The federal health law known as the Patient Protection and Affordable Care Act aims to increase the nation’s access to medical care while ensuring quality and improving patient outcomes.
That’s a tall order, and no one knows for certain whether Obamacare will achieve all those goals.
The result will be critical for Florida, where an estimated 3.8 million people lived without health insurance in 2011, representing about a quarter of the state’s population, according to the U.S. Census Bureau. In the entire United States, only Texas has a higher rate of uninsured residents. Within Florida, Miami-Dade County is home to the largest number of uninsured — an estimated 744,000 people in 2011, or more than one in three residents. Broward’s uninsured rate is 26 percent, or about 392,000 people.
Many of these individuals stand to benefit from the centerpiece of the healthcare reform law: the online health insurance exchanges unveiled Oct. 1 — at healthcare.gov — where Americans can shop for health insurance plans. A marketplace for small business owners with fewer than 50 employees has been delayed until Nov. 1, and enrollment through a Spanish-language website, cuidadodesalud.gov, also has been delayed until about Oct. 21.
On the exchanges, people will find out if they are eligible for federal subsidies to help pay for insurance premiums and out-of-pocket costs, or if they are eligible for Medicaid, the federal-state health insurance program for the poor.
Enacted in March 2010, the health law will roll out in phases through 2018, and it already has triggered significant reforms, including new regulations for insurance companies, hospitals and other healthcare providers, and new protections and requirements for consumers.
The consumer reforms include:
• Dependent coverage for adult children has been extended to age 26 for all individual and group policies.
• Insurance companies must publicly justify rate increases of 10 percent or more before raising premiums.
• The adoption of a “medical loss ratio,” which requires that insurance companies spend at least 80 percent of customer premiums on healthcare and quality improvement — or issue a rebate to policyholders.
• Insurance companies also are prohibited from placing lifetime limits on the dollar value of coverage for individual and group health plans, and they’re not allowed to rescind coverage except in cases of fraud.
• Beginning in 2014, insurance companies can no longer deny coverage to individuals based on preexisting medical conditions.
• Health insurance plans sold through the exchange must offer at least 10 “essential benefits” that include hospitalization, emergency services, outpatient services, maternity and newborn care, mental health and substance abuse services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services with dental and vision care.
The law also affects providers. Healthcare reform is encouraging doctors, hospitals and other healthcare providers to reduce hospital readmissions, manage chronic conditions more effectively and improve outcomes of patients by changing the way doctors are paid by Medicare, the government healthcare program for the elderly that sets the pace for all other health insurers.