Changes to the health care system in 2012 and over the next few years will affect all Americans regardless of socioeconomic background. The Patient Protection and Affordable Care Act (PPACA), which President Barack Obama signed into law in 2010, increases medical coverage responsibility for all Americans and creates accountability for providers and hospitals.
Goals of the new law include containment of healthcare costs, coverage and expanded access for the uninsured, reform of the insurance industry and efforts to actively prevent disease and reduce costly chronic conditions.
The reforms will also provide coverage to 32 million uninsured people by 2019, provide changes to insurance rules to protect consumers, build on existing employer- and government-sponsored insurance program and test ways to tie payment of hospitals and physicians to quality improvement.
All Americans and their providers will play a much more active role in their medical and health outcomes. As an overview of the law, of which portions will be phased in through 2016, the top 8 changes consumers need to know are:
1. All U.S. citizens and documented residents are required to have health insurance.
2. Plans will not have lifetime benefit limits or annual coverage limits.
3. Coverage will not be denied based on health status or cancelled when someone gets sick or injured.
4. Dependent adult children can remain on a parents' policy until age 26.
5. No insurance coverage exclusions for pre-existing conditions beginning in 2014.
6. Health insurance premiums will be controlled.
7. Consumers can access insurance plans through a new marketplace, or insurance exchange.
8. Subsidies will be available to help consumers purchase insurance through the exchange.
Individuals with traditional Medicare coverage should not see substantial changes, but may receive some additional benefits, such as free preventive screenings (e.g., colonoscopies and mammograms), a free annual physical or wellness visit, and discounts for brand-name prescription drugs. Individuals with Medicare Advantage plans, however, may see changes in their benefits depending on how their insurance company responds to reduced funding for this type of plan.
By 2014, employers with more than 50 employees must offer qualified health coverage. State-based health exchanges will be created for small businesses, so they can have access to affordable plans for their employees and vouchers will be available to lower income employees who opt to enroll in a plan in the exchange.
Appropriate medical coverage is important, but so is maintaining a healthy lifestyle so that health issues do not arise. While the changes place a strong emphasis on personal preventive care, the government is forming a council to create new health policies and a national health promotion and disease prevention strategy. There's also new funding for research in public health services and systems to examine best practices in the area of prevention.
Please join me and pediatrician Dr. John Vigorita on Friday, March 2, 12p.m. at Overlook Medical Center's Wallace Auditorium for an in depth discussion and question and answer session about "Healthcare Reform and What it Means To You." We are offering a light lunch and free parking, so we ask that you register at 800-247-9580 or go to 'Classes & Events' at www.atlantichealth.org. Please mention you heard about it on the SummitPatch blog. See you there!
—By Alan Lieber, President, Overlook Medical Center at Atlantic Health