By Roger Linnett
This is part of a continuing series, summarizing recently activated benefits that are part of the Afford- able Care Act, commonly known as Obamacare. These new provisions were based on a 2011 report from the Institute of Medicine, the health arm of the National Academy of Sciences, which relied on inde- pendent physicians, nurses, scientists and other ex- perts as well as evidence-based research to develop its recommendations. They take effect at the in- sured’s next policy renewal date on or after August 1.
Increased Access –
With about 7 million uninsured Californians, nearly 20 percent of the population, California will greatly benefit this year because of these new provi- sions:
• As much as $15 billion per year in new federal funding for the state to help imple- mentation.
• “Bridge” insurance programs that now cover low-income people and those with pre-existing conditions will remain in force until health care reform is fully imple- mented.
• Establishment of The California Health Benefits Exchange, which will act as a de- fined marketplace, much like the stock mar- ket, for consumers to buy insurance and apply for subsidies as needed. The ex- change will begin enrolling prospective policyholders in 2014.
Increased coverage –
Forty seven million women, more than 5 million in California, who are now covered by individual or group insurance or Medicare will now be able to schedule preventive screening and counseling with- out incurring any additional out-of-pocket co-pays or deductibles.
Women and their doctors, not insurance compa- nies, will now make decisions about their health needs, increasing the chance of catching potentially serious conditions at an earlier stage and substan- tially reducing the possibility of crushing medical bills for them and their families.
And, although women are the major beneficiar- ies of these new provisions, men and children can also take advantage of covered preventive services that includes flu shots and other immunizations, screenings for cancers, high blood pressure, choles- terol and depression.
The health care law has already helped women gain access to potentially life-saving tests and serv- ices such as mammograms, cholesterol screenings and flu shots without co-insurance or deductibles, and women under Medicare also receive screenings and tests for diabetes and osteoporosis.
The following preventative services for women are now also covered:
• Annual “Well Woman” visits for all women who are sexually active or over age 21, including a physical, Pap test and clini- cal breast and pelvic exams.
• For women who are pregnant or nurs- ing, gestational diabetes screening, breast- feeding support, supplies and counseling have been added to already available tests for Hepatitis B and anemia and folic acid supplements.
• Screening and counseling for domes- tic and interpersonal violence.
• HPV (Human PapillomaVirus) DNA testing for women 30 or older.
• Screening and counseling for HIV/ AIDS and other sexually transmitted dis- ease.
• FDA-approved contraceptive meth- ods, and contraceptive education and counseling.
This last item has caused a storm of controversy, driving opponents of the law to paroxysms of eccle- siastical fervor, claiming government intrusion into religious freedom. Bear in mind, though, that these are the same people who are relentlessly trying to plant their flag in the national vagina.
The Obama administration has said it will make common-sense accommodations with regard to con- flicting religious dogma. Additionally, the admini- stration announced that non-profit, religious employ- ers who do not currently offer contraceptive cover- age would not have to comply with the requirement for a year, and new regulations would be developed and finalized by the end of the year to accommodate religious concerns while ensuring access to these benefits for their employees.
Plus, group health plans and issuers that have maintained grandfathered status are not required to cover these services and certain nonprofit religious organizations, such as churches and religious schools, will not be required to cover these services.
Nevertheless, insurance companies know it is way more cost-effective to prevent a pregnancy than to pay for it.
Lowered Costs and Rebates –
According to a February 2012 brief by the Asst. Sec. for Planning and Evaluation at the U.S. Dep’t. of Health and Human Services called “The Cost of Covering Contraceptives Through Health Insurance”: “When medical costs associated with unintended pregnancies are taken into account, including costs of prenatal care, pregnancy com- plications and deliveries, the net effect on premi- ums is close to zero.” (http://1.usa.gov/zNTGuv)
The brief also found that taxpayers realize a saving of $4 for every dollar spent on publicly- funded family planning.
Because of a provision that went in effect January 1, 2012, called the Medical Loss Ratio (MLR), which was inserted into the health care law by Sen. Al Franken (D-MN), insurers had to issue rebates to policy holders by August 1, if they spent more than 15 percent of premiums on admin- istrative items for companies with more than 50 employees, or 20 percent with fewer than 50 or those with individual policies.
Nearly two million Californians recently re- ceived almost $74 million in rebates from their health insurers based on 2011 financial records. Individual policyholders received rebates directly. Group policyholders, who paid either part or all of the premiums, are entitled to either a rebate or credit toward future premiums. Consult your em- ployer’s plan administrator for details.
If you have an individual or a group policy and your insurance provider complied with the MLR provision, you probably received a letter in which they congratulated themselves for not ripping you off.
Information for this article was compiled from: whitehouse.gov, kaiserhealthnews.org, aspe.hhs.gov, insurance.ca.gov and healthcare.gov.