By Kristin Hammam
Vice President of Content, WebMD
As the Supreme Court prepares to hear arguments over the Affordable Care Act, President Obama’s sweeping and controversial health care reform law, the White House hosted a roundtable discussion on the law’s impact on women and families. WebMD and 10 female-focused websites and bloggers were invited to join the discussion with Deputy Chief of Staff Nancy-Ann DeParle and Deputy Assistant to the President for Health Policy, Jeanne Lambrew.
The Affordable Care Act was signed into law on March 23, 2010 and is rolling out over the course of four years. Its biggest impact, extending health insurance to approximately 30 million people, doesn’t kick in until 2014.
DeParle said that the biggest criticism of the law that contains the most misinformation is “that it does nothing to control costs.” As an example, she said that Medicare spending per beneficiary is about the lowest it has ever been. Lambrew added that the White House plans to release information Thursday indicating that premium growth has slowed for health insurance.
Another criticism DeParle addressed was the individual mandate, the part of the law that requires everyone to purchase health insurance. The mandate’s legality will be debated during next week’s Supreme Court hearings. “A lot of people think that the so-called individual mandate is a huge new imposition on their liberty based on what they’ve heard from some, when, in fact, for many, most, I suppose, Americans, nothing is going to change,” DeParle said. “They’ll just check a box that says ‘Yes, I have insurance.’” The government will help cover the cost of insurance for those who can’t afford it.
While acknowledging the law is far from perfect, DeParle highlighted what she cited as achievements of the law to date. (Note: WebMD will provide a response from opponents of the law in a blog post Wednesday.) They include:
Pre-existing Coverage Insurance Plans – These plans are intended to provide insurance to people with pre-existing medical conditions who have been uninsured for 6 months. They are serving as a bridge between 2010 and 2014, when insurance companies won’t be able to deny coverage to anyone with a pre-existing condition. According to the White House, there are up to 50,000 Americans now enrolled in these programs, called PCIPs, the majority of whom are women. Lambrew says that although the volume of people enrolled in PCIPs is lower than expected, they are helping the sickest people. “We know this program is helping maybe a smaller than anticipated, but much sicker population,” she told the roundtable.
No lifetime limits – Under the law, individual and group plans can no longer place a lifetime dollar limit on most medical benefits. DeParle notes that 105 million people are now benefitting from this provision.
Children with pre-existing conditions – Insurers are no longer permitted to deny coverage to children due to their health status, or exclude coverage for pre-existing conditions. This applies to new and grandfathered plans in the group market, but not to people with existing plans they bought on their own in the individual market.
Coverage for young adults – Young adults up to age 26 can now stay on their parents’ plan as long as they don’t have insurance themselves through an employer. “Two-and-a-half million more adults have insurance because they were able to get on their parents’ plan,” said DeParle.
Drug discounts for Medicare recipients – Under the law, seniors who fall into the so-called ‘donut hole,’ the gap in Medicare Part D prescription drug coverage, receive discounts on covered brand-name and generic drugs. The White House said that 3.6 million seniors with Medicare have saved an average of $600 each in 2011 because of these discounts. They also noted that 57% of Medicare recipients are women.
Applying insurance premiums to health care – Under the new law, insurance companies have to spend at least 80% of premiums dollars they collect on health care, as opposed to administrative costs or profits. “We’re actually seeing insurance companies that aren’t raising their rates as much as they otherwise would have because this requirement means that if they don’t meet it they have to pay back rebates this summer,” said DeParle. The rebates will be paid to insurance customers.
Preventive care without co-pays – New health plans starting on or after Sep. 23, 2010 must pay in full for preventive care including blood work to check for conditions such as diabetes, cancer screenings (such as mammograms and colonoscopies), vaccines, and well baby and child visits. This means no copayments or deductibles apply, although grandfathered plans in the group and individual markets are exempt. Starting August 1, 2012 more comprehensive preventive care services will be available with no out-of-pocket costs. This includes annual well-women visits, screening for gestational diabetes, testing for the HPV virus, HIV counseling and screening, and lactation counseling. The Department of Health and Human Services (HHS) released a report today saying that 45 million women received free preventive care last year due to this provision.
One of the preventive services available to women with new health plans this August will be contraceptives. Religious employers, such as churches and synagogues, are exempt from this requirement. It does apply to religious-affiliated hospitals and colleges, some of which are opposed to sponsoring employee health benefits that cover contraception. Last week, the administration proposed a few options to address this issue, and is currently seeking public comment.
The question was raised about whether this is the fight to be having now.
“We weren’t looking for a fight,” said said DeParle. She added that they asked the Institute of Medicine, which is an independent group of clinicians and public health experts, to do a study and they came back with the recommendation.
Premiums for women – Starting in 2014, the law will make it illegal to charge women higher premiums just because they are women. Lambrew quoted a report just released by the National Women’s Law Center saying that women who purchase insurance on the individual insurance market pay approximately $1 billion a year more than men.
The Supreme Court will hear oral arguments on the Affordable Care Act over three days starting on March 26. For a full explanation of the key issues the Court will review, you can check out our Special Report. Our news team will be actively covering the hearings as well as the outcome. A decision from the Supreme Court is expected by the end of June.