Healthcare Reform 101
In March 2010, the Affordable Care Act (ACA) was signed into law. The intent of the bill is to lower healthcare costs, increase access to healthcare and enhance the quality of healthcare for all Americans. In fact, healthcare reform impacts different groups and individuals differently.
What Is Healthcare Reform?
“Healthcare reform” generally refers to the collective overhaul of the United States’ healthcare and insurance system that began to be implemented in 2010.
In March 2010, a comprehensive healthcare reform law was enacted in two parts: The Patient Protection and Affordable Care act was signed into law March 23, 2010, and was amended by the Health Care and Education Reconciliation Act on March 30, 2010. The name “Affordable Care Act” (ACA) is used to refer to the final amended version of the law.
The goal of ACA is to lower healthcare costs, increase access to healthcare and enhance the quality of healthcare for all Americans. Learn the specifics of the law
How Will It Affect Me As a PH Patient or Caregiver?
According to the Congressional Budget Office, the legislation will provide coverage to 32 million currently uninsured Americans - a leap toward the vision that every PH patient will have healthcare that is universal, continuous (portable), affordable, sustainable and accessible.
The ACA does not fully address all the concerns of the PH community. However, many of the ACA's provisions align with PHA's long-standing advocacy initiatives to improve the quality of care for PH patients.
The ACA includes provisions that:
- Prohibit insurers from rescinding (canceling) policies once a beneficiary becomes sick
- Establish high-risk pools for people with pre-existing conditions who have been uninsured for at least six months
- Eliminate pre-existing condition exclusions for people 19 years of age and younger
- Eliminate lifetime caps
- Require insurance coverage of routine patient care costs associated with clinical trials
- Require insurers to allow young adults to stay on their parents’ policy until age 26
- Gradually phase-out the Medicare Part D “donut hole” (began in 2010 and completely phases out in 2020)
- Require most individuals to obtain coverage or face penalties; there is a corresponding requirement for states to establish health insurance exchanges – or marketplaces – where insurance companies can offer plans for individuals and small businesses
- Establish subsidies for low income families to purchase coverage through the exchanges
- Eliminate pre-existing condition exclusions for adults
- Eliminate annual benefit caps
- Prohibit waiting periods of greater than 90 days for private insurance coverage to begin
- Require guaranteed issue and renewability of coverage, with rating variation based only on age, rating area, family composition and tobacco use
View a more detailed timeline
What Is PHA's Commitment to Healthcare Reform?
As reform efforts begin to shift toward implementation, PHA is committed to monitoring these changes and listening to your feedback and experiences under the new law. We will also continue to advocate - through action alerts, coalitions with other health organizations and correspondence directly with government officials and insurance companies - for policy and regulations that both mirror our Statement of Principles on Healthcare Reform and increase access to healthcare for PH patients.
How Can I Get Involved and Where Can I Find More Information on Healthcare Changes?
PHA’s Coverage Connection
Leave a comment about your experience with healthcare and insurance, read the latest PH-centered insurance updates and find out what other PH community members are saying about their personal insurance challenges. You can also sign up for PHA’s Coverage Connection email updates. Learn more
As the official U.S. government site on healthcare reform, healthcare.gov provides information to help you understand the new law, tools to find insurance options, tips on how to stay healthy and a glossary to explain insurance terminology. Learn more
Caring Voice Coalition (CVC)
As an organization that provides programs aimed at helping patients with insurance reimbursement, patient support services and public advocacy, CVC can help guide you through the Health Insurance Marketplace. Learn more
Contact us with insurance questions, success stories or suggestions.
PHA is proud to be able to make educational materials and programs like these available for free to everyone because of the generous support from members of the community just like you. Donations are welcome!