Where we stand after federal health care reform law’s first year
BY MONIFA THOMAS March 21, 2011 8:04PM
Updated: August 4, 2011 4:20PM
Nearly one year after federal health care reform was signed into law, the Affordable Care Act has introduced a number of consumer-friendly reforms to the insurance market.
Yet, the bulk of the law’s major provisions have yet to kick in. And the constitutionality of the so-called “individual mandate” requiring most Americans to buy health insurance is still being debated in the courts.
Here’s an overview of some of the most tangible changes so far for various groups:
Seniors
More than 130,000 Illinois Medicare beneficiaries who hit the prescription drug coverage gap known as the “doughnut hole” received a one-time $250 tax-free rebate last year, according the U.S. Department of Health and Human Services. Seniors who hit the doughnut hole this year will receive a 50 percent discount on all brand-name drugs. Starting this year, annual wellness exams for Medicare recipients are covered free of charge. In addition, the law provides financial assistance for employers to maintain health coverage for early retirees who are not yet eligible for Medicare. More than 300 Illinois-based companies received nearly $41 million in funding for early retiree insurance last year.
Children and young adults
Under the law, insurance companies can no longer deny health insurance to children because they have a pre-existing medical condition. That provision is expected to help an estimated 226,900 children in Illinois, according to an analysis released Monday by the consumer group Families USA. Young adults who do not have employer-sponsored health coverage can also stay on their parents’ insurance plan until they’re 26, a change that should help more than 130,000 uninsured young adults in the state, Families USA estimates.
People with pre-existing conditions
States were required to set up temporary high-risk insurance pools for people who can’t get affordable coverage because of a pre-existing condition. Illinois was allocated $196 million in federal funding to set up its pool, which launched in August and is expected to cover 4,000 to 6,000 people who had been uninsured for at least six months, according to the Illinois Department of Insurance. That’s a fraction of the Illinois residents estimated to be living with chronic conditions. But it provides a bridge until 2014, when the pools will be replaced with state-based insurance exchanges that will let people shop for low-cost health insurance.
For the general population, health reform also created new rules barring insurance companies from setting lifetime coverage limits for most benefits or canceling coverage because of mistakes made on insurance applications.
Still, many Americans will have to wait until 2014 to see the impact of health reform. That’s when, in addition to the creation of the exchanges, insurance companies would no longer be able to refuse coverage to anyone based on a pre-existing condition. Medicaid eligibility would be widened to an estimated 500,000 to 800,000 low-income Illinois residents, according to the Illinois Health Care Reform Implementation Council. And income-based tax credits would help low-income or unemployed adults pay for affordable coverage through the newly-created exchanges.
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