The recent decision of the U.S. Supreme Court upholding the Patient Protection and Affordable Health Care Act (ACA) has generated a flurry of interest and controversy over the law. Like our health care system, the act is long and, at times, confusing.
Myths and fears about the law abound. This column will attempt, without advocating for or against the law, to dispel a few of the myths and alleviate some of the fear.
Myth: The Supreme Court’s finding that the ACA is constitutional as a tax means the act is going to raise my taxes.
Measure: The fact that we are a nation of laws does not mean that our system of laws is simple or immediately clear. Under our system of laws, a measure can be deemed a tax for one purpose while at the same time be deemed a penalty for other purposes. Admittedly, this is not an easy concept to wrap your head around.
However, that is exactly the case with the ACA provision that non-exempt persons who do not purchase insurance will have to pay a certain amount for making that choice. The Supreme Court found this amount was a tax, for purposes of determining the law was constitutional, in part because this portion of the law is administered by the IRS. For practical purposes, this measure is a penalty because only those who not purchase insurance will be penalized.
If you currently have health insurance and retain it, you will not have to pay the penalty. The ACA will not cause anyone to pay more taxes than they currently pay. Even those who decide to go without insurance will not see their taxes raised. They will have to pay the penalty assessed by the law for not purchasing insurance.
Myth: I will not be able to keep my present insurance coverage under ACA even if I am happy with it.
Measure: The new health care law will allow you to keep your current health insurance. Insurance plans in existence on March 23, 2010, will be “grandfathered” in. ACA protects you in several ways. The insurance company cannot significantly reduce benefits, it cannot significantly increase co-pays or deductibles and it cannot lower employer contributions more than 5 percent of the grandfathered plan.
Insurance companies cannot lower annual insurer caps on benefits in grandfathered plans. Companies are not allowed to add an annual cap to a grandfathered plan that does not already have one unless the plan has a lifetime cap and the annual cap is being replaced by the annual cap that is at least as high as the lifetime cap.
Although the grandfathered plans are exempt from some of the new law’s requirements, even these plans cannot put lifetime limits on their plans or rescind coverage for an unintentional mistake in an application for coverage. Furthermore, these grandfathered plans must extend parents’ coverage to children up to age 26.
Myth: Under the new health care law the premiums under my current plan will skyrocket.
Measure: The ACA contains provisions designed to allow all Americans to obtain affordable insurance. The Secretary of Health and Human Services is given power under the act to post on the Web the portion of premium dollars an insurance company pays out for care as opposed to the portion it spends for promotion or profit.
The law requires insurance companies who spend too much on salaries and other non-care related expenses to pay its customers a rebate. Also, the law contains provisions to strengthen the ability of states to identify and crack down on unreasonable rate increases by insurance companies.
Myth: The ACA rather than my doctor will prescribe my treatment options.
Measure: Nothing in the new health care bill interferes with the relationship between you and your physician. Nor does the ACA dictate the treatment he or she prescribes. Tim Butterworth, an Institute for Policy Studies associate fellow and a New Hampshire state representative, stresses this. He cautions, however, that factors have nothing to do with the health care law may be influencing what treatment you are offered.
According to Butterworth, these factors include drug companies who track the doctor’s prescriptions and offer awards for prescribing their pills, hospitals who have purchased expensive equipment like MRI machines who offer doctors a bonuses for ordering tests using this equipment, insurance companies who refuse to pay for certain treatments they deem experimental, and bosses, doctors or hospitals that block certain treatments for religious reasons.
Myth: The ACA is going to cause me to lose my Medicare benefits.
Measure: Under the ACA everyone on Medicare keeps the same guaranteed benefits. The health care law adds some new benefits. ACA gradually closes the prescription drug coverage gap, the so-called “doughnut hole.”
Under the health care act an array of preventative care services are provided with no co-pay required. These free services include cardiovascular screening tests, breast cancer screening/mammograms, pap smears, pelvic exams, bone density tests, sigmoidoscopy and colonoscopy to screen for colorectal cancer, flu shots, Hepatitis B shots, HIV screening, abdominal aortic aneurysm screening and medical nutritional therapy.
Medicare will pay for an “Annual Wellness Visit” in which recipients will be given a comprehensive health risk assessment from which they can develop a prevention plan with their doctor. The health care law adds incentive to improve access to primary care doctors by providing a 10 percent bonus to primary care doctors and nurses for quality care and extra payment to doctors and nurses who provide primary care in areas of the country doctors are in short supply.
Myth: If Texas refuses to offer expand Medicaid benefits to those within 133 percent of poverty level income, the Federal government will withhold all funding for the current Medicaid program in the state.
Measure: The U.S. Supreme Court removed from the ACA the provision which allowed the Secretary of the Treasury to withhold all Medicaid funding from states who refused to expand their Medicaid programs to those within the 133 percent of poverty level income. Therefore, should Texas refuse to expand its Medicaid program, it will forfeit only those funds which would have paid for the expansion but will retain all other Medicaid funds.
Should Texas agree to expand its Medicaid program under ACA, the federal government will pay 100 percent of that expansion cost until 2016. Thereafter, the federal government’s program will be reduced over time to a minimum of 90 percent.
This column attempts to address a few thorny questions about the Affordable Care Act in a simplified fashion. Where I have failed to make a point clear and understandable, I hope you will favor me with your questions by phone at 254-797-0211 or by e-mail at firstname.lastname@example.org.
Sandra W. Reed is an attorney with Katten & Benson, an elder law firm in Fort Worth. She lives in beautiful Somervell County, near Chalk Mountain.