than men for the exact same coverage. And to add insult to injury, health plans often haven’t even covered the care women need. The health care law creates equality for women in the health insurance market. In 2014, insurers will no longer be able to turn women away because they were pregnant or were victims of domestic violence. And women will have the freedom to make important life choices without basing them on health insurance.
The health care law also makes sure that the new free preventive services include the care that women rely on every day from birth control to mammograms to pap smears to a well woman visit where you can sit down and talk with your doctor. Now, women will no longer have to choose between a co-pay and the care they need to stay healthy.
For newer plans, these rules around the proven prevention strategies are in effect now. After 2014, ALL plans must follow these rules. Here are some of the screening tests for which women will not be required to pay co-pays or deductibles.Some of these have age limits or are limited to women who are pregnant.Anemia screening on a routine basis for pregnant womenBacteriuria urinary tract or other infection screening for pregnant womenHepatitis B screening for pregnant women at their first prenatal visitRh Incompatibility screening for all pregnant women and follow-up testing for women at higher riskBreast Feeding interventions to support and promote breast feeding
For newer plans, these rules around the proven prevention strategies are in effect now. After 2014, ALL plans must follow these rules. Here are some of the screening tests for which women will not be required to pay co-pays or deductibles.Some of these have age limits or are limited to women who are pregnant.More details if needed:Alcohol Misuse screening and counselingBlood Pressure screening for all adults; Cholesterol screening for adults of certain ages or at higher risk; Type 2 Diabetes screening for adults with high blood pressureColorectal Cancer screening for adults over 50Depression screening for adultsHIV screening for all adults at higher riskSexually Transmitted Infection (STI) prevention counseling for adults at higher riskMammography screenings every 1 to 2 years for women over 40Cervical Cancer screening for sexually active womenChlamydia screening for younger women and other women at higher risk; Gonorrhea screening for all women at higher risk; Syphilis screening for all pregnant women or other women at increased risk
The Act does the same for other proven preventive services. Here’s a list that should be of specific interest to this audience. These services as well as the screenings listed on the previous slide, should move us towards the goal of healthy mothers and healthy babies.I am not knowledgeable on all the details – the law is over 800 pages. The website healthcare.gov is aimed at consumers and is a great resource about the ACA.Immunization vaccines for adults--doses, recommended ages, and recommended populations varyTobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco usersAlcohol Misuse counselingObesity screening and counseling for all adultsDiet counseling for adults at higher risk for chronic disease
The health care law also makes sure that the new free preventive services include the care that women rely on every day, from birth control to mammograms to pap smears to a well-woman visit where you can sit down and talk with your doctor. Now, women will no longer have to choose between a co-pay and the care they need to stay healthy.
The health care law is a work in progress. But it has already made huge improvements that over time will touch every American in some way. To learn more about the law and any of the new benefits I mentioned, please go to healthcare.gov. You’ll find information and plenty of resources you can share with your friends and family. Thank you.
OFFICE ON WOMENS HEALTHU.S. Department of Health and Human Services Nancy C. Lee, M.D. Deputy Assistant Secretary for Health-Women’s HealthPreventive Women’s Health Services & Health Care Reform: Closing the Gaps Women’s Health 2012, Washington, DC March 18, 2012
AFFORDABLE CARE ACT: WHY NOW?• Health insurance market was working well for the insurance industry, but not for patients & clinicians.• 50+ million Americans uninsured. Tens of millions more underinsured. Those with coverage often afraid of losing it.• Many medical practices work without support they need to provide coordinated, patient-centered care that is safe and effective.
THE AFFORDABLE CARE ACTSince 2010, it’s already helped millions of Americans by:• Lowering health care costs• Improving quality of coverage for insured• Providing new options for coverage for uninsured• Giving states flexibility & resources to implement law
HOW ACA BENEFITS YOU & YOUR PATIENTS• Holds insurers accountable through new consumer protections• Expands insurance coverage to more than 34 million people• Reduces administrative burden so more time with patients• Creates more opportunities to coordinate care New protections strengthen patient coverage, your practice, and the entire health care system
THE LAW PROTECTS WOMENInsurers will no longer be able to deny coverage to womenbecause • they’re pregnant, • they gave birth by c-section, • they’re a breast cancer survivor, or • they’re a victim of domestic violence.And no woman will have to stay in a job just to have healthinsurance.
THE LAW KEEPS WOMEN HEALTHYFor women who have a new private health insurance planor a private insurance policy beginning on or afterSeptember 23, 2010, the following preventive serviceshave been covered, without charge, since 9/23/10. • With no copayment • With no co-insurance • With no deductible
COVERED SERVICES FOR PREGNANT WOMEN Screening • Bacteriuria • Tobacco use counseling • Anemia • Alcohol misuse • Hepatitis B counseling • STIs • Breastfeeding • HIV counseling • Rh incompatibilityFrom: http://www.uspreventiveservicestaskforce.org/uspstf/uspsabrecs.htm
COVERED PREVENTIVE SCREENINGS FOR WOMEN • Blood pressure • Lipid disorders • Cancer screening • Depression – Cervical • Diabetes – Mammography • HIV (increased risk) – Colorectal • Osteoporosis • STIsFrom: http://www.uspreventiveservicestaskforce.org/uspstf/uspsabrecs.htm
COVERED PREVENTIVE SERVICES FOR WOMEN • Alcohol misuse screening/counseling • Healthy diet counseling • Obesity counseling • Tobacco cessation interventions • ACIP-recommended immunizations From http://www.uspreventiveservicestaskforce.org/uspstf/uspsabrecs.htm
NEW COVERED PREVENTIVE SERVICES FOR WOMENFor women having a new private health insurance plan or a privateinsurance policy beginning on or after September 23, 2010, thefollowing preventive services will be covered on August 1, 2012. • With no copayment • With no co-insurance • With no deductible
EIGHT NEW COVERED PREVENTIVE SERVICES• Screening for gestational diabetes• HPV DNA testing• Counseling on STIs for all women• Screening/counseling for HIV infection for all women• FDA-approved Contraceptive Methods & Sterilization; Patient Counseling• Lactation support/counseling; cost of renting breastfeeding supplies• Screening and counseling for interpersonal violence• At least one Well-Woman visit annually
THE ACA AND “GRANDFATHERED” HEALTH PLANS• “If you like your health plan, you can keep it.” -- President Obama• “Grandfather” Rule: Plans that existed on March 23, 2010—when ACA became law—are exempt from some of ACA’s provisions. Strict guidelines apply.• Plans will lose their “grandfather” status if they choose to significantly cut benefits or increase out-of-pocket spending for consumers.• ACA does require all private health plans to provide important new benefits beginning September 2010. • No lifetime limits on coverage; • Can’t cancel coverage because of an honest mistake on the application; • Extension of parents’ coverage to young adults under 26.