WHAT WOMEN GAIN
- Some 32 million more individuals will gain access to health care coverage. It is estimated that the vast majority in the United States, some 95% will gain coverage. Undocumented immigrants, however, will still not have access.
- The new law provides a major advance for women – a Title IX for health care. The law bans discrimination based on sex, race, national origin, ethnicity, age or disability by any health program or activity which receives federal financial assistance. It states that, with a few exceptions specified in the law, an individual can not “be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any health program or activity, any part of which is receiving federal financial assistance.” It explicitly cites Title IX of the Education Amendments of 1972 which prohibits sex discrimination in federally funded education programs; Title VI of the Civil Rights Act which prohibits race discrimination; the Age Discrimination Act of 1975 and the Rehabilitation Act of 1973.
Gender Discrimination in Pricing will be Eliminated
- Typically, in most states, women with plans, pay on the average some 48% higher premiums than men for the same health insurance coverage. This practice, called gender rating, will be prohibited for individual or group plans for employers with less than 100 employees.
No Charge for Preventive Care
- Starting in 2010, every new insurance policy will be required to include a basic preventive health care package that includes pap smears, mammograms and immunizations without co-pays or deductibles.
Caps on Benefits Eliminated
- Lifetime caps on benefits will be eliminated immediately and annual limits will be eliminated in 2014. Prior to 2014, plans may only implement restricted annual limits. These limits will be defined by the Secretary of Health and Human Services.
Discrimination Based on Pre-Existing Conditions Eliminated
- Exclusions for pre-existing conditions will be eliminated for children beginning this year and in 2014 for adults. A temporary high risk insurance pool program will be established to cover eligible adults until 2014. This will prevent the exclusion of coverage for the condition of pregnancy, injuries caused by domestic violence, the second or more caesarian deliveries, re-occurrence of breast cancer, etc.
Bans Recision of Coverage for Illness
- Insurers are not allowed to drop someone as soon an illness is diagnosed or a claim is made.
Extended Coverage for Adult Daughters and Sons
- Beginning this year, young people can remain on their parent’s family coverage until age 26 whether or not they are married and whether or not they are employed.
Mental Health Parity
- Plans in the health insurance exchange will be required to provide mental health coverage beginning in 2014.
Benefits for Older People
- Medicare guaranteed benefits are not reduced.
- The Medicare prescription drug “Donut Hole” will be reduced starting with a $250 payment to beneficiaries this year. By 2020, beneficiary payments will be reduced to 25% of drug costs in the gap.
- Beginning in 2011, Medicare will cover full cost of preventive care, including cancer screenings, annual physical examinations and immunizations.
For Women without Insurance Coverage
- Beginning in 2014, an estimated 16 million people will gain access to coverage through expansion of Medicaid and the Children’s Health Insurance Programs (SCHIP). Currently, Medicaid only covers pregnant women, children under 8, the elderly, disabled and blind who earn less than 100% of the federal poverty level (currently $10,830 for an individual and $22,050 for a family of three). The new act extends coverage to individuals under 65 who are not entitled to, or enrolled in Medicare and have incomes at or below 133% of the poverty level.
Provides Accessibility of Affordable Health Insurance
- Beginning in 2014, an additional 24 million people will be able to purchase health insurance at group rates through state exchanges. Most citizens and legal residents will be required to purchase health insurance, but federal subsidies will be provided for some 75% of these individuals whose incomes are between 133% and 400% of the federal poverty level. Employers with more than 50 employees will be required to offer health insurance coverage or pay a penalty of $2,000 per employee. Small businesses with less than 25 employees will receive tax credits for providing coverage.
Discrimination against Lower Paid Employees Ban
- Employers will not be able to provide plans with less coverage to lower-paid workers, who are more likely to be women or people of color.
Addresses National Nursing and Primary Care Physicians Shortage
The law increases the numbers of nursing education slots, providing loan repayments and retention grants and offering grants for employment and training of family nurse practitioners. It provides scholarships, loan programs and bonus payments to private care physicians and general surgeons. It also expands health accessibility by doubly the capacity of community health centers. New programs will increase support for school-based and nurse-managed health centers.
1. H.R.3590, The Patient Protection and Affordable Health Care Act
2. H.R.4872, the Health Care and Education Reconciliation Act of 2010
3. White House Blog 3/23/10 http://www.whitehouse.gov/blog/2010/3/23/whats-health-care-bill
4. http://dpc.senate.gov/healthreformbill/healthbill96.pdf U.S. Census Bureau.