Healthcare Reform Act Q&A

What is the Affordable Care Act (ACA)?

The Patient Protection and Affordable Care Act, more commonly known as the Affordable Care Act, is federal health reform legislation that was enacted on March 23, 2010. The law includes many provisions to help patients with liver disease obtain and maintain health insurance, receive high quality health care and promote research.

Why was the law needed?

Prior to the passage of the ACA, there were 49.9 million Americans without health insurance.

The Congressional Budget Office predicts that 32 million more people will have insurance by 2019 because of the ACA. Besides providing insurance coverage for more Americans, the ACA also protects those with insurance through an extensive patients’ bill of rights that includes prohibitions that prevent insurance companies from dropping individuals when they become sick and ensuring those with pre-­‐existing conditions will no longer be denied coverage.

What does the ACA mean for individuals with liver disease?

The ACA includes provisions that remove lifetime limits on benefits and address drug costs for Medicare beneficiaries. Before the rules about pre-­‐existing conditions for those over the age of 19 take effect in 2014, the law establishes the Pre-­‐Existing Condition Insurance Plan (PCIP), an interim measures, to provide coverage for those unable to obtain coverage prior to ACA’s passage. Also, individuals with liver disease cannot be charged higher health insurance premiums because of their conditions.

What does the ACA mean for children with liver disease?

Children under 19 with liver disease cannot be denied coverage because of their condition.

Also, young adults are allowed to remain on their parent’s insurance plans until age 26.

What does the ACA mean for seniors with liver disease?

Seniors with liver disease on Medicare will receive new benefits. Since the implementation of Medicare Part D, seniors who reached the “donut hole” were responsible for the full cost of their prescription drugs. The ACA is slowly facing out this coverage gap, and by 2020, seniors will only be responsible for 25 percent of the cost of their drugs in the donut hole.

American Liver Foundation  39 Broadway, Suite 2700, New York, NY 10006-3003  Tel: 212-668-1000  Fax: 212-483-8179 HelpLine: 800-GO-LIVER (800-465-4837)  www.liverfoundation.org

The ACA also created a new Annual Wellness Visit in Medicare. Beneficiaries are entitled to one AWV per year without any cost sharing. During this visit, patients will meet with their primary care physician to identify health risks and develop a personalized prevention plan. This visit will be integral helping patients with liver disease manage their condition and prevent developing complications from their condition.

Also, Medicare beneficiaries will receive preventive services rated A or B by the United States Preventive Services Task Force (USPSTF) free of charge.

How does the law impact low income individuals?

Individuals and families with incomes up to 133 percent of the poverty level will be eligible for Medicaid beginning in 2014. States who opt to participate in the expansion will receive federal funds for the Medicaid expansion.

Will patients with liver disease have to pay more for insurance?

Once the ACA is fully implemented, insurance companies will no longer be able to charge higher rates because a patient has liver disease or any other condition.

I need to buy my own health insurance. How does the ACA impact my ability to do so?

Beginning in 2014, individuals will be able to buy insurance from the newly established health insurance exchanges which will provide insurance to individuals and small employers with less than 100 employees in each state. All insurance plans offered in the exchanges will be required to cover a defined set of essential benefits. If your state does not establish a health insurance exchange, the federal government will provide access to one.

How did the Supreme Court decision impact the implementation of the ACA? The Supreme Court upheld the individual mandate and the Medicaid expansion in the ACA, but prohibited the federal government from withholding all Medicaid funding if a state opts not to participate in the Medicaid expansion. Those states that opt not to participate in the Medicaid expansion will continue to receive federal funding for their Medicaid program, but will not receive the additional funds meant to expand Medicaid coverage in the state.

American Liver Foundation  39 Broadway, Suite 2700, New York, NY 10006-3003  Tel: 212-668-1000  Fax: 212-483-8179 HelpLine: 800-GO-LIVER (800-465-4837)  www.liverfoundation.org