The Affordable Care Act has already covered one in four uninsured Americans – more than ten million – and improved coverage for virtually everyone with health coverage.
Insurers can no longer discriminate against preexisting conditions, charge women more just for being women, or put caps on the care you receive. Hospitals, doctors and other providers are changing the way they operate to deliver better care at lower cost. In the years to come, the ability to buy portable and affordable plans on a competitive marketplace will allow countless Americans to move, start businesses, and dream big American dreams — without worrying if an illness will bankrupt them. Here is how the Affordable Care Act is working for families in Utah:
After Health Reform: Improved Access to Care
- And Gallup recently estimated that the uninsured rate in Utah in 2014 was 13.3 percent, down from 15.6 percent in 2013.
- Prohibits coverage denials and reduced benefits, protecting as many as 1,150,918 Utahns who have some type of pre-existing health condition, including 206,400 children.
- Eliminates lifetime and annual limits on insurance coverage and establishes annual limits on out-of-pocket spending on essential health benefits, benefiting 1,183,000 people in Utah, including 387,000 women and 411,000 children.
- Expands Medicaid to all non-eligible adults with incomes under 133% of the federal poverty level. If Utah expands Medicaid, an additional 68,000 uninsured people would gain coverage.
- Establishes a system of state and federal health insurance exchanges, or marketplaces, to make it easier for individuals and small-business employees to purchase health plans at affordable prices through which 128,220 people in Utah were covered in March 2015.
- Created a temporary high-risk pool program to cover uninsured people with pre-existing conditions prior to 2014 reforms which helped more than 1,293 people in Utah.
- Creates health plan disclosure requirements and simple, standardized summaries so 1,894,300 people in Utah can better understand coverage information and compare benefits.
After Health Reform: More Affordable Care
- Creates a tax credit to help 86,330 people in Utah who otherwise cannot afford it purchase health coverage through health insurance marketplaces.
- Requires health insurers to provide consumers with rebates if the amount they spend on health benefits and quality of care, as opposed to advertising and marketing, is too low. Last year, 104,576 consumers in Utah received $3,296,969 in rebates.
- Eliminates out-of-pocket costs for preventive services like immunizations, certain cancer screenings, contraception, reproductive counseling, obesity screening, and behavioral assessments for children. This coverage is guaranteed for more than 1,509,455 people in Utah including 539,479 women.
- Eliminates out-of-pocket costs for 220,972 Medicare beneficiaries in Utah for preventive services like cancer screenings, bone-mass measurements, annual physicals, and smoking cessation.
- Phases out the “donut hole” coverage gap for 27,176 Medicare prescription drug beneficiaries in Utah, who have saved an average of $838 per beneficiary.
- Creates Accountable Care Organizations consisting of doctors and other health-care providers who share in savings from keeping patients well while improving quality, helping 48,921 Medicare beneficiaries in Utah.
- Phases out overpayments through the Medicare Advantage system, while requiring Medicare Advantage plans to spend at least 85 percent of Medicare revenue on patient care. Medicare Advantage enrollment has grown by 31,723 to 115,317 in Utah since 2009.
After Health Reform: Improved Quality and Accountability to You
- Provides incentives to hospitals in Medicare to reduce hospital-acquired infections and avoidable readmissions. Creates a collaborative health-safety learning network, the Partnership for Patients, that includes 25 hospitals in Utah to promote best quality practices.
We're not done. Other legislation and executive actions are continuing to advance the cause of effective, accountable and affordable health care. This includes:
- Incentive payments for doctors, hospitals, and other providers to adopt and use certified electronic health records (EHR). In Utah more than 26.2 percent of hospitals and 65.5 percent of providers have electronic health records systems.
- A new funding pool for Community Health Centers to build, expand and operate health-care facilities in underserved communities. Health Center grantees in Utah now serve 123,116 patients and received $55,910,832 under the health care law to offer a broader array of primary care services, extend their hours of operations, hire more providers, and renovate or build new clinical spaces.
- Health provider training opportunities, with an emphasis on primary care, including a significant expansion of the National Health Service Corps. As of September 30, 2014, there were 122 Corps clinicians providing primary care services in Utah, compared to 75 clinicians in 2008.
