ACA Update: Moving Forward with the Affordable Care Act

By Emily McKinley, Health Information Specialist

Shortly after the election, President Obama and his administration showed the nation that health care remained a priority by issuing three proposed rules, which regulate the implementation of health care reform. Those rules included guidelines prohibiting discrimination against individuals with chronic diseases and pre-existing conditions; parameters outlining the standards of coverage in regards to essential health benefits; and measures to encourage expansion of employee wellness programs.

The first rule, prohibiting insurance market discrimination on the basis of pre-existing conditions and chronic illnesses has been a long anticipated provision of the ACA. This rule will be fully implemented in 2014. It outlines that Americans will be guaranteed insurance coverage regardless of previous or current health, treatments, or other factors, and further guarantees that individuals will be able to maintain their coverage even in the event of illness. The rule also ensures that fair insurance premiums will be assigned. That is to say, insurance premiums cannot be adjusted for factors such as health, gender, or length of coverage. They will be adjustable on the grounds of family size, geography, age, and tobacco use. The variations in premiums based upon those factors will be regulated and cannot exceed certain thresholds. This rule goes further to protect consumers in that it will require health insurers to maintain a single, statewide, risk pool for both small business and individual insurance markets. This measure is designed to prevent insurers from breaking the pools into smaller, higher risk pools in order to manipulate premiums.  This rule also includes guidelines for catastrophic plans—those in which individuals may have the option to pay relatively low premiums in order to avoid high out-of-pocket costs. These individuals would still have access to preventative services without cost sharing but may have minimum coverage for other, minor illness expenses.

The second proposed rule expands upon the regulations issued with regard to essential health benefits. This rule was not only designed to ensure the implementation of essential health benefits but also to help consumers understand the coverage offered in each plan, which serves to make the plans more easily compared. Moreover, this rule continues to offer states flexibility in the overall design and expansion of their Medicaid programs so long as the plans meet the benchmarks established by the ACA.

Finally, the Obama administration issued a third rule outlining regulations regarding the expansion and promotion of employment-based wellness plans. These plans encourage employers and employees to participate in a variety of wellness programs, such as fitness courses, smoking and tobacco cessation programs, and others, by offering a variety of incentives. The rule establishes that these programs must be designed in a non-discriminatory way, such that all employees have equitable opportunities and incentives to participate in some fashion, regardless of baseline health.

For more information about these rules, please visit http://www.hhs.gov/news/press/2012pres/11/20121120a.html. Additional information about the ACA can be found at http://www.healthcare.gov or by contacting Family Voices Indiana at 317.944.8982 or info@fvindiana.org.