Saturday, June 30, 2012

Understanding "Obamacare"

This site has information on what the Affordable Care Act does, in understandable language. I have included some highlights of the provisions already in effect.

http://www.reddit.com/tb/vbkfm

What people call "Obamacare" is actually the Patient Protection and Affordable Care Act. However, people were calling it "Obamacare" before everyone even hammered out what it would be. It's a term mostly used by people who don't like the PPACA, and it's become popularized in part because PPACA is a really long and awkward name, even when you turn it into an acronym like that.

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Already in effect:

It allows the Food and Drug Administration to approve more generic drugs (making for more competition in the market to drive down prices)

It increases the rebates on drugs people get through Medicare (so drugs cost less)

It establishes a non-profit group, that the government doesn't directly control, PCORI, to study different kinds of treatments to see what works better and is the best use of money.

It makes a "high-risk pool" for people with pre-existing conditions. Basically, this is a way to slowly ease into getting rid of "pre-existing conditions" altogether. For now, people who already have health issues that would be considered "pre-existing conditions" can still get insurance, but at different rates than people without them.

It forbids insurance companies from discriminating based on a disability, or because they were the victim of domestic abuse in the past (yes, insurers really did deny coverage for that)

It says that health insurance companies can no longer tell customers that they won't get any more coverage because they have hit a "lifetime limit". Basically, if someone has paid for health insurance, that company can't tell that person that he's used that insurance too much throughout his life so they won't cover him any more. They can't do this for lifetime spending, and they're limited in how much they can do this for yearly spending.

Kids can continue to be covered by their parents' health insurance until they're 26.

No more "pre-existing conditions" for kids under the age of 19.

Insurers have less ability to change the amount customers have to pay for their plans.

People in a "Medicare Gap" get a rebate to make up for the extra money they would otherwise have to spend.

Insurers can't just drop customers once they get sick.

Insurers need to have an appeals process for when they turn down a claim, so customers have some manner of recourse other than a lawsuit when they're turned down.

Anti-fraud funding is increased and new ways to stop fraud are created.

A limit is placed on just how much of a percentage of the money an insurer makes can be profit, to make sure they're not price-gouging customers.

A limit is placed on what type of insurance accounts can be used to pay for over-the-counter drugs without a prescription. Basically, your insurer isn't paying for the Aspirin you bought for that hangover.

Any new health plans must provide preventive care (mammograms, colonoscopies, etc.) without requiring any sort of co-pay or charge.

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