Publication Library

Browse by tag

referendum c state budget tabor fmap recovery act 2010 colorado legislature health reform medical loss ratio taxes jobs and economic security transparency and accountability revenue annual report colorado center on law and policy snap food stamps health coverage health affordability earned income tax credit children health law and policy update child tax credit exempla hospitals colorado benefits management system public benefits weston v hammons election 2010 poverty health insurance work supports self-sufficiency standard jobs and economy unemployment insurance health access mental health high-risk pool health co-ops pre-existing conditions medicaid aiming for the middle gallagher amendment amendment 23 public option 2009 colorado legislature grandfathered health plans cobra health insurance exchange income 2007 colorado legislature arveschoug-bird tobacco securitization federal budget rainy day fund refund anticipation loans 2008 colorado legislature welfare reform colorado works deficit reduction act citizenship referendum d 2010 colorado legislatutre old age pension tax credits tax exemptions tax deductions provider rates state of working colorado government election 2008 education income tax single sales factor state children's health insurance program social security early retiree reinsurance program hospital provider fee insurance access sustainable growth rate formula recission prescription drugs medicare false claims act colorado all-payer health claims database insurance affordability 2011 colorado legislature election 2011 immigration child health plan plus health law and policy refugees family economic security economic self-sufficiency hospital conversion sidebar newsletter elder economic security long-term care accountable care collaborative 2012 colorado legislature

Sign Up

Receive email updates

Thanks To Our
Generous Donors Like:

Charles Stewart Mott Foundation

During its first year, Affordable Care Act provided better access to coverage and vital market reforms

The federal Patient Protection and Affordable Care Act, which marks its one-year anniversary March 23, has brought considerable change to help improve the consumer health insurance experience, control costs and increase access to coverage. Major insurance market reforms have gone into place, new options have opened up for people with pre-existing conditions, small businesses can now avail themselves of tax credits for offering insurance to employees, and seniors who fall into the prescription drug coverage gap in Medicare have begun seeing some relief.

The Affordable Care Act (ACA) won’t be fully implemented until 2014, but even during its first year it has set the nation on a path toward providing affordable, quality coverage for everyone. Here’s a look at some of the major provisions that have gone into effect during the first year and how they affect Coloradans.

Making insurance work better for consumers
One of the promises of the ACA is to make health insurance work better for consumers. Several changes have gone into effect that make it easier to purchase health coverage and stay covered.

  • No more lifetime limits and phase-out of annual limits. As of September 2010, new and existing health insurance plans are required to eliminate lifetime limits on health coverage. Existing group plans and new individual plans began phasing out annual limits on insurance coverage.
  • Prohibition on rescissions. Insurance companies are no longer permitted to rescind, or retroactively cancel, coverage when the client gets sick unless there has been an intentional misrepresentation or fraud.
  • More premium dollars on health care. The ACA requires insurance companies to spend 80 to 85 percent of each premium dollar on medical care and quality improvement measures, rather than administration and overhead. Also known as the medical loss ratio, the provision helps ensure value for consumers. Insurance companies that do not meet the standard must provide rebates to customers.

Increasing access to coverage
Increasing access to coverage means providing more affordable options for consumers to purchase coverage, and decreasing barriers to accessing coverage.

  • Colorado health benefit exchange act. A bill to begin the process of creating a health benefit exchange in Colorado was introduced in the Colorado General Assembly on March 21. When it goes online in 2014, the exchange will be a competitive marketplace for consumers to shop for health coverage, and it will administer tax credits to qualifying individuals and families. Colorado received nearly $1 million to begin planning for the exchange.
  • No denying children with pre-existing conditions. Insurance companies are no longer allowed to deny insurance to children with pre-existing conditions. While this measure led to initial disruptions in the individual insurance market in Colorado and other states, there remained a couple options for coverage. New state legislation will clear the way for greater choice. At the time of implementation it was estimated the provision could help about 2,000 uninsured children with pre-existing conditions.
  • Young adult coverage on parents’ plan. As of September 2010, adult children are permitted to remain on, or be added to, their parents’ health insurance plan as a dependent, regardless of whether they are in fact dependent on their parents. The provision provides a source of affordable coverage for the age group in Colorado with the highest rate of uninsurance; 18,600 young adults were expected to be affected.
  • New insurance plan for people with pre-existing conditions. GettingUsCovered is an insurance plan for people who have been denied coverage due to a pre-existing condition and have been uninsured for at least six months as a result. GettingUsCovered provides subsidized coverage and has enrolled more than 400 people since it was created in August 2010.
  • Grants to health centers. Health centers that serve low-income and uninsured people in Colorado have received $18.7 million to increase capacity to serve Colorado communities. A new clinic with the capacity to serve 5,000 Coloradans opened in Englewood in March 2011.
  • Tax credits for small businesses. Small businesses with less than 25 employees and average wages of less than $50,000 may qualify for tax credit of up to 35 percent of the contribution to employees’ health coverage.

Controlling costs
Controlling costs is as much about controlling costs to the individual or business purchaser of health care coverage as it is about decreasing costs to the system as a whole.

  • Closing the Medicare prescription drug coverage gap, the “donut hole”. One of the first provisions implemented under the ACA was a $250 rebate to seniors who had hit the coverage gap, also known as the donut hole, in their prescription drug coverage. In Colorado, 42,351 rebate checks were distributed from Jan. 1 to Feb. 28 this year. Seniors who hit the gap in their prescription drug coverage in 2011 will receive a 50 percent discount on name-brand drugs. Each year until 2020, a new provision will kick in that ultimately will close the gap altogether.
  • Free preventive care visits. Recommended preventive services no longer require a copayment and are not subject to a deductible for people enrolled in employer-based coverage or new individual plans, and for seniors in the Medicare program. Additionally, seniors in Medicare receive a free annual wellness check-up. Removing cost as a barrier to seeking preventive care can help avert illness and improve health.
  • Early retirement relief. In Colorado, 44 companies, local governments and unions have taken advantage of the Early Retirement Reinsurance Program, under which the government provides financial relief to help cover the costs of early retirees’ (ages 55 to 64) health insurance claims.
  • Rate review. Colorado received $1 million in grant funding to enhance its capacity to review insurance company proposed rate increases and to make the rate review process more transparent for the public.

Contact: Adela Flores-Brennan
Health care attorney
303-573-5669, ext. 313

Released March 22, 2011

| More

View PDF Document