The Affordable Care Act contains many new consumer protections designed to improve affordability, create wider access to health care, and prevent waste and fraud.
Health Reform: the First Six Months
From Consumer’s Union, an easy-to-understand guide that explains the first set of health reform changes.
The Affordable Care Act improves the health insurance marketplace by strengthening consumer protections and providing consumers with the information they need to choose the best health care coverage for their families.
Preventing Waste, Fraud, and Abuse
Reducing waste, fraud, and abuse saves taxpayer dollars and protects the health care investments made by individuals, businesses, and government. Health care reform strengthens Medicare and Medicaid’s existing compliance and enforcement tools, reducing fraud and abuse and saving billions of taxpayer dollars.
Making Coverage Affordable
Health care reform makes insurance premiums more affordable and reduces out-of-pocket expenses for lower and middle income individuals and families. It provides sliding-scale tax credits for individuals and families with incomes above the Medicaid thresholds but below 400 percent of poverty. It prohibits insurers from limiting their coverage for individuals or families through annual or lifetime limits. It also protects individuals and families either self-insured or insured by their employer with a new plan from catastrophic costs with a cap on total out-of-pocket spending. In addition, it broadens Medicaid coverage to include individuals and families with incomes below 133 percent of poverty.
Health care reform will ensure that all Americans have access to quality, affordable health care coverage through shared responsibility among individuals, businesses, and the government. Individuals will also be responsible for purchasing health insurance coverage, and most employers will be responsible for offering coverage. Individuals, employers, and the government are all responsible for contributing to the cost of coverage.
The Health Insurance Exchanges
The Affordable Care Act will create state‐based health insurance Exchanges, for states that choose to operate their own exchanges, and a multi‐state Exchange for the others. The Exchanges will make health insurance more affordable and accessible for small businesses and individuals.
Innovative Delivery System Reform
Reining in rising health costs and improving quality hinges on doctors, hospitals, and other providers working together to ensure that they provide the right care to the right patient at the right time. Rather than rewarding the quantity of care, payment systems must be modernized to reward high quality care. Realigning payment incentives will reduce waste, slow the growth of health care costs and improve Americans’ health. Health care reform contains multiple provisions to reform the health care delivery system.
In order to achieve affordable, quality health care for all, the Affordable Care Act establishes standards to ensure that all plans in the new health insurance Exchanges cover a comprehensive set of necessary services and offer protections for consumers.
Addressing Health and Health Care Disparities
African Americans, Hispanics, and Native Americans are roughly twice as likely to be uninsured as the rest of the population. Studies have shown that access to care is a significant factor in health outcomes. The legislation will offer insurance through a health insurance Exchange and provide premium assistance to those who can’t afford it, significantly reducing disparities in accessing high‐quality health care.
Temporary High Risk Pool Fact Sheet
Provides information about the temporary high risk pool program included in the Affordable Care Act and chart outlining potential allocations of high risk pool funds to states.
Web Portal Fact Sheet
The Affordable Care Act establishes an internet portal to help individuals and small businesses identify insurance options in their state. The web portal will help consumers navigate their options in the individual and small business private market and help them determine if they may be eligible for a variety of existing public programs., including existing state high risk pools, new high risk pools, Medicaid, Medicare and the Children’s Health Insuance Program (CHIP).