1-10: What's Really in the Affordable Care Act

[Guest guest]

VS, Can you explain how the Oregon Health Transformation law is either

the same or different than the ACA ?

s. fuchs dc

http://www.medscape.com/features/slideshow/bm-aca?sssdmh=dm1.771614 & src=nl_newsalert

The Patient Protection and Affordable Care Act (ACA) was signed into

law on March 23, 2010 by President Obama. Some love it, others hate it, but

many people have only a vague idea of what's in the almost 2000-page law.

McDonough, DPh, MPA, a Professor of Health Policy and Management at Harvard

University School of Public Health, was invited by Senator Ted Kennedy to

participate in the committee that helped draft the law. In his book, Inside National Health Reform, McDonough

offers a look at the ACA many haven't seen. It breaks down the law according to

the 10 Titles that comprise it, offering an easy-to-follow guide of the changes

affecting the insurance and medical industries, as well as patients, and when

these changes will happen. Here is an overview of the titles as explained in

the book.

Title I. Quality, Affordable Health Care for All Americans

This

title fundamentally changes the nature and operation of private health

insurance in the United

States. Beginning in 2014, no health insurer

will be able to sell or rate coverage based on an individual''s medical

history; most Americans will be required to obtain health insurance; and

substantial financial subsidies will be available to low- and moderate-income

Americans to help them afford the cost of health insurance. Most states will

operate new " health insurance exchanges " to make shopping for health

insurance easier. Small businesses and individuals can shop these insurance

exchanges for competitive rates. Other important changes in health insurance,

including the banning of lifetime and annual benefit limits, were implemented

in 2010.

Title

II. The Role of Public Programs

This

title creates substantial changes to Medicaid, the federal-state program for

many low-income persons. Beginning in 2014, all lower-income individuals will

be eligible to enroll in their state's Medicaid program, not just those who fit

into categories such as disabled, children, or parents. For the first time,

Medicaid will become a more uniform national program with uniform eligibility

and enrollment standards as well as quality improvement requirements.

Title

III. Improving the Quality and Efficiency of Health Care

This

title establishes new mechanisms to improve the quality of medical care in the United States

by making it more efficient and effective, and more patient-centered. Medicare

will be improved with the addition of new preventive benefits for enrollees;

and the Medicare Part D drug benefit will be made more affordable by closing

the coverage gap known as the " donut hole. " Medicare's rate of growth

will be lowered to provide about $450 billion in savings between 2010 and 2019,

which should fund about half the cost of the ACA.

Title

IV. Prevention of Chronic Disease and the Improvement of Public Health

Title IV

is the most ambitious law ever passed to promote healthier lifestyles for all

Americans and to prevent disease and disability. A National Prevention, Health

Promotion, and Public Health Council will devise a national prevention

strategy, backed up by a $13 billion Trust Fund. Evidence-based clinical

preventive services will be provided in most public and private health

insurance policies without cost-sharing. Chain restaurants will be required to

post the calorie content of their foods.

Title

V. Healthcare Workforce

This

title establishes a National Healthcare Workforce Commission to analyze and

plan for workforce needs and to make recommendations to congress and the

administration. Support is provided to expand the healthcare workforce,

especially in primary care. Major expansions for community health centers and

the National Health Service Corps are funded.

Title

VI. Transparency and Program Integrity

Title VI

provides new authority to federal and state agencies to combat fraud and abuse

in Medicare, Medicaid, and private health insurance. Drug companies and medical

suppliers will report most gifts and other gratuities to physicians for public

release on a federal Website. The Patient Centered Outcomes Research Institute

is established as a public-private entity to support research on comparative

clinical effectiveness. New transparency requirements on the nursing home

industry will provide information to protect and empower patients and their

families. The Elder Justice Act provides a national framework to combat

violence, neglect, and financial exploitation of senior citizens.

Title

VII. Improving Access to Innovative Medical Therapies

This

title directs the US Food and Drug Administration to develop a regulatory

pathway to permit the development, manufacture, marketing, and sale of

biosimilar biologic products, generic-like versions of biopharmaceutical drugs.

It also ends anticompetitive efforts to keep generic drugs off the market, and

offers drug discounts to hospitals and communities that serve low-income

patients.

Title

VIII. CLASS: Community Living Assistance Supports and Services

This

title authorizes a new national and voluntary long-term disability insurance

program to provide workers with daily cash payments and support if they become

permanently and temporarily disabled. People who enroll in CLASS must pay

premiums for a minimum of 5 years. The funding is flexible and can be used for

a range of services. No tax money will be used to fund this program. Its only

permitted financing source -- enrollee premiums -- must be sufficient for at

least 75 years if the Health and Human Services Secretary is to launch the

program.

Editor's

Note: The Obama administration announced on October 15 that it was abandoning

plans for CLASS. Congress is expected to quickly draft legislation to repeal

the provisions of this title.

Title VIII. CLASS: Community Living

Assistance Supports and Services

This

title authorizes a new national and voluntary long-term disability insurance

program to provide workers with daily cash payments and support if they become

permanently and temporarily disabled. People who enroll in CLASS must pay

premiums for a minimum of 5 years. The funding is flexible and can be used for

a range of services. No tax money will be used to fund this program. Its only

permitted financing source -- enrollee premiums -- must be sufficient for at

least 75 years if the Health and Human Services Secretary is to launch the

program.

Editor's

Note: The Obama administration announced on October 15 that it was abandoning

plans for CLASS. Congress is expected to quickly draft legislation to repeal

Title

IX. Revenue Provisions

This

section covers the financing for slightly less than half the cost of the ACA.

Key provisions establish new Medicare taxes on high-income wage earners, as

well as new taxes on pharmaceutical manufacturers, health insurance providers,

and medical device manufacturers. Also included is an excise tax on high-cost,

employer-provided health insurance; changes to health savings accounts and

other individual health accounts; and a 10% tax on indoor tanning services.

Title

X. Strengthening Quality, Affordable Healthcare for All Americans

The final

title in the act is the " Manager's Amendment, " which includes

amendments and additions to Titles I-IX, reflecting the unusual legislative

process leading to passage of the ACA. Additional changes to Titles I-X were

approved in a separate measure called the Health Care and Education

Reconciliation Act (HCERA) signed into law by President Obama 1 week after he

signed the base law on March 23, 2010. This title also reauthorizes the Indian

Health Care Improvement Act, which provides healthcare to American Indians and

Alaskan natives.

Contributor

Information

E. McDonough, DPh, MPA

Professor of Health Policy and Management

Harvard University School

of Public Health

Boston, Massachusetts

E. McDonough, DPh, MPA, has disclosed no relevant financial relationships.