Health Care Reform:
The Affordable Care Act

HealthCare.gov makes it easy for consumers and small businesses to compare insurance plans and find other important information.

Health care is the fastest growing area of federal spending, with the country spending over $2.5 trillion annually. Coupled with the fact that over 40 million Americans lack insurance, meaningful health care reform was long overdue.

People across western and central Wisconsin have shared with me for years their concerns with our current health care system. Our economy continues to suffer as Wisconsin families fall further into debt due to rising health care costs. Comprehensive health care reform could not wait and I was glad to help shape and support the Affordable Care Act (ACA) of 2010. As a member of the Ways and Means Subcommittee on Health, I was intimately involved in the health care reform debate. Now, as the law continues to be implemented, I will fight efforts to repeal the law.

We cannot afford to repeal health care reform. Please watch the video below, with my reaction to the 37th vote taken in the House to repeal the ACA.

 

Health care reform is already benefiting Wisconsin families. A recently released report found that without the ACA, drug costs for over 63,500 Wisconsin seniors would be $46.4 million higher and 43,000 young adults would not have had coverage through their parents’ plans. Furthermore, 968,000 women and 482,000 seniors and people with disabilities in the state would not have received free preventive care, and 283,000 people would not have received $10.4 million in rebates from their insurance companies.

At the same time, the law’s most significant reforms have yet to take effect, including the provision that will prevent private insurers from denying Americans coverage because of a preexisting condition or kicking them off their plan because they get sick – both of which become effective in 2014.


The Affordable Care Act: Just the Facts

43,000 young adults in Wisconsin have coverage through their parents’ plans.

63,500 Wisconsin seniors saved over $46 million in 2012 alone on prescription drugs. That’s an average of $731 per senior. Wisconsinites have saved over $103 million on their medications since the ACA passed.

968,000 women and 482,000 seniors have taken advantage of free preventive care provided under the ACA.

283,000 people received $10.4 million in rebates from their insurance companies because the ACA requirement that 80% of premium dollars on health care instead of overhead, executive salaries, marketing and profit.

Next year, 497,400 Wisconsinites will have access to quality, dependable health insurance coverage that they can’t access today – that 10% of all Wisconsinites under 65.

Already, 2.1 million people in Wisconsin, including 791,000 women and 580,000 children, are free from worrying about lifetime limits on coverage. Health care reform restricts use of annual limits right now and bans them completely in 2014.

Health Centers in Wisconsin have received $43.5 million under the Affordable Care Act to expand their efforts to provide coverage to low income and uninsured individuals.

More than 140,000 Wisconsin residents will benefit from over $3.5 million in rebates from insurance companies, thanks to the health care reform law.

77.8 million consumers nationwide saved $3.4 billion up front on their premiums as insurance companies operated more efficiently under the Affordable Care Act.


Consumer Rights and Protections

The Affordable Care Act puts consumers back in charge of their health care by establishing a “Patient’s Bill of Rights.” Insurance companies used to be able to denying coverage to children who had asthma or were born with a heart defect, putting a lifetime cap on the amount of care they would pay for, or cancelling your coverage when you got sick just by finding an accidental mistake in your paperwork. The Patient’s Bill of Rights protects you from these and other abusive practices. Here are some examples:

End to pre-existing condition discrimination: Insurance companies can no longer deny coverage to children because of a pre-existing condition like asthma and diabetes, providing peace of mind for parents of the more than 17.6 million children with pre-existing conditions. Starting in 2014, no American can be discriminated against due to a pre-existing condition.

No more lifetime caps on benefits: In the past, some people with cancer or other chronic illnesses ran out of insurance coverage because their health care expenses reached a dollar limit imposed by their insurance company. Under the health care law, insurers can no longer impose lifetime dollar limits on essential health benefits and annual limits are being phased out by 2014. More than 105 million Americans no longer have lifetime limits thanks to the new law.

End to Coverage Cancellations: Insurance companies can no longer drop your coverage when you get sick due to a mistake you made on your application.


More Affordable Coverage

The law helps you by bringing down health care costs and making sure your health care dollars are spent wisely. Insurance companies will now be accountable to their customers for how they are spending premium dollars, and how much they are raising rates. Plus, the new law will help lower costs through new tax credits and new marketplaces where insurers will have to compete for your business.

Value for your premium dollar: Thanks to the Affordable Care Act’s 80/20 rule, if insurance companies don’t spend at least 80 percent of your premium dollar on medical care and quality improvements rather than advertising, overhead and bonuses for executives, they will have to provide you a rebate. The first rebates were made in the summer of 2012.

Stopping unreasonable rate increases: In every State and for the first time ever, insurance companies are required to publicly justify their actions if they want to raise rates by 10 percent or more.

Small business tax credits: Small businesses have long paid a premium price for health insurance – often 18 percent more than larger employers. Over 17,000 businesses in western and central Wisconsin could be eligible for the tax credits to provide health insurance coverage to their employees.


Better Access to Care

The health care law builds on what works in our health care system. And it fixes what’s broken by providing you with more health insurance choices and better access to care.

Affordable insurance marketplaces: Affordable Insurance Marketplaces are one-stop marketplaces where consumers can choose a private health insurance plan that fits their health needs. Sign up starts October 1, 2013 and coverage starts January 1, 2014. Wisconsin’s Health Insurance Marketplace will be federally facilitated. To see if you are eligible for tax subsidies to help make health insurance more affordable and sign up for updates, click here:

Free prevention benefits: Insurers are now required to cover a number of recommended preventive services, such as cancer, diabetes and blood pressure screenings, without additional cost sharing such as copays or deductibles. Already, 54 million Americans with private health coverage have gotten better preventive services coverage as a result.

Coverage for young adults: Under the law, most young adults who can’t get coverage through their jobs can stay on their parents’ plans until age 26 – a change that has already allowed 3.1 million young adults to get health coverage and given their families peace of mind.

 

I encourage you to explore the below links to learn how health care reform directly affects you:

I am a Small Business Owner

I am a Family Farmer

I am a Senior I am a Young Adult

 

 

Protecting Medicare through Health Care Reform

The new health care reform law provides Medicare recipients with access to free preventive care and a free annual wellness visit every year. In 2012, 34.1 million seniors received one or more of these free services, including about half a million individuals in Wisconsin.

People who hit the Medicare prescription drug donut hole are getting a discount on their prescription drugs. In 2012 alone, more than 3.5 million seniors saved more than $2.5 billion on Rx drugs, or an average of $706 per senior. In Wisconsin, more than 63,000 seniors have saved more than $46 million on prescription drugs. By 2020, the health reform law will eliminate the donut hole completely, ensuring that care is provided when you need it the most.

I am fighting to protect guaranteed benefits for all 47 million Americans on Medicare. Estimates by the Department of Health and Human Services indicate that the new benefits and services provided to Medicare recipients by the Affordable Care Act will save the typical senior over $3,500 over the next decade. The Affordable Care Act strengthens Medicare and extends the solvency of the Medicare Trust Fund by 8 years – from 2016 to 2024--by squeezing waste out of the system and making it more efficient, without reducing benefits.


Lowering Health Care Costs by Promoting Value Over Volume

Part of the health care reform bill included provisions from legislation I authored, the Medicare Payment Improvement Act of 2009. The provisions move the Medicare system from one that pays for the quantity of services provided to one that is quality-based and addresses the long-term sustainability of the program. Currently, Medicare reimbursements are based on the number of procedures performed. This often results in unnecessary or repeated medical services and billions of dollars in waste. The long term sustainability of our health care system depends on us changing this flawed structure. Including these provisions in the larger health care reform bill creates incentives for physicians and hospitals to work together to improve patient care and to use resources efficiently.

The payment and delivery system reforms in the ACA are already having an impact on lowering costs and improving quality by incentivizing the type of quality care already being provided by health care providers in Wisconsin. Recent studies show that:

• Health care spending grew by 3.9 percent in 2011, continuing for the third consecutive year the slowest growth rate in fifty years.
• Health-care costs grew slower than the rest of the economy in 2011 for the first time in more than a decade.
• Slower growth is projected to reduce Medicare and Medicaid expenditures by $1 trillion dollars over the next ten years according to Congressional Budget Office compared with previous projections.
• The growth of private plan premiums has also slowed. Annual premiums for employer-sponsored family health coverage increased by only 4 percent in 2012 – the smallest increase in all but one of the last 13 years.


Fighting Republican Efforts to End Medicare as We Know It

On March 21, 2013, House Republicans passed their budget, which ends Medicare as we know it and replaces it with a voucher system that increases costs to seniors and reduces benefits. The GOP plan ends the guaranteed coverage seniors paid for. I strongly oppose this.

Analyzing a virtually identical budget proposal from last Congress, the nonpartisan Congressional Budget Office (CBO) states that, under the GOP plan, seniors “would bear a much larger share of their health care costs than they would under the traditional program.” According to CBO, the GOP plan would more than double the typical senior’s out-of-pocket health care spending in 2022, compared to what their costs would be under traditional Medicare – increasing their out-of-pocket costs by more than $6,000. Seniors’ health care costs would continue to skyrocket over time because the voucher would grow much slower than health care costs, leaving seniors to pay more. According to CBO, under the GOP plan, by 2030 seniors would be paying 68 percent of their health care costs – with the voucher covering only 32 percent.


Republican Plan Cuts Medicaid

Under the 2014 budget proposed by House Republicans, Medicaid’s guarantee of coverage would be eliminated, Medicaid would be turned into a block grant program, and the federal contribution to Medicaid would be reduced by nearly $800 billion over the next decade. Other changes proposed by House Republicans would allow states to eliminate coverage for seniors, individuals with disabilities, children, pregnant women, and others currently enrolled in Medicaid. These changes would have a profound impact on Medicaid’s ability to provide health coverage to millions of Americans.