Happy Birthday, Health Care Reform!

By David Loud

On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act of 2010 (ACA), the biggest step towards achieving health care for all in our country in 100 years of trying. One year later, let us consider some of what has been accomplished so far.

For people on Medicare:
Free preventive care: In 2011, for the first time, 44 million beneficiaries are entitled to a free annual wellness visit, as well as free preventive services such as mammograms and colonoscopies.

Lowering drug costs: In 2010 over 3.7 million people received $250 rebate checks for falling in the “donut hole,” including 62,543 in Washington State. In 2011, prescription costs will be further lowered by a 50% discount on brand-name drugs in the donut hole (which will close completely by 2020).

Strengthening Medicare: The ACA has extended the solvency of the Medicare Trust Fund by 12 years, to 2029. There are new tools to crack down on Medicare fraud and abuse, and a record $4 billion was recovered for taxpayers in 2010.

For early retirees:
Over 5000 health plan sponsors that cover retirees not yet eligible for Medicare, including union health & welfare trusts, are benefiting from lower costs through ACA’s Early Retiree Reinsurance Program. These sponsors, including 79 in WA, received $535 million in reimbursements in 2010, helping more than 4.5 million retirees.

For young adults:
People can now stay on their parents’ health plans until their 26th birthday if they do not have coverage of their own. Data are not available yet, but the US Department of Health & Human Services (DHHS) estimates that 180,000 young adults in WA may benefit from this provision.

For children with pre-existing conditions:
Children under 18 can no longer be denied coverage due to pre-existing conditions. Enrollment data are not available yet, but DHHS estimates that around 250,000 kids nationally could get coverage through this provision. (The ACA will ban insurers from pre-existing condition exclusions and denials for everyone in 2014).

For small businesses:
Tax credits: More than 4 million small businesses are estimated to be eligible for tax credits starting in 2010, covering up to 35% of the cost of insuring employees (this goes to 50% in 2014). The percentage of employers with fewer than 10 employees that offer health coverage rose from 46% in 2009 to 59% in 2010.

For everyone with private insurance:
No more lifetime limits on coverage: Starting in 2010, plans are no longer able to place a lifetime limit on a person’s coverage. Annual limits on coverage will be banned in 2014.

No more recissions: Starting in 2010, plans are no longer allowed to drop people from coverage simply because they become sick, previously a common insurance industry practice.

Limiting insurance companies’ profiteering: Insurers must now spend at least 80% of their premiums (85% for large plans) for medical services, rather than for administration, profits and CEO pay. Before ACA, insurers sometimes kept 30-40% or more of their premiums for themselves.

For bringing cost under control:
The ACA takes strides towards bending the cost curve that was going out of control, and the Congressional Budget Office estimates that it will trim $1 trillion from the federal deficit over 10 years. Many innovations in the delivery of care, spurred by provisions of the ACA, will help achieve greater savings by moving us from a fee-for-service system that pays for quantity and a focus on disease to one that pays for quality, outcomes of care, and a focus on wellness and prevention.

THE FIGHT TO FULFILL THE PROMISE

There’s plenty to celebrate on the anniversary of ACA. But many of the biggest gains we will see under ACA lie ahead, especially in 2014 when more than 30 million people will gain access to quality and affordable health care coverage through state-based Insurance Exchanges and an expansion of Medicaid eligibility.

In the meantime, the Great Recession has increased the ranks of the uninsured to 59 million just as crises in state budgets are resulting in the shredding of the safety nets, including Medicaid and other programs for the working poor like WA’s Basic Health Plan. The Republican/corporate-led onslaughts against healthcare reform, unions, reproductive rights, the social safety net and democracy itself are inflicting great damage and threatening our well-being and future.

But with Wisconsin’s mass movement of resistance to Republican union-busting leading the way, it looks like a “sleeping giant” may finally be awakening and that the American people are taking up the challenge to change the country’s course away from the bleak future the Republicans are trying to impose on us. In this struggle, one of our most important battlegrounds will be to defend the gains of the Affordable Care Act and build on them to fulfill the promise of healthcare for all.

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Sources for this article: Dept. of Health & Human Services, Congressional Research Service. For comprehensive and authoritative information on the Affordable Care Act, its implementation and how it may affect you, see www.HealthCare.gov.

David Loud is community liaison for Congressman Jim McDermott and a member of PSARA.