JCRC: New health care law offers important benefits

By Stephen W. Skrainka

On March 21, Congress passed and on March 23, President Barack Obama signed into law The Patient Protection and Affordable Care Act (“Affordable Care Act”). Soon after, Congress passed and the President signed the related Health Care and Reconciliation Act of 2010. The members of the Jewish Community Relations Council (JCRC) Health Care Advisory Committee, made up of physicians and laypeople, have studied the new law. We believe these new health care provisions will lead to a number of positive changes to our health care system that will benefit the Jewish community and the larger community. 

“The recent legislation gives us the opportunity to modernize the delivery of health care and improve insurance coverage for all Americans,” says Dr. Gary A. Ratkin, Medical Director, Missouri Baptist Cancer Center and Clinical Associate Professor of Medicine at Washington University School of Medicine. Ratkin is also a member of the JCRC Health Care Advisory Committee.

The JCRC believes it is important that you know the facts about what is in the new law.

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What follows are just a small number of the benefits that flow from the new health care law. As noted, some of the changes take place this year, with others phased in between now and 2014.

• Coverage for Young Adults: Starting Sept. 23, young adults under age 26 will be allowed to stay on their parents’ family policy or be added to it. Beginning no later than the commencement of the first plan year after Sept. 23, 2010 (some plans are voluntarily starting earlier), young adults who have lost coverage will have 30 days to sign up. If they later lose coverage they will be able to sign up at that time. This offers a safety net for parents worried about children graduating from college who may not be able to find a job with health benefits immediately upon graduation given the current economic climate.

• Help for Seniors Caught in the Donut Hole: In 2007, more than eight million seniors hit the “donut hole” which is the gap in prescription drug coverage in Medicare Part D. Under the original Medicare Part D law, this year once seniors in a Medicare prescription drug plan have surpassed $2,830 in total drug costs expended, they are in the donut hole and must pay the full cost of all prescription drugs until their total out of pocket costs reach $4,550. Under the Affordable Care Act, beneficiaries who have hit the donut hole will receive a $250 rebate this year. Beginning next year, the Act provides for a 50 percent discount on brand name drugs in the donut hole, and the donut hole will gradually be completely closed for all prescription drugs by 2020. The Act strengthens the financial security of Medicare and extends it for nine years. No Medicare taxes or trust fund money are used to pay for Health Reform.

• Health Care More Available and Affordable for Kids: Starting this year, health insurers are prohibited from excluding children from coverage because they have a pre-existing health condition. Also starting this year, all new insurance plans are required to cover basic prevention and wellness services for children without charging parents a deductible or co-payment. In other words, new plans starting this year must allow parents to take their children for annual wellness exams without having to pay any out-of-pocket costs. In addition, starting in 2014, insurance plans must cover pediatric dental and vision services. Currently many plans do not include dental and vision coverage for children.

• Free Preventive Care for Women and Seniors: Not only must insurance plans provide for preventive services for children with no co-pay or deductible required, but starting this year the Act also requires insurance companies to cover preventive and wellness health care that women need at no charge. This includes pregnancy care and screenings for breast and cervical cancer. For seniors on Medicare, the Act requires, starting in 2011, that seniors not be charged co-pays or deductibles for preventive care. Also starting in 2011 seniors must be provided with free annual wellness check-ups and other preventive services under Medicare. Today seniors must pay 20 percent of the cost of many preventive services and office visits.

• Security and Peace of Mind About Health Care Coverage: One of the most important and basic elements of the Affordable Care Act is that it provides security and peace of mind for all Americans whose life circumstances might otherwise cause them to lose their health care coverage. An individual who loses his job will be not be left without affordable health care options, as the new law provides for creation of a health care exchange that must provide several insurance options at affordable prices and that meet federal minimum requirements for quality and benefits coverage. Someone changing jobs cannot not be prevented from getting insurance from her new employer because of a pre-existing condition. And someone who develops a serious medical condition or illness that requires extensive treatment, cannot be dropped from coverage from his insurance provider.

• Non-Institutionalized Long Term Care for Disabled: The Jewish Community has long advocated for the CLASS Act which is included in the Affordable Care Act.  This provides a new voluntary, self-insured long term insurance program to help families pay for long-term supports and services in the home if desired when a loved one develops a disability or advances in age and needs assistance to continue living at home.  The reforms also expand state options to provide more home and community based service if the individual chooses to remain at home.  This is less costly than present programs that require the use of nursing homes instead.

• Note on August Referendum On “Individual Mandate:”The Affordable Care Act contains provisions for a tax to encourage those who can purchase affordable health insurance to do so.  This individual responsibility is deemed essential to the insurance reforms enacted (elimination of pre-existing conditions, annual and lifetime benefit caps, etc) in order to spread the insurance risks more broadly, fairly and lower the cost of such insurance.  In August Missouri voters are scheduled to vote on Proposition C which includes a question purporting to make this requirement unenforceable in Missouri if voters approve it.  Most observers believe that Proposition C, if adopted, would be unconstitutional under the federal Constitution and we will simply waste tax dollars litigating its validity.  If this referendum were actually effective to take Missouri out of the newly enacted federal health care reforms, then Missourians would still be obligated to pay their federal taxes that support these benefits for other states  while denying themselves the increased health insurance competition and reforms and millions of dollars of coverage and jobs this Act is now beginning to bring to Missouri!

The U.S. Department of Health and Human Services has developed a website with very detailed information about the many ways in which the Affordable Care Act helps small businesses, families, children, early retirees, seniors, young adults, individuals with disabilities and others. For more information, go to www.healthrcare.gov. The JCRC also is available to provide a presentation to your organization, chavurah, or other group about what federal health reform means for Missourians and all Americans.

Stephen W. Skrainka, is a member of the Board of the Jewish Community Relations Council of St. Louis and Chair of its Health Care Advisory Committee.