ACA benefits keep coming

ACA benefits keep coming

August 5th, 2012 in Opinion Times

Two key milestones achieved in the past week had nothing to do with politics and elections, yet their impact on health care will be of greater significance that any of the week's elections. As of last Wednesday, Aug. 1:

• Health insurance companies had to mail rebates to customers by that date if their policy premiums did not meet new Affordable Care Act standards requiring insurers to spend at least 80 percent of their revenues from customers' premiums on actual medical care. The 80 percent minimum applies to individual and small-group policies. For large-group policies, the minimum expenditure on provision of medical care was 85 percent of premium dollars. So check your mail: Blue Cross Blue Shield of Tennessee, for example, has mailed a total of $8.6 million to 73,000 policy holders. Checks from other insurers are in the mail, too.

• New health insurance policies are henceforth required to provide eight new additional preventive-care services to women without cost-sharing or co-pay requirements. These new preventive-care benefits may not be available to all women right away: Some may have to wait until their current annual health insurance policies are renewed. In any case, all insured women will get these benefits as January 1, 2014.

The new benefits for women cover: Well-woman visits, including an annual well-woman preventive-care visit to provide or help schedule the recommended preventive-care services; Gestational diabetes screening for pregnant women; Contraception and contraceptive counseling (abortifacient drugs are not included ); HIV screening and counseling; Breastfeeding support, supplies and counseling; Interpersonal and domestic violence screening and counseling; STI counseling relating to sexually transmitted infections; HPV DNA testing to help prevent cervical cancer relating to human papilloma virus.

These gender specific services covering 47 million American women often have been unavailable or unaffordable to a large percentage of women who need them. They are being covered under the ACA without cost-sharing requirements to help address serious national health-care threats that apply specifically to women. They're especially necessary because women's health-care policies before the ACA often were more expensive and less comprehensive than those for men.

These new benefits under the Affordable Care Act -- referred to both by its critics and some proponents as Obamacare -- are just the latest steps in the roll-out of ACA reform standards designed to give Americans fairer and better treatment from their health care providers and insurance companies.

The main part of the ACA -- establishment of state health care exchanges for flat-rate, comprehensive-care, subsidized insurance polices for people without employer-based insurance -- won't take effect until January 2014. But other reforms designed to prompt health-care providers to enhance care, minimize cost and promote efficiency and collaboration are underway, as well.

The initial steps of Obamacare to help individual Americans have also proved to be extraordinarily useful. Insurers' exemptions for pre-existing conditions for children have been banned -- a godsend to them and their parents -- and use of exemptions for pre-existing conditions against adults will be banned in January 2014.

Annual limits for insurance coverage and arbitrary, cruel cancellation of policies when people become ill have been banned; lifetime limits on coverage will be banned in January 2014. The "doughut hole" on Social Security prescription costs has been narrowed, and will be closed under the ACA. Uninsured children up to age 26 have been allowed to remain on their parents' insurance, ending the problem of lack of insurance for millions of young adults.

Forward-looking insurers, hospitals and physicians are embracing ACA-driven changes to expand quality care and insurance coverage, and drive down the huge, 19 percent share of GDP that hampers America's economic competitiveness while excluding care for 50 million Americans. When all other advanced industrialized nations provide quality universal health care at a cost of 8-to-12 percent of GDP, and enjoy a healthier society by all measurable indices as well, it makes good economic sense all around to embrace the ACA.

That makes right-wing movement to go backwards on health-reform and repeal the ACA increasingly unfathomable, and unimaginably destructive and wholly counter-productive to our nation's well-being.