Six Month Anniversary of "The Affordable Care Act"

medical imageThere is much to complain about concerning the "Affordable Care Act" that became law six months ago. But when you wade through the misinformation and rhetoric, families across America will find there is a lot to like.

(The following is excerpted from the Huffington Post)

These changes take effect on September 23rd.

  • There is an immediate end to denial of coverage for children with pre-existing conditions.
  • Lifetime caps on the amount of insurance an individual can have will be banned. Annual caps will be limited. Insurers must cover all benefits up to $750,000, and then in 2014 caps will be banned.
  • New plans must cover checkups and other preventative care without co-pays. This includes wellness visits, mammograms and immunizations. All plans will have this coverage by 2018.
  • More young adults will be covered on their parent's health plans as the age rises to the age 27.
  • Any new plan must now implement an appeals process for coverage determinations and claims. The Affordable Care Act will now allow Americans to appeal to external review boards if necessary, and provides $30 million to states to strengthen consumer assistance offices.

 

Over the next few years these changes will be effective:

  • Small Businesses with fewer than 50 employees will get tax credits covering up to 50% of what they pay in employee premiums.
  • "Donut hole" rebates will be given to seniors to reimburse them for Medicare drug coverage to fill 50 percent of that "donut hole".
  • Recissions will come to an end. Insurance companies will no longer be able to drop someone when he or she gets sick.
  • New screening procedures will be implemented to help eliminate health insurance fraud and waste.
  • Non-profit Blue Cross organizations will be required to maintain a medical loss ratio -- money spent on procedures over money incoming -- of 85 percent or higher to take advantage of IRS tax benefits.
  • A two-year temporary credit (up to a maximum of $1 billion) will encourage investment in new therapies for the prevention and treatment of diseases.
  • A temporary high-risk pool will be set up to cover those adults with pre-existing conditions. In 2014 health care exchanges will eliminate the program.

 

More needs to be done in the next Congress. The most important is to discuss and consider the effect on healthcare costs by the existence of the 1,300 private, for-profit health insurance companies.  Overhead found in private, for-profit insurance companies account for a third of America's healthcare expenses. This overhead includes underwriting, billing, sales, marketing, huge profits and exorbitant executive pay. The latest estimate of that portion of overhead that are profits, exorbitant executive pay and other costs not associated with healthcare delivery amounts to nearly $350 billion each year.

The question that will be before the next Congress will be: "What value does America and Americans receive for the $350 billion spent each year?"

 

A New Day for Health Care in America

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