July 11, 2012 >> back to issue

Healthcare Reform and the Supreme Court: What Does It Mean for You?

On June 28, the Supreme Court declared the Affordable Care Act (ACA), including the minimum coverage requirement, constitutional. While the ACA, commonly known as healthcare reform, does not address all of the points in PHA’s Statement of Principles on Healthcare Reform, it does contain the following provisions that will benefit PH patients and their families:

  • Prohibits insurance providers from denying coverage to children younger than 19 years due to pre-existing conditions. Starting in 2014 this rule will apply to adults as well.
  • Bans insurers from enacting lifetime benefit caps. PH patients will no longer have to worry about their insurer ending their coverage because expensive medications have maxed out their benefits. By 2014, annual limits will also be removed.
  • Allows children to stay on their parents’ health insurance plan until they are 26 years old.
  • Gradually closes the Medicare Part D coverage gap or “donut hole.” Previously the donut hole required patients to pay 100 percent of medication costs out-of-pocket after their and their insurers’ contributions reached a pre-determined amount (usually $2,930) and before catastrophic coverage began, costing patients an average of $3,600 out-of-pocket. Starting in 2012 these out-of-pocket costs will be reduced, and by 2020 patients will only be responsible for 25 percent of brand name and generic drugs.
  • Requires insurance coverage of routine patient care costs associated with clinical trials.

PHA will continue to follow the ACA for the PH community and post updates about the implementation process.

Read PHA’s Statement of Principles on Healthcare Reform.

Learn more about the ACA at HealthCare.gov.

The information provided on the PHA website is provided for general information only. It is not intended as legal, medical or other professional advice, and should not be relied upon as a substitute for consultations with qualified professionals who are familiar with your individual needs.

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NORD

The National Organization for Rare Disorders (NORD) awarded PHA the Abbey S. Meyers Leadership Award in 2012 for outstanding service to PHA members in advocacy, education and other key areas.