Health Care Reform

Affordable Care Act/"Obamacare"

Here you can find out more information about the Affordable Care Act (ACA), how it will impact you, and where you can find more information about implementation in your state.  One of the key provisions in the ACA is the requirement that states must set up insurance exchanges and that those exchanges must have a basic Essential Health Benefit (EHB).  The Amputee Coalition is working with advocates to ensure that prosthetic devices and custom orthotic devices are included in every state's EHB which would go toward achieving insurance fairness for amputees by ensuring adequate and affordable prosthetic care.

National Health Council Tool for Patients: Exchange Enrollment Assistance

If you have been trying to find out about the health insurance policies sold through the new state exchange, there are programs available to help you. While some marketplace websites are having technical issues enrolling people online, you can also apply by phone or through one of the three in-person programs.

The three in-person programs include: Navigators, In-Person Assisters, and Certified Application Counselors. The National Health Council has created an information tool – Enrollment Assistance Programs for the Health Insurance Exchanges –  to help you identify the right personal assistance program for you.

These three types of assistance programs work to provide insurance and eligibility information to patients in a fair, accurate, and impartial manner. You can use these unbiased assistance programs to answer your questions or concerns when shopping on the marketplace. To find a list of assistance programs in your area, visit LocalHelp.HealthCare.gov.

Remember also that the federal government's live chat feature is up and running. This resource can help people who are unable to reach an in-person assister and cannot find answers through the exchange websites. You can chat with a customer service representative by going to HealthCare.gov/contact-us/.

The National Health Council wants to ensure that patients are informed consumers when buying plans on the exchange, and that they have the necessary help to pick a plan that is appropriate for your health care needs.  Click here for the National Health Council's "Application Checklist for the Health Insurance Marketplace."

Please use these tools to learn more about the enrollment assistance options and reach out to programs in your area while shopping for plans on the health insurance exchanges.  

This toolkit is being provided for informational purposes. Please understand that Amputee Coalition staff members have not been trained as Navigators for the Affordable Care Act (ACA), and therefore are not able to give specific information about specific plans within your marketplace.  Always keep in mind that when selecting a health plan to try to select a plan that provides the best coverage for your current and future health needs.

States Continue to Move Forward on Essential Health Benefits

Almost every state is currently looking at the establishment of EHB's in their state. States are expected to announce their plans and findings by the end of 2012, and the plans will be reviewed to ensure they fully comply with the requirements laid out in the Affordable Care Act.

To find out more about the implementation of EHB's and the Affordable Care Act in your state, the Amputee Coalition encourages you to go to http://www.statereforum.org/states.  You can also find more information about the ACA here: http://www.healthcare.gov/law/index.html

What is in the Affordable Care Act?

  • Young adults can stay on their parents health insurance until 26 years of age
  • Pre-existing illnesses and conditions cannot be denied health insurance benefits
  • There is no ceiling on the cost of health care for a specific medical condition
  • Significant Medicaid expansion is called for but states do have the right to opt out without losing current benefits covered by the Federal Government
  • Medicare benefits are kept constant
  • Prescription drug costs will decrease because of the elimination of the "gap in payment that currently exists under Medicare Part D
  • You have the right to keep your employer's coverage
  • In 2014, you can purchase health insurance through your state's health insurance exchange, low to middle income individuals may be eligible for a subsidy to help pay for their health insurance costs
  • Taxpayers who don't have health insurance by January 1, 2014 will be required to pay a penalty tax on their annual tax returns.  This would not apply to individuals on Medicare, Medicaid, employer insurance, or self insured

Supreme Court Ruling June 2012

The Supreme Court of the United States (SCOTUS) found major provisions in the Patient Protection and Affordable Care Act (ACA) to be constitutional. The court has ruled that the individual mandate that virtually all Americans buy health insurance is constitutional. Although the mandate was not upheld on the grounds that Congress could use its power to regulate commerce between the states, five justices, including Chief Justice Roberts, and Justices Ginsburg, Breyer, Sotomayor and Kagan, ruled that it is constitutional to require someone to pay the tax penalty if they refuse to buy insurance under Congress' authority to impose its taxing power. This penalty upholds the individual mandate portion of the ACA.

Due to the fact that the Court has ruled that the Mandate is constitutional, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn't comply with the new requirements, rather than all of their Medicaid funding.

The ruling on Medicaid will result in some changes to the implementation of the law and how states go about expanding of the Medicaid program. States deciding to forego Medicaid expansion will not be putting in jeopardy all of the Medicaid funds only the additional dollars that were set aside for the expansion. The remainder of the law is upheld which will result in the Department of Health and Human Services to continue to move forward with the development of rules, regulations, and the implementation schedule as laid out in the law.

To this end, the Amputee Coalition will continue to work toward ensuring that prosthetic and custom orthotic devices are deemed Essential Health Benefits which would require base coverage for the devices in all insurance plans. The Court's ruling also upholds the provision that individuals cannot be denied coverage based on a pre-existing condition.

To read the Court's decision in its entirety, you can see it on the Court's website here: http://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf
With the re-election of President Barack Obama, it appears likely that health care reform will continue to move forward as previously outlined by the administration.

More Resources:

www.healthcare.gov
www.statereforum.org
Link to full text
Supreme Court opinion

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