Education Center

President Obama signed historic and transformative health care reform legislation into law on March 23, 2010. Want to know how it will impact you? NPAF's Health Care Reform Education Center has lots of information on what health care reform means for patients. Want to know more? Visit www.healthcare.gov to understand the new law and how it will affect you and your family. Healthcare.gov includes interactive features as well as implementation timelines that will help educate you on how and when the law will take effect.

Consumers Confused About Cost-Sharing Provisions in Insurance Plans, Study Finds Health insurance consumers are confused about cost-sharing provisions in health plans, a Consumers Union analyst said Feb. 4 in releasing a report on the subject. While participants generally liked new disclosure forms providing definitions of health insurance terms developed under the Patient Protection and Affordable Care Act (PPACA), "they really did not understand the forms' cost-sharing provisions," said Lynn Quincy, senior policy analyst for Consumers Union. Quincy spoke at a luncheon titled, "Making Health Insurance Choices Understandable for Consumers." Consumers should be able to use the disclosure form to "meaningfully" compare health insurance options and to make plan selections that are in their best interest, she said. More consumer testing needs to be conducted on health insurance plans as PPACA is implemented, she said. Consumers Union sponsored the study, Making Health Insurance Cost-Sharing Clear to Consumers: Challenges in Implementing Health Reform's Insurance Disclosure Requirements, conducted in fall 2010, examining reactions among participants to an early version of standard health insurance definitions and benefits developed by the National Association of Insurance Commissioners. A revised version was sent to the departments of Health and Human Services and Labor last December. The agencies are expected to issue a regulation in March standardizing summaries of benefits and coverage explanations that must be used by all health insurance plans beginning in 2012 (242 HCDR, 12/20/10). A total of 118 respondents in four cities, including people who were uninsured, participated in the study, Quincy said. The four-page standard disclosure form of uniform definitions of common insurance and medical terms, descriptions of coverage, and cost-sharing provisions will be used by more than 180 million consumers, she said. By improving the disclosure forms, "We're really having a profound effect on consumers everywhere," she said.

Consumers Had 'Extreme Difficulty.' Respondents had "extreme difficulty" determining cost-sharing provisions in plans, Quincy said. Cost sharing refers to how much patients will pay versus how much insurers pay for medical services. While most study participants felt confident that they understood concepts such as coinsurance and deductibles, they "struggled" in trying to estimate their out-of-pocket costs for medical services, she said. There is much confusion among consumers about the difference between deductibles, copayments, coinsurance, out-of-pocket maximum payments, annual benefit limits, out-of-network provisions, and interactions among those features, she said. For example, it is not clear to many people whether copayments count toward deductibles or out-of-pocket maximum payments, she said. Concrete numeric examples would be useful to consumers in describing coverage provisions, and consumers wanted clearer information on minimum and maximum payments they likely would have to pay under different plans, she said. In addition to understanding plan terms, consumers will need "better measures of network adequacy ... and better measures of provider quality," Quincy said. The standardized summary of benefits and coverage required by PPACA should be used in all consumer documents consistently over time, and tools for measuring "health insurance literacy" need to be developed, Quincy said. The study found that most of the respondents had either "low" or "mid-level" health insurance literacy, she said.

Overwhelmed by Too Many Choices Contributing to consumer confusion is the large number of health plans to choose from, said Karen Pollitz, director of the Office of Consumer Support in the Center for Consumer Information and Insurance Oversight, a part of the Centers for Medicare & Medicaid Services. "Too many choices can overwhelm people, and when it comes to the private health insurance market today, I would say policies are almost as varied and different as snowflakes," Pollitz said at the luncheon. While ultimately PPACA should cause the health insurance market to become more standardized, plan designs and differences will proliferate before that happens, Pollitz said. There is a new emphasis being placed on value-based insurance design to produce greater efficiency in health care delivery, she noted. This means that insurers will provide higher levels of coverage if patients go to a value-based provider within an insurer's network, she said. The intention is to steer people to providers who have proven track records for quality and good outcomes, she said, but this added dimension further complicates consumers' ability to understand their benefits. Information is not adequately disclosed to consumers today, Pollitz said. People have little way of knowing if their insurer networks meet their coverage needs, whether the best doctors for all medical fields are in the networks, or how to evaluate drug formularies, she said.

New 'Coverage Fact Tools' Coming New "coverage fact tools" are to be developed as part of plan summaries under PPACA that show what health plans would pay under benchmark care scenarios, such as for pregnancy or serious and chronic medical conditions, Pollitz said. The tools would show, for example, how much a policyholder would pay under different policies for typical breast cancer treatments, Pollitz said. With such tools, "You can begin to see how the differences in the cost-sharing features and the benefits exclusions and limitations work together," she said. Research has found that out-of-pocket payments patients would typically pay for breast cancer treatments under two policies that appeared similar varied from $6,000 to $38,000, Pollitz said. Research showed that even comparing "bronze" policies in Massachusetts's health insurance exchange, which provide the lowest level of actuarial value, out-of-pocket annual payments for diabetes varied from $950 to $4,400, she said. "I don't think we should kid ourselves that we're ever going to get to one-plan-fits-all for everybody," Pollitz said. "There will continue to be a lot of variation." Finally, new measures need to be developed to monitor problems consumers face in terms of medical debt, uncompensated care, and forgone care, Pollitz said. "If we move everybody into new plans [and] they're not-so-good plans ... we haven't really finished our work," she said. By Sara Hansard

From the White House - Voices of Health Reform: James's Story James Howard from Katy, Texas was diagnosed with brain cancer in March, 2010 and later thought his lack of health insurance was a death sentence. One of his prescription drugs alone cost $10,000 a week and he had no idea how he would afford the costs of prescriptions, doctor's visits, tests and treatments. James searched, but could not find affordable health insurance until he discovered the Pre-Existing Condition Insurance Plan.

Here's how the Pre-Existing Condition Insurance Plan works: The Pre-Existing Condition Insurance Plan is a bridge to 2014, when the health insurance exchanges will offer people like James and small businesses a competitive marketplace where they can shop for more affordable insurance based on price and quality. In addition, in 2014, denying coverage or charging higher premiums based on a pre-existing condition will be prohibited. But we know that people like James need immediate relief. Between now and 2014, the Pre-Existing Condition Insurance Plan offers health insurance to Americans who have been uninsured for at least six months and have a pre-existing condition or have been denied health coverage because of their health condition. Depending on where you live, the plan is operated by either your state or the Department of Health and Human Services. James is grateful for the coverage the Pre-Existing Condition Insurance Plan offers and says that without it, he would not have been able to continue his treatments. Tonight, you'll be able to spot James as he watches the State of the Union address here in Washington with First Lady Michelle Obama and other Americans from across the country. Listen to his story

From the White House - What They're Saying About the Affordable Care Act

Health Care Providers: What They're Saying About the Affordable Care Act

As Congress considers legislation that would repeal the Affordable Care Act, it's important to take a look at who is opposing repeal. Here's what organizations representing doctors, nurses and health care providers are saying:

American Nurses Association "...[W]e believe that a vote for repeal would be a devastating step backward."

American Medical Association "The AMA does not support initiatives to repeal the Affordable Care Act. Expanding health coverage, insurance market reforms, administrative simplifications and initiatives to promote wellness and prevention are key parts of the new law that reflect AMA priorities."

American Academy of Family Physicians "A repeal of all provisions in the Patient Protection and Affordable Care Act will return our health care system to its previous trends of unsustainable, increasing costs and ever-growing numbers of under- and uninsured Americans. It will have negative consequences on Americans' access to needed health care for years to come."

American College of Physicians "ACP believes that Congress should preserve and - as necessary - improve on these and other important reforms created by the Affordable Care Act, not repeal them."

Association of American Medical Colleges "The nation's medical schools and teaching hospitals stand behind the Affordable Care Act. Ensuring that all Americans have health care coverage is a moral imperative for our nation, and enactment of the Affordable Care Act was an important step toward that goal."

National Association of Community Health Centers "From the perspective of community health, however, the new law moves our nation to the goal of more affordable and accessible health care for all people and we stand strongly in support of it."

American Osteopathic Association "The Affordable Care Act made fundamental and important changes in our health care system that will improve the health of our patients individually and our nation as a whole."

Catholic Health Association "On behalf of the Catholic Health Association of the United States (CHA), the national leadership organization of more than 2,000 Catholic health care systems, hospitals, long-term care facilities, sponsors, and related organizations, I strongly urge you to maintain support for efforts to improve and strengthen our nation's health care system by opposing the legislation before the House to repeal the Affordable Care Act (ACA)."

American Public Health Association "Implementation of the Affordable Care Act is critical to addressing a number of the biggest challenges facing our health system including the escalating costs associated with our health care system, uneven quality and more than 100,000 deaths due to medical errors, discriminatory practices by health insurance providers and the shrinking ranks of the nation's primary care providers. The enactment of the Affordable Care Act begins to shift our health system from one that focuses on treating the sick to one that focuses on keeping people healthy and addresses these challenges."

Asian and Pacific Islander American Health Forum "Almost 60 percent of Asian Americans receive health care coverage through their employers and the last thing we should be doing is weakening the ability of small business owners to provide quality health care to their employees. We must not place the interests of insurance companies ahead of small businesses, our communities, and our families. When insurance companies are free to pursue profit without accountability, people have fewer choices, fewer options, and little recourse. We can't let that happen."

Doctors for America "As doctors, we see how our broken health care system is failing patients and health care providers. Passing and implementing the Patient Protection and Affordable Care Act is an important first step to fixing a broken system, and we must continue to move forward. Repealing the health care reform law will only move our health care system backward - and millions of patients simply can't afford that. We urge the new Congress to work with patients and providers to improve the health reform law so we can build a health care system that works for everyone."

National Hispanic Medical Association "NHMA supports the Affordable Care Act as it is a step forward in caring for the health of the underserved communities and all Americans. Investing in the health of Americans, our most valuable resource, is sound policy and a wise course of action when so many diseases are preventable and treatable. For this reason we ask you to cast a vote against H.R.2."

Seniors Groups: What They're Saying About the Affordable Care Act

As Congress considers legislation that would repeal the Affordable Care Act, it's important to take a look at who is opposing repeal. Here's what organizations representing seniors are saying:

AARP "As the House prepares to vote this week on repeal of the Affordable Care Act (ACA), I am writing to make clear AARP's position. While we respect that there are those who do not support the ACA, AARP opposes repeal because the new law includes many vital provisions important to older Americans and their children."

Leadership Council of Aging Organizations "Millions of Americans have already benefited from provisions of the Affordable Care Act, including millions of seniors who received $250 towards the cost of their prescription drugs when they entered the Part D doughnut hole. The economic and physical health of seniors and their families will continue to benefit as the law is implemented further. We urge you not to deprive them of the protections created by the Affordable Care Act, and to vote against repeal."

National Consumer Voice for Quality Long Term Care "Repeal of the Affordable Care Act would eliminate all of these urgently needed improvements in long-term care and protection of the elderly. Please vote against the bill to repeal the law."

Center for Medicare Advocacy "Health care reform is helping families struggling to deal with illnesses, age, unemployment, and under-employment. The law advances family values. It's time to implement, not repeal health care reform!"

Alliance for Retired Americans "The proposal to be voted on in the U.S. House this week to repeal the 2010 health reform law is unconscionable. Seniors are clear on this: DO NOT raise our prescription drug costs; DO NOT re-open the Medicare Part D prescription drug doughnut hole; and DO NOT take away our free preventive screenings by repealing this law."

Generations United "It is imperative that lawmakers not pass H.R. 2 and repeal the Affordable Care Act. It will be devastating to children, young adults and older people."

National Committee to Preserve Social Security and Medicare "Not only is a repeal fiscally irresponsible, it takes away crucial Medicare improvements for seniors in the new law."

Medicare Rights Center "As the U.S. House of Representatives prepares for floor debate and a vote next week on a bill (HR 2) that would repeal the Affordable Care Act, the Medicare Rights Center expresses concern that repealing health care reform would sacrifice Americans' wellbeing for the sake of political gain. Health reform extends the solvency of the Medicare trust fund, reduces the federal deficit, introduces initiatives to enhance quality and coordination of care, and provides real benefits to Medicare consumers by eliminating cost-sharing for many preventive services and closing the coverage gap in the Medicare prescription drug benefit. Knowing what the Medicare Rights Center knows from our clients, repeal of this legislation would hurt older adults and people with disabilities."

National Council on Aging "The National Council on Aging (NCOA), the leading nonprofit service and advocacy organization for older Americans, is urging the 112th Congress not to repeal the landmark Affordable Care Act (ACA). Already, the ACA is providing critical benefits for seniors and their families, including a 50% discount on brand-name prescription drugs in the Medicare Part D "doughnut hole" or coverage gap, a free annual wellness visit to help older adults develop a personal prevention plan, and full coverage of important preventive services such as diabetes tests and prostate cancer screenings."

National Association of Area Agencies on Aging "If repeal is allowed to go forward millions of older Americans would be deprived of new prescription drug benefits for those individuals who fall into the Medicare Part D "donut hole" and all working Americans would stand to lose benefits provided under the new CLASS program that would help them pay for long-term care when they need them. Repeal also means older adults will not be able to take advantage of new Medicare prevention and wellness benefits to help them better manage their chronic conditions and stay healthy. We urge all Members of Congress to vote against repeal and allow key provisions of the ACA to be implemented that will improve the health and security of our nation's older adults."

View Fact Sheets on How Reform Will Impact You

Additional Resources

View The Commonwealth Fund's ACA Implementation Timeline

View Kaiser Family Foundation Reform Summary & Timeline

View Full Text of ACA legislation

Want to know more about where NPAF stands on the issues?

NPAF Pillars of Health Care Reform

NPAF Patient Centered Health Care Reform Solutions

NPAF Dispelling the Myths of Health Care Reform