Seven Reasons to be Thankful for Health Reform this Holiday Season

This holiday season you may be surprised to find some gifts from the Affordable Care Act (aka health reform) in your stocking. I say “surprised” because a recent Kaiser Family Foundation poll found that the American public still doesn’t know what is in the health reform law and what is not.

If you haven’t been sick this year or are not included in the following categories of people who are benefiting from health reform, it makes sense that you won’t have paid much attention. You may not experience concrete benefits until it is fully implemented in 2014. But just in case you know someone in these categories, here’s the list of health reform “gifts” available this year (see my blog on the Health Insurance Resource Center for more details):

1. If you are 65 or older — (and eligible for Medicare) — seniors who are enrolled in Medicare Advantage plans (that’s Part C or the managed care part of Medicare) may have seen their premiums reduced this year. Some may even have access to ZERO premium health plans. Seniors also now receive free preventive treatments and a rebate of $500 if their drug coverage hits the “donut hole” in 2011.

2. If you haven’t turned 26 yet — you may have been able to stay on your parents’ health plan this year, even if you are working or don’t live at home. 1.8 million young people had access to this benefit. And 90,000 children under the age of 19 could not be denied coverage because of a pre-existing condition due to a change that was implemented in 2011.

3. If you needed preventive care (or had the good sense to get it) — you had access to it this year without a co-payment or deductibles.

4. If you were a small business owner — with fewer than 25 employees and average wages of $50,000 a year, you were eligible for a substantial tax credit if you offered health insurance coverage to your workers.

5.If you have been uninsured for 6 months because you couldn’t afford coverage or had a serious medical condition — you could enroll in your state’s “pre-existing condition insurance pool” and get coverage at a more reasonable rate. (Read this story about a woman who had criticized Obama for the health care law but then got cancer, apologized to Obama publicly because she was able to find coverage from her state’s high risk pool.)

6. If you did accrue substantial medical bills this year, the law restricts annual limits on health insurance coverage.

7. And if you are an individual who buys insurance on your own, not through an employer — you know how hard it is to get that coverage and how expensive it can be. But one of the benefits of health reform identified by only 38 percent of the Kaiser poll respondents is something called the “medical loss ratio”. The MLR requires that health plans pay out at least 80 percent of your premium for actual medical care (85 percent if it’s a large plan). That is, they can only spend 20 percent of your premium on advertising and other administrative costs. If they do not spend at least 80 percent on medical care, they have to pay a rebate to you, the consumer, most likely in the form of a reduced premium. I mention the individual buyer of coverage here, because most insurers who offer plans through the group market (small or large) likely meet those 80 percent requirements today. It is the insurer who markets to individuals that may be failing to meet the 80 percent requirement. We can thank HHS for holding the line on the MLR regulations to the benefit of the rest of us. The MLR may be one of the best holiday gifts of all.

Did you already know most of this? Congratulations, but you are in the minority. The Kaiser poll also found that the majority of respondents had heard very little from the media about health reform in the past thirty days, other than what is being said in the Republican debates. In the midst of a great amount of doom and gloom over the economy, and constant attacks on the president and the Affordable Care Act, it’s important to remember that some good things have been done for the most vulnerable of our friends and family. Pass it along!

Linda Bergthold, PhD, is an independent health policy consultant and researcher and Senior Advisor at the Center for Medical Technology Policy. She currently serves as on various boards and committees to evaluate new technologies and review research from the consumer perspective. Follow her on Twitter: @lab08

This post first appeared at The Huffington Post.

Categories: Uncategorized

Tagged as: , , ,

10 replies »

  1. It’s because of the lobbyist. Have you ever asked yourself why is it that the same lobbyist that added all the junk into this bill are now funding the GOP/TeaParty so that they get cut out the best parts?

  2. How come five or six good rules require several hundred pages of legislation? It’s the rest of the bill that’s the problem.

  3. Although I am a UK citizen and quite honestly don’t envy your health care system. I am surprised that over here and in the US many people and that includes Health Care professionals, have yet to understand that with the improvement in medicines and procedures covering most ill health conditions plus the knock on effect of the baby boom, older average age, Countries cannot sustain 100% health Care across the board. In other words it just isn’t affordable,
    This means that other methods of providing the care has to be sought, reducing overheads, health insurance etc.

  4. So Dennis just dissected one piece in order to make it sound thoroughly vetted. One good example is if you make more than $85,000 a year why shouldn’t your premium go up? Most likely you have a full time job that offers health care. As far as the rebate the article is wrong because there is a $500 reduction for all as far as the Plan D, so that is better than a rebate. The decrease in cost is not a 2011 effect it is and over all effect of the 2010 act.

  5. The way I look at it this is not perfect but it is a step in the right direction. Could have been much better, so we will have to keep pushing to get it where it needs to be. We could have at least had a public option with a clause that allowed states to opt-out but Reid kept pushing for single payer and Olympia Snowe backed out of that deal due to GOP/TeaParty pressure. The GOP/TeaParty was against the public option with and opt-out because if any state opted-out and it ended up being a success they could have seen their political landscape changed forever.

  6. WoW It’s amazing to hear someone criticize something but never say why?

    P.S. More than half the country isnregistered Democrats, but the issue is they don’t always turn out. Which is why Paul Weyrich is on video taped record saying “I don’t want everybody to vote”

  7. A pure partisan bill????………..that is about the only thing accurate in your response MD, and the democrats like with civil rights, women voting, medicare we will take you kicking and screaming into an America where 100% of the people have the same health care available to them that you do…..we are the only industrialized country that does not give health care to 100% of it’s citizens and there is a huge partisan group who likes it that way. One of the nearly 50 million and counting who until this plan, could NOT get any prevention medicine! I am now insured via my small business, where previously because of my asthma and also being a woman in Texas (the state with less women insured than any other state) I did not have health coverage. Note, not that I could not afford it, it was simply denied to me because of my pre-exsisting condition! Thank God your type of thinking is in the minority!

  8. All I can see is a whole lot of bureaucratic red tape that will need to be dealt with and paid for, thusly increasing the costs per person covered under the new bill. We need a single payer nationalized plan now. Cover everyone for less money. Yeah a whole bunch of people will be out of work, but at least they’ll have health care .

  9. This post is inaccurate and/or misleading as it relates to Medicare so I would be careful with other “facts” cited. The editorial says:

    “If you are 65 or older — (and eligible for Medicare) — seniors who are enrolled in Medicare Advantage plans (that’s Part C or the managed care part of Medicare) may have seen their premiums reduced this year. Some may even have access to ZERO premium health plans. Seniors also now receive free preventive treatments and a rebate of $500 if their drug coverage hits the “donut hole” in 2011.”

    1. Everyone 65 or over — and some people under 65 — are “eligible” for Medicare. For almost everyone, Part A is free and Part B is $100 per month. The rare exceptions are:
    — for Part A if you did not work enough SSA hours, it is not free (but you are still eligible to buy it)
    — for Part B if you make over $85,000 a year your premiums go up

    2. Many people on Parts B and D — not just some on Part C — saw their premiums decrease for 2012. And some saw them increase. ZERO-premium Part C plans have been around for years. None of the raises or decreases had any thing to do wth the 2010 Patient Protection and Affordable Care Act

    3. There is no $500 rebate if your drug costs hit the donut hole in 2011 (or 2012). There are 50% discounts on expensive brandname drugs and much smaller discounts on generic drugs if you fall into the donut hole.

  10. Pay no attention to the man behind the curtain, in this case the woman, just enjoy the lights and smoke. Really, the benefits outweigh the detriments, detriments which are sizeable and consequential by the way? A Pure partisan bill is going to benefit the majority of Americans? Hate to dissapoint the usual suspects of apology and defense, not even half of Americans are registered Democrats. Jeez, who are these people and what planet do they return to after dropping off these campaign pamphlets!?

    “Independent health policy consultant and researcher”, really? How about including a responsible disclaimer what these posters have to gain if PPACA stays as is. First Reich, now Bergthold again. To someone like me, just the big bun to smother the one antiPPACA post you had last week, interestingly NOT part of the list of active posts since you had it on for what, 2 days? We pay attention to the deeds, Mr Holt. Fair and unbiased I do not offer as adjectives of this site.