Fate of Lesser-Known Obamacare Benefits Not Known

Jan. 24, 2017 -- As President Donald Trump takes the first steps toward his promised “repeal and replace” of the Affordable Care Act, it’s not clear what benefits -- if any -- will remain in a new law.

Just hours after taking office last week, Trump signed an executive order directing the Health and Human Services secretary and heads of other federal agencies to use their authority to relieve Americans, businesses, state governments, and others “of any provision or requirement of the Act that would impose a fiscal burden.”

Details about how this will unfold remain thin, and Republicans have not yet offered a specific replacement plan for the law.

Most people are familiar with some of the more popular parts of the Affordable Care Act (also known as Obamacare), such as free preventive services and allowing children to stay on their parents’ policies until the age of 26.

But the law also includes many other protections for people who buy coverage on their own. And it bolstered coverage for people with work-based health insurance plans, Medicaid, and Medicare.

Here are eight lesser-known benefits that the Affordable Care Act put into law.

1. Breast Pumping

The law requires employers to offer working moms who breastfeed a reasonable break and private place other than a bathroom where they can pump their milk while at work.

In addition, your health plan must provide coverage for breastfeeding support and counseling, either before or after you give birth, and cover the cost of a breast pump.

2. Menu Labels

If you’re watching your waistline, you may have noticed during the past year that some of your favorite restaurant menu items include calorie information -- a requirement of Obamacare that took effect in 2016.

Under the law, meals sold in restaurants and other places that have at least 20 stores that sell ready-to-eat food are required to have their calorie count listed.

Given the nation’s obesity epidemic, “People in the public health world think it is a good idea,” says Mark Hall, director of the Health Law and Policy Program at Wake Forest University.

To date, research hasn’t shown that menu calorie counts have had a major impact on the number of calories people consumed. But Hall says that much like warning labels on cigarette packs, their presence could begin to change societal impressions over time.

Continued

3. Services for People With Disabilities

For families who have children with autism or other special needs, the law guarantees services that help kids improve their skills, gain new skills, and achieve their personal potential. Services covered may include physical and occupational therapy and speech-language pathology.

Hall says that in the past, some insurers resisted paying for services that could improve functioning because lifelong disabilities require ongoing treatment. “This [provision] came in and said you can’t set those limits.”

4. Drug Savings for People on Medicare

Before the Affordable Care Act became law, seniors and people with disabilities with high drug costs often reached a limit to their Medicare Part D drug coverage, known as the doughnut hole. At that point, they had to pay the full cost of their drugs until they hit a certain dollar amount.

The Affordable Care Act requires the drug industry to help defray these costs, gradually closing the gap in coverage. The doughnut hole has been narrowing each year and was supposed to close by 2020.

“Since passage of the ACA, almost 12 million Medicare beneficiaries have received discounts on prescription drugs totaling over $26.8 billion, an average of $2,272 per beneficiary,” says David Lipschutz, managing attorney with the Center for Medicare Advocacy.

At a Senate hearing last week about his nomination to head Health and Human Services, Rep. Tom Price, R-GA, didn’t respond directly to questions about the doughnut hole and whether he’d allow the savings that consumers gained under the law to continue.

5. Annual Wellness Visits for Medicare

Many people are aware that Obamacare made annual wellness visits and preventive services -- such as colonoscopies, mammograms, and flu shots -- available to people with private and work-based insurance at no additional cost. But the law also added annual wellness visits for seniors, which more than 10 million people have taken advantage of.

Continued

6. Ban on Annual and Lifetime Dollar Limits

Before health care reform, 87% of health insurance plans sold on the individual market had lifetime coverage limits averaging $4.3 million, according to an analysis by online broker eHealth. Most plans also capped how much they would spend in a given year as well. Once you hit that cap, you essentially became uninsured.

Under the law now, insurers can’t limit how much they’ll pay for your care.

"For individuals who needed costly care -- like a baby born prematurely or someone with hemophilia or multiple sclerosis -- that often meant a desperate scramble to find new coverage options as one after another benefit limit was reached," says JoAnn Volk, a research professor at the Center on Health Insurance Reforms (CHIR) at Georgetown University’s Health Policy Institute

7. Drug Coverage

Before the Affordable Care Act, an eHealth report from 2013 found that 88% of individual and family insurance plans covered prescription drugs, and some limited coverage to generics only.

The law requires all health plans sold directly to individuals and families (not employer health plans) to cover drugs, including brand-name ones and generics. In addition, insurers must have a process that allows you to request access to drugs not covered in your plan, says Sabrina Corlette, a research professor at the Center on Health Insurance Reforms (CHIR) at Georgetown University’s Health Policy Institute.

“We know some drugs work for some people and others do not. If you’re someone for whom drug A doesn’t work, your plan has to let you take drug B.”

8. Limits on Out-of-Network Emergency Room Visits

Under Obamacare, you pay the same copayments or coinsurance for out-of-network emergency care as you would if you went to a hospital that participates in your plan. Any care provided in the ER beyond what your insurer covers -- including the bills submitted by out-of-network doctors -- may still be yours to pay.

WebMD Health News Reviewed by Sarah Goodell on January 24, 2017

Sources

SOURCES:

U.S. Department of Labor: "Break Time for Nursing Mothers."

Health Affairs: "The FDA’s Menu-Labeling Rule."

Mark Hall, director, Health Law and Policy Program, Wake Forest University.

Healthcare.gov: "Habilitative/Habilitation Services."

CMS.gov Newsroom: "Nearly 12 million people with Medicare have saved over $26 billion on prescription drugs since 2010."

David Lipschutz, managing attorney, Center for Medicare Advocacy.

eHealth Cost and Benefit Report: "The Cost and Benefits of Individual and Family Health Insurance Plans 2009."

JoAnn Volk, research professor at the Center on Health Insurance Reforms (CHIR) at Georgetown University’s Health Policy Institute.

Sabrina Corlette, research professor, Center on Health Insurance Reforms (CHIR) at Georgetown University’s Health Policy Institute.

HHS.gov: "ER Access and Doctor Choice."

© 2017 WebMD, LLC. All rights reserved.

Pagination