Now that health care reform has become law, what does that mean for you? The new law includes provisions that will improve your access to quality health care in several ways.

• Key Provisions That Take Effect Immediately
• Health Care Reform and Seniors
• Health Care Reform and Small Businesses
• Health Care Reform and Women
• Health Care Reform and Young Adults
• Benefits to the 13th Congressional District

(Under the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act)

• Small Business Tax Credits—Offers tax credits of up to 35 percent of employer premium contributions for those small businesses that choose to over coverage. Effective beginning for calendar year 2010. (Beginning in 2014, offers credits of up to 50 percent of employer premium contributions, for up to 2 years.)

• Begins to Close the Medicare Part D Donut Hole—Provides a $250 rebate to those Medicare beneficiaries who hit the donut hole in 2010. Beginning in January 2011, there is a 50% discount on prescription drugs in the donut hole. (Also completely closes the donut hole by 2020.)
• Free Preventive Care Under Medicare—Eliminates co-payments for preventive services and exempts preventive services from deductibles under the Medicare program. Effective on January 1, 2011.
• Help for Early Retirees—Creates a temporary re-insurance program (until the Exchanges are available) for employer health plans providing coverage for early retirees, helping to protect coverage while reducing premiums for employers and these early retirees age 55-64. Effective on June 21, 2010.

• No Discrimination against Children with Pre-Existing Conditions—Prohibits all employer plans and new plans in the individual market from denying coverage to children with pre-existing conditions. Effective for plan years beginning on or after September 23, 2010.
• No Rescissions—Bans all health plans from dropping people from coverage when they get sick. Effective for plan years beginning on or after September 23, 2010.
• No Lifetime Limits on Coverage—Prohibits all health plans from placing lifetime caps on coverage. Effective for plan years beginning on or after September 23, 2010.
• Tightly Regulates Annual Limits on Coverage—Tightly restricts the use of annual limits by all employer plans and new plans in the individual market, to ensure access to needed care. Effective for plan years beginning on or after September 23, 2010.
• Free Preventive Care under New Plans—Requires new private plans to cover preventive services with no co-payments and with preventive services being exempt from deductibles. Effective for plan years beginning on or after September 23, 2010.
• New, Independent Appeals Process for New Plans—Ensures consumers in new plans have access to an effective internal and external appeals process to appeal decisions. Effective for plan years beginning on or after September 23, 2010.
• More for Your Premium Dollar—Requires all health plans to put more of your premiums into your care, and less into profits, CEO pay, etc. This medical loss ratio requires plans in the individual market to spend 80 percent of premiums on medical services, and plans in the large group market to spend 85 percent. Insurers that don’t meet these thresholds must provide rebates to policyholders. Effective on January 1, 2011.
• No Discrimination Based on Salary—Prohibits new employer health plans from establishing any eligibility rules for health care coverage that have the effect of discriminating in favor of higher wage employees. Effective for plan years beginning on or after September 23, 2010.

• Immediate Help for the Uninsured with Pre-Existing Conditions (Interim High-Risk Pool)—Provides immediate access to insurance for Americans who are uninsured because of a pre-existing condition - through a temporary high-risk pool – until the Exchanges are up and running in 2014. Effective on July 1, 2010.
• Extending Coverage for Young People up to 26th Birthday through Parents’ Insurance—Requires plans to allow young people up to their 26th birthday to remain on their parents’ insurance policy, at the parents’ choice. Effective for plan years beginning on or after September 23, 2010.

• Community Health Centers—Increases funding for Community Health Centers to allow for nearly doubling the number of patients served over the next 5 years. Effective beginning in fiscal year 2011.
• More Primary Care Practitioners—Provides new investments to increase the number of primary care practitioners, including doctors and nurses. Effective beginning in fiscal year 2011.
• Health Insurance Consumer Assistance—Provides aid to states to establish offices of health insurance consumer assistance to help consumers file complaints and appeals. Effective beginning in fiscal year 2010.
• Creates New, Voluntary, Public Long-Term Care Insurance Program—Creates a long-term care insurance program to be financed by voluntary payroll deductions to provide benefits to adults who become functionally disabled. Effective on January 1, 2011.
• Holds Insurance Companies Accountable for Unreasonable Rate Hikes—Creates a grant program to support states in requiring health insurance companies to submit justification for requested premium increases. Effective beginning in fiscal year 2010.

• No Discrimination against Adults with Pre-Existing Conditions
• Ban on Higher Premiums for Women
• Premiums Based on Age Can Only Vary by a Maximum of 3-to-1 Ratio
• Cap on Out-Of-Pocket Expenses for Private Health Plans

• Better Primary Care. The new law ensures that you have access to and can spend more time with your primary doctor. It also makes sure your care is better coordinated to ensure you get recommended treatments, particularly for chronic diseases, such as diabetes and hypertension.
• Lower Drug Costs. The new law ends the Medicare Part D donut hole for prescription drug coverage, starting with a $250 rebate for those in the donut hole in 2010. It provides a 50% discount on brand-name drugs in the donut hole, beginning in 2011. It also phases in additional discounts for brand-name and generic drugs to close the donut hole completely by 2020.
• Free Preventive Care. You will pay nothing on recommended preventive care services, including a free annual wellness visit, that will keep you healthier longer.
• Protection of Medicare. Before this law was signed, the Medicare Trust Fund was projected to be exhausted in just seven years, in 2017, which if not addressed, would have caused cuts to services. The new law extends the solvency of the Medicare Trust Fund by at least nine years to help ensure that Medicare can cover all Americans as they get older.
• Tighter Oversight. The law focuses health care dollars on your care and benefits and cracks down on waste, fraud, abuse, and overpayments that enrich private companies.

Printable Version - Handout: Health Care Reform and Seniors

• Affordable Coverage. The reform creates Health Insurance Exchanges—or a competitive marketplace—where small businesses can purchase affordable coverage. Through the Exchanges, small business owners and workers can do one-stop comparison shopping for an affordable plan that offers lower rates like those big businesses pay, stable pricing, lower administrative costs, and choice of quality plans for employees.
• Tax Credits. Health reform provides $40 billion in tax credits to help small businesses offer their employees health insurance coverage.
• Exemption from Responsibility to Offer Coverage. Because providing employee health coverage is unaffordable for many of America’s small businesses, the reform exempts small firms with fewer than 50 employees from the employer responsibility requirements that begin in 2014. This means that 96% of U.S. firms—5.8 million of 6 million—will be exempt.
• Help with Wellness and Prevention. Small businesses that want to promote healthy behavior have access to health plans for their workers that provide free preventive care. The new law also creates a grant program to encourage small employers to develop employee wellness programs.
• Reformed Rating Rules. The new law reforms rating rules so that small businesses will no longer pay higher premiums if they have employees with high health costs due to age or sickness.
• Immediate Help for the Uninsured. For those small businesses with workers who have been uninsured for several months or denied a policy based on “pre-existing conditions,” a high risk pool will immediately offer insurance and assistance to help pay the premiums.
• Access to the Best Doctors. The best doctors in America can see patients—even those who own or work for small businesses in rural areas—through telehealth networks and telehealth resource centers established through grants.

Printable Version - Handout: Health Care Reform and Small Businesses

• Ends Discrimination based on Gender and Pre-Existing Conditions. When reforms are fully implemented in 2014, health insurance reform will make it illegal for insurance companies to use “gender rating”—charging women more than men for the same coverage. Charging women higher premiums or denying them coverage for such “pre-existing conditions” as pregnancy, having had a C-section, or being a victim of domestic violence will also be against the law. Beginning this year, an interim high-risk pool will provide those who are currently uninsured because of a pre-existing condition with access to affordable coverage.
• Provides Maternity Coverage. Health insurance reform includes coverage of maternity services in the essential benefits package in the new Health Insurance Exchanges.
• Expands Access. Currently, less than half of America’s women can obtain affordable health insurance through a job, partly because more women tend to work for smaller businesses and/or part-time. The law creates new Health Insurance Exchanges, or competitive marketplaces, for the millions who do not have health insurance through their employers. The Exchanges will give America’s women new insurance security—guaranteeing choice of quality, affordable insurance (at rates large groups get) if they lose their job, switch jobs, move or get sick. Premium assistance will be provided to those with incomes up to 400% of poverty.
• Makes Health Care Affordable. Women more often face unaffordable out of pocket costs and preventive services. Reform reins in exploding premiums, expands access to affordable health insurance to all Americans, provides premium assistance for those who need it, bans insurance companies from imposing lifetime caps, and tightly restricts their use of annual caps on coverage. It eliminates all co-pays for preventive services, both under Medicare and private plans.
• Improves Employer-Provided Coverage. The new law stabilizes and strengthens our current employer-provided health insurance system, including increasing competition for better prices. The Congressional Budget Office estimates, that under reform, there will be nine million more Americans in employer provided coverage by 2019.

Printable Version - Handout: Health Care Reform and Women

• Preventive Care for Better Health. The new law offers free preventive care for all people insured under new plans and invests in public health to create a system that promotes wellness and prevention.
• Insurance Industry Reforms That Save You Money. This year, reform eliminates lifetime limits on how much insurance companies cover if you get sick. Starting in 2014, reform puts a cap on what insurance companies can force you to pay in co-pays and deductibles. In 2014, reform bans new group plans from establishing eligibility requirements that have the effect of discriminating in favor of higher wage employees, who tend not to be younger workers.
• One-Stop Shopping and Competition. The Health Insurance Exchanges created by reform will give you the benefits of group purchasing power so you can compare prices and get more affordable plans with better benefits.
• Insurance Security. Reform guarantees choices of quality, affordable health insurance. Young adults frequently change jobs, move, or hold part-time or temporary jobs. Under reform, making such changes will not matter.
• Extended Health Coverage through Parents. The law requires health plans to allow young people who are not covered by their employers to remain on their parents’ insurance up to their 26th birthday.
• Health Care Not Tied to a Job. Reform offers affordable insurance to those without job-based coverage, starting in 2014, and provides premium assistance to those who cannot afford it.
• Health Care When You Need It Most. Reform prevents insurance companies from dropping you if you get sick. In 2014, it will also ban companies from denying coverage to those with pre-existing conditions.

Printable Version - Handout: Health Care Reform and Young Adults


The health care reform bill will:

• Improve coverage for 241,000 residents with health insurance.
• Give tax credits and other assistance to up to 153,000 families and 9,600 small businesses to help them afford coverage.
• Improve Medicare for 80,000 beneficiaries, including closing the donut hole.
• Extend coverage to 61,000 uninsured residents.
• Guarantee that 12,400 residents with pre-existing conditions can obtain coverage.
• Protect 2,200 families from bankruptcy because of unaffordable health care costs.
• Allow 42,000 young adults to obtain coverage on their parents’ insurance plans.
• Provide millions of dollars in new funding for 15 community health centers.
• Reduce the cost of uncompensated care for hospitals and other health care providers by $129 million annually.