On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act. The law creates many new health insurance reforms that are scheduled to roll out between 2010 and 2014. Many of them are already in place. Listed below are some of the reforms already in place, along with the date they became effective.
Putting Information for Consumers Online. The law provides for an easy-to-use website where consumers can compare health insurance coverage options and pick the coverage that works for them (http://www.healthcare.gov). Effective July 1, 2010
Ending Insurance Companies’ Practice of Refusing to Cover Children with Pre-Existing Health Conditions. The health care law includes new rules to prevent insurance companies from denying coverage to children under the age of 19 due to a pre-existing condition. Effective for health plan years beginning on or after September 23, 2010 (Note: Insurance companies will be prohibited from refusing to cover adults with pre-existing conditions in 2014).
Providing Access to Insurance for Uninsured Adults with Pre-Existing Conditions. The Pre-Existing Condition Insurance Plan (PCIP) provides new coverage options for adults who have been uninsured for at least 6 months because of a pre-existing condition. More information about Iowa’s Pre-Existing Condition Insurance Plan (PCIP) can be found at http://hipiowafed.com/index.htm National program effective July 1, 2010
Extending Coverage for Young Adults. Under the law, young adults are allowed to stay on their parents’ health care plan until they turn 26 years old. Check with your insurance company or employer to see if you qualify. Effective for health plan years beginning on or after September 23, 2010
Prohibiting Insurance Companies from Ending or Withdrawing Coverage. In the past, insurance companies could search for an error, or other technical mistake, on a customer’s application and use this error to deny payment for services when he or she got sick. The health care law makes this illegal. Effective for health plan years beginning on or after September 23, 2010
Eliminating Lifetime Limits on Insurance Coverage. Under the law, insurance companies are prohibited from imposing lifetime dollar limits on essential benefits, like hospital stays. Effective for health plan years beginning on or after September 23, 2010
Regulating Annual Limits on Insurance Coverage. Insurance companies’ use of yearly dollar limits on the amount of insurance coverage a patient may receive are restricted for new plans in the individual market and all group plans. In 2014, the use of yearly dollar limits on essential benefits will be banned for new plans in the individual market and all group plans. Effective for health plan years beginning on or after 9/23/2010
Appealing Insurance Company Decisions. The law provides consumers with a way to appeal coverage determinations or claims to their insurance company, and establishes a review process outside of the insurance company. Effective for new plans beginning on or after September 23, 2010. The Iowa Insurance Commission handles the outside appeal process to review insurance company decisions – more information can be found here: http://www.iid.state.ia.us/external_review
Providing Free Preventive Care. All new plans must cover certain preventive services such as mammograms and colonoscopies without charging a deductible, co-pay, or coinsurance. Effective for health plan years beginning on or after September 23, 2010
Requiring Nonprofit Hospitals to Establish a Written Financial Assistance Policy. Nonprofit hospitals are required to establish a written financial assistance policy which includes:
eligibility criteria for financial assistance, and whether such assistance includes free or discounted care;
the basis for calculating amounts charged to patients;
the method for applying for financial assistance;
the actions the nonprofit hospital may take in the event of nonpayment, including collections action and reporting to credit agencies;
requirements to widely publicize the policy; and
requirements that nonprofit hospitals offer patients an opportunity to apply for financial assistance prior to engaging in collection activities.
Effective March 23, 2010
Prohibiting Nonprofit Hospitals from Charging Uninsured Patients Higher Prices than Insured Patients. In the past, nonprofit hospitals have negotiated lower rates for goods and services with insurance companies while charging uninsured patients higher prices. The new law prohibits nonprofit hospitals from charging uninsured patients higher prices. The new law requires that uninsured patients be charged either (a) the lowest negotiated rate; (2) the average of the 3 lowest negotiated rates, or (3) the Medicare rate. Effective March 23, 2010
Offering Prescription Drug Discounts to Seniors on Medicare Part D. Seniors who reach the “donut hole” will receive a 50% discount when buying Medicare Part D covered brand-name prescription drugs. Over the next eight years, Seniors will receive additional savings on brand-name and generic drugs until the “donut hole” is eliminated in 2020. Effective January 1, 2011
Offering Women Access to a Full Range of Free Recommended Preventive Services. Women will have access to a full range of recommended preventive services without cost sharing, including well-woman visits; screening for gestational diabetes; human papillomavirus (HPV) testing for women 30 years and older; sexually transmitted disease and (HIV) screening and counseling; FDA-approved birth control methods and counseling; breastfeeding support, supplies, and counseling; and domestic violence screening and counseling. Effective for health plan years beginning on or after August 1, 2012
The Affordable Care Act is currently being challenged in the courts. The U.S. Supreme Court is scheduled to rule on whether the law is constitutional. A decision is expected by June 30, 2012. If the Supreme Court decides the law is unconstitutional, all or part of the reforms listed above may be ended. If it is upheld as constitutional, they will remain in place. The Supreme Court can also choose to strike down certain parts of the law as unconstitutional and uphold other parts of the law as constitutional.
Iowa Legal Aid provides help to low-income Iowans when legal problems block access to quality and reliable health care. To find out if assistance is available for a health law issue, call 1-800-532-1275.
Last legal review June 2012