Six Months After Enactment – Do You Know How Health Reform Will Affect You?

Health reform is back in the news this week.  Why?  Today marks the six-month anniversary of the President signing this landmark legislation into law and several of the most-talked about and popular provisions of the law take effect today.

The provisions taking effect today that impact the colorectal cancer community are:

Coverage of Preventive Services: New plans must provide dozens of preventive services – including colonoscopies – without charging a copayment (any preventive service with an A or B rating from the Unites States Preventive Services Task Force must be covered).
Why This Is Important: Eliminating cost sharing requirements for preventive colorectal cancer screening will lower the cost of screening services for individuals which will help to increase population-based screening rates thereby helping to lower the incidence and mortality rates from this disease that is preventable and treatable if caught early.
Loophole: The law waives the deductible when a screen turns diagnostic, but not the co-pay. The Colorectal Cancer Coalition believes a fix needs to be enacted so that the co-pay is waived for a screening colonoscopy when it turns therapeutic.

Elimination of Lifetime Limits: No lifetime limits on benefit payouts.
Why This Is Important: Many colorectal cancer patients face a lifetime of cancer treatment. Caps on insurance result in very difficult decisions about the care they will receive and how they are going to pay for it.
Loophole: Lifetime limits are still generally permitted to the extent that the benefits are not “essential health benefits.” Future regulations will define the term “essential health benefits.” For now, the term includes at least the following categories of service: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services; prescription drugs; rehabilitative services and devices; laboratory services; preventive and wellness services and chronic care management; and pediatric services.

Elimination of Annual Limits: Begins to phase out annual limits on benefit payouts, starting by making the limit no less than $750,000. While the lifetime prohibition is immediate, the prohibition against annual dollar limits is phased in through 2014 for “essential health benefits.”
Why This Is Important: See above – same reason that the elimination of lifetime limits is important.
Loophole: May be limited in some cases. Employers whose plans don’t meet requirement can apply each year for a waiver. Individual plans that are grandfathered are also exempt.

Prohibition Against Recissions: The Affordable Care Act prohibits health insurance plans from dropping you or reducing your benefits if you become sick. Applies to both grandfathered and non-grandfathered plans.
Why This Is Important: Newly diagnosed patients will no longer have to worry that they might lose their health insurance coverage because of their cancer diagnosis.

A lot of attention has focused on the elimination of pre-existing condition exclusions. Eliminating pre-existing conditions exclusions is very important for cancer patients. Pre-existing condition exclusions lock the millions of Americans with at least one chronic illness (nearly one third of the population) into existing plans and employment. While this provision takes effect for children today, it is phased in and it is not until 2014 that all group health plans will be prohibited from imposing any pre-existing condition exclusions on children and adults.

Read more about the provisions taking effect today in a special guest blog from Jay Angoff, Director of the Office of Consumer Information and Insurance Oversight “Six Months of the Affordable Care Act: Rights and Protections for Cancer Patients.”

And to learn more about provisions that have already taken effect, and about the provisions that are still to come and will be phased in until the Affordable Care Act fully takes effect in 2018 take a look at our Health Reform and You Webpage.

And remember there is still work to be done! Even after all the provisions of the Affordable Care Act take effect in 2018, many Americans may be newly insured but will still fail to receive the right treatment at the right time. The Colorectal Cancer Coalition continues to support research to help develop new treatments and to support efforts to increase awareness about the importance of early detection and screening.