What's Happening With The Healthcare Reform Law?

The Patient Protect and Affordable Care Act (Affordable Care Act) was passed last year to enable millions of Americans to obtain health insurance. Starting on January 1, 2011, important provisions of the healthcare reform law will go into effect. However, some of the most major changes like the requirement that everyone buy health insurance and the establishment of state health insurance exchanges will not be in effect until 2014. Other changes were instituted last year, including the prohibition on health insurers to discriminate based on a person’s pre-existing condition. Many of these changes will benefit transgender individuals, who face barriers to accessing medical care and health insurance coverage. Here are some of the changes that will begin this year:

• Medical-loss ratio requirements for insurers.

Health insurers must spend at least 80% of the premiums that they receive for medical care, instead of keeping that money for profits or administrative costs (85% for the large group market). If they fail to do so, they are required to issue refunds to their customers.

• Closing Medicare’s donut hole.

The term “donut hole” refers to Medicare Part D’s coverage gap once beneficiaries reach a certain threshold. Part D provides prescription drug coverage for seniors. The Affordable Care Act has several provisions to close the donut hole. The law requires pharmaceutical companies to provide Medicare beneficiaries a 50% discount on brand- name drugs. Additionally, the law progressively closes the gap over time by gradually increasing federal subsidies for generic prescriptions so that the donut hole will no longer exist by 2020.

• The Community Living Assistance Services and Supports (CLASS) Act.

The CLASS Act creates a new voluntary, national long-term care insurance program. By 2012, individuals who are over 18 years of age and employed at least part-time can buy insurance to help pay for long-term care if they become disabled.

• Health home payments.

Some states allow beneficiaries to obtain long-term care services at home. Since these home-care programs are underfunded, the Affordable Care Act requires the federal government to provide extra funding to these programs.

• Flexible Spending Accounts (FSAs).

The rules for FSAs have changed so that costs for over-the-counter drugs will not be reimbursed unless prescribed by a doctor. Please refer to NCTE’s document on FSAs. The Kaiser Family Foundation has a useful timeline for the Affordable Care Act here: http://healthreform.kff.org/timeline.aspx