This week, our country made history. We achieved what presidents since Teddy Roosevelt have attempted — to pass comprehensive health insurance reform to help the American people. This is a victory for all Coloradans.
This legislation is the single greatest deficit reduction package since President Bill Clinton’s 1993 budget, which ushered in an era of budget surpluses and economic growth. It will reduce the deficit by more than a trillion dollars in the next 20 years and put us back on a path to fiscal responsibility, all while providing coverage to 95 percent of Americans.
The Patient Protection and Affordable Care Act and the Reconciliation Act of 2010 will offer immediate benefits to millions of Americans through key provisions including:
■ Small business tax credits: Offers tax credits to small businesses to make employee coverage more affordable. Tax credits of as much as 35 percent of premiums will be immediately available to firms that choose to offer coverage. Effective beginning for calendar year 2010. Beginning in 2014, the small business tax credits will cover 50 percent of premiums.
■ Begins to close the Medicare Part D doughnut hole: Provides a $250 rebate to Medicare beneficiaries who hit the doughnut hole in 2010. Effective for calendar year 2010. Beginning in 2011, institutes a 50 percent discount on brand-name drugs in the dougnut hole; also completely closes the doughnut hole by 2020.
■ Free preventative care under Medicare: Eliminates co-payments for preventive services and exempts preventive services from deductibles under the Medicare program. Effective beginning Jan. 1, 2011.
■ Help for early retirees: Creates a temporary re-insurance program (until the exchanges are available) to help offset the costs of expensive premiums for employers and retirees for health benefits for retirees ages 55 to 64. Effective 90 days after enactment.
■ Ends rescissions: Bans insurance companies from dropping people from coverage when they get sick. Effective six months after enactment.
■ No discrimination against children with pre-existing conditions: Prohibits new health plans in all markets plus grandfathered group health plans from denying coverage to children with pre-existing conditions. Effective six months after enactment. Beginning in 2014, this prohibition would apply to all persons.
■ Bans lifetime limits on coverage: Prohibits health insurance companies from placing lifetime caps on coverage. Effective six months after enactment.
■ Bans restrictive annual limits on coverage: Tightly restricts the use of annual limits to ensure access to needed care in all new plans and grandfathered group health plans. These tight restrictions will be defined by HHS. Effective six months after enactment. Beginning in 2014, the use of any annual limits would be prohibited for all new plans and grandfathered group health plans.
■ Free preventive care under new private plans: Requires new private plans to cover preventive services with no co-payments and with preventive services being exempt from deductibles. Effective six months after enactment.
■ New, independent appeals process: Ensures consumers in new plans have access to an effective internal and external appeals process to appeal decisions by their health insurance plan. Effective six months after enactment.
■ Ensures value for premium payments: Requires plans in the individual and small group market to spend 80 percent of premium dollars on medical services, and plans in the large group market to spend 85 percent. Insurers that do not meet these thresholds must provide rebates to policyholders. Effective Jan. 1, 2011.
■ Immediate help for the uninsured until exchange is available (interim high-risk pool): Provides immediate access to affordable insurance for Americans who are uninsured because of a pre-existing condition through a temporary subsidized high-risk pool. Effective 90 days after enactment.
■ Extends coverage for young people up to 26th birthday through their parent’s insurance: Requires new health plans and certain grandfathered plans to allow young people up to their 26th birthday to remain on their parent’s insurance policy, at the parent’s choice. Effective six months after enactment.
■ Community health centers: Increases funding for Community Health Centers to allow for nearly a doubling of the number of patients seen by the centers in the next five years. Effective beginning in fiscal year 2010.
■ Increasing number of primary care doctors: Provides new investment in training programs to increase the number of primary care doctors, nurses and public health professionals. Effective beginning in fiscal year 2010.
■ Prohibits discrimination based on salary: Prohibits group health plans from establishing any eligibility rules for health care coverage that have the effect of discriminating in favor of higher wage employees. Effective six months after enactment.
■ Health insurance consumer information: Provides aid to states in establishing offices of health insurance consumer assistance in order to help individuals with the filing of complaints and appeals. Effective beginning in fiscal year 2010.
■ Creates new, voluntary, public long-term care insurance program: Creates a long-term care insurance program to be financed by voluntary payroll deductions to provide home and community-based services to adults who become functionally disabled. Effective on Jan. 1, 2011.
Pat Waak is chairwoman of the Colorado Democratic Party and has served as assistant director for the Center for Population and Family Health at Columbia University.