This is the beginning of a dramatic expansion of health care access, eventually adding coverage for 32 million people, increasing access to family planning and preventive care, and starts to limit some of the most despicable insurance company practices, said Eleanor Smeal, president of the Feminist Majority Foundation. “But women were forced to pay a price. Abortion was the only medical procedure singled out with punitive restrictions. We must repeal the Hyde Amendment,” said Smeal. Right to lifers in Congress held health care reform hostage at critical stages in the legislative process. Led by Representatives Bart Stupak (D-MI) and Joseph Pitts (R-PA), they managed to win abortion restrictions that go beyond the Hyde Amendment, which prohibits the use of federal funds for abortion services except in cases of rape, incest, or impending death of the woman. Stupak and his dwindling band of right-to-lifers tried to get more restrictions in the legislation. But, the pro-choice caucus, led by Representatives Diana DeGette (D-CO) and Louise Slaughter (D-NY) and pressure from the pro-choice groups prevented it. At the last minute, President Obama agreed to sign an executive order implementing the Nelson so-called “compromise” abortion restrictions in the Act to win Stupak’s and a dwindling group of 4-5 anti-abortion Democrats’ votes. The executive order does not go beyond the Nelson amendment. And what many reports have ignored is that contraceptives are covered and millions more women will gain access to family planning. As President Obama signs this morning the Patient Protection and Affordable Care Act, it is important we review the major provisions. Some important provisions go into effect in 2010. Here are some highlights of the final health reform bill: – Denial of coverage for pre-existing conditions will be eliminated within six months for children. Within three months there will be a high-risk pool created to enable adults with pre-existing conditions to obtain affordable coverage, and insurance denials for adults with pre-existing conditions will be banned in 2014. – Lifetime caps on coverage will be eliminated immediately, and restrictive annual limits will be capped. When the insurance exchanges begin operating in 2014, no caps will be allowed. – The practice of dropping an insurance policy as soon as an illness is diagnosed or a claim is made, known as rescission, will be banned immediately. – Beginning this year, young people can remain on their parents’ health insurance policy until age 26 if they are not covered through an employer plan. – This year the “donut hole” in Medicare prescription drug coverage will begin to close, beginning with a modest payment of $250 for those who are in the donut hole. – There will be a package of required basic benefits for every new insurance policy, including preventive care like PAP tests and mammograms without co-pays or deductibles, prescription drugs including contraception, and specifically including maternity coverage, which today is not covered by most individual policies. – Gender rating in premiums will be eliminated for individuals or group plans for employers with less than 100 employees, a significant relief for women who can pay up to 48 percent higher premiums for the same coverage. Currently, there are no limits to how much older people can be charged in premiums, compared to younger people. In the new bill, this “age rating” will be limited to 3 to 1. – Discrimination in favor of higher-paid employees will also be banned, so that employers will not be able to give lesser plans to lower-paid workers, who are more likely to be women and people of color. – The program will require most citizens and legal residents to have health insurance coverage, and will create state-based exchanges through which individuals can purchase coverage. There will be premium and cost-sharing subsidies available to those with incomes between 133 percent and 400 percent of the federal poverty level. The insurance exchanges will open in 2014. – Beginning in 2014, about 15 million people will gain access to coverage through Medicaid. Today, Medicaid only includes pregnant women, children under 8, the elderly, blind and disabled, living under the federal poverty level. Under the new act, all people living at less than 133 percent of the federal poverty level (e.g. $18,310 for a family of three in 2009) will have health care through Medicaid. – The same year an additional 17 million people will be able to purchase insurance at group rates through the to-be-established state insurance exchanges. The program will require most citizens and legal residents to purchase health insurance coverage, but it is estimated that initially about 90 percent of those purchasing insurance through an exchange will receive federal subsidies or premium credits to make it affordable. These credits will be available to those whose income is between 133 percent and 400 percent of the federal poverty level (approx. $55,000 for a family of three). – Also in 2014, all employers with more than 50 employees will be obligated to provide insurance coverage for their employees, or pay a penalty of $2000 per employee. – There will be a formal appeal process for consumers to challenge claim rejections and other unfair insurance practices, with funding to help consumers protect their rights. – Under the so-called Nelson Compromise, abortion access is restricted in the to-be established insurance exchanges (beginning in 2014). Abortions cannot be covered by any federal subsidy or funding in accordance with current law (Hyde Amendment), but individuals may buy insurance plans in the insurance exchanges that offer abortion coverage as long as they pay for it with their own money. To “segregate” the payments in plans providing abortion coverage, the Nelson language requires that the policyholder must make two payments, one for the bulk of the coverage and a second minimal amount to an allocation fund that would include the abortion coverage. Individual states may “opt-out” of this provision allowing abortion coverage, but only if they pass a new law prohibiting their Insurance Exchange from including plans that cover abortion services. The executive order on abortion restrictions from President Obama implements the Nelson provisions already in the bill. For additional detailed analysis, please see a fact sheet from the Kaiser Family Foundation (see PDF).