How the Health Care Law is Making a Difference for the People of Pennsylvania
The Affordable Care Act is working to make health care more affordable, accessible, and high quality for the people of Pennsylvania by:
Through the Health Insurance Marketplace Pennsylvanians can compare qualified health plans, get answers to questions, find out if they are eligible for lower costs for private insurance or health programs like Medicaid and the Children’s Health Insurance Program (CHIP), and enroll in health coverage.
At the end of the first annual open enrollment period, enrollment in the Marketplace surged to eight million people nationwide. In Pennsylvania alone, 318,077 individuals selected a Marketplace plan between October 1, 2013 and March 31, 2014 (including additional special enrollment period activity through April 19, 2014).
Of the 318,077 Pennsylvanians who selected a plan:
- 54% are female and 46% are male;
- 33% are under age 35;
- 30% are between the ages of 18 and 34;
- 73% selected a Silver plan, while 8% selected a Bronze plan; and,
- 81% selected a plan with financial assistance.
Although open enrollment for 2014 coverage is over, the next open enrollment period begins on November 15, 2014 for coverage that can begin as early as January 1, 2015. Click here to learn more about your coverage options outside of open enrollment.
Pennsylvania has received $34,832,212 in grants for research, planning, information technology development, and implementation of its Marketplace.
Thanks to the Affordable Care Act, states have new opportunities to expand Medicaid coverage to individuals with family incomes at or below 133 percent of the federal poverty level (generally $31,322 for a family of four in 2013). This expansion includes non-elderly adults without dependent children, who have not previously been eligible for Medicaid in most states.
Pennsylvania has seized this opportunity to expand Medicaid and, as of this July, more than 31,346 Pennsylvanians have gained Medicaid or Children’s Health Insurance Program (CHIP) coverage since the beginning of the Health Insurance Marketplace’s first open enrollment period in October, 2013. Across the nation, 8 million more Americans are now enrolled in Medicaid and CHIP.
The Affordable Care Act increases access to comprehensive coverage by requiring most health plans to cover ten essential health benefit categories, to include hospitalization, prescription drugs, maternity and newborn care, and mental health and substance use disorder services. The health care law expands mental health and substance use disorder benefits and federal parity protections for 62 million Americans nationwide, including 2,260,075 Pennsylvanians.
Under the health care law, if your plan covers children, you can now add or keep your children on your health insurance policy until they turn 26 years old. Thanks to this provision, over 3 million young people who would otherwise have been uninsured have gained coverage nationwide, including 91,000 young adults in Pennsylvania.
As many as 5,489,162 non-elderly Pennsylvanians have some type of pre-existing health condition, including 656,877 children. Today, most insurers can no longer deny coverage to anyone because of a pre-existing condition, like asthma or diabetes, under the health care law. And they can no longer charge women more because of their gender.
Health insurance companies now have to spend at least 80 cents of your premium dollar on health care or improvements to care, rather than administrative costs like salaries or marketing, or they have to provide you a refund. This means that 90,485 Pennsylvanians with private insurance coverage benefited from $5,198,874 in refunds from insurance companies, for an average refund of $75 per family because of the Affordable Care Act.
In every State and for the first time under Federal law, insurance companies are required to publicly justify their actions if they want to raise rates by 10 percent or more. Pennsylvania has received $5,312,084 under the new law to help fight unreasonable premium increases. Since implementing the law, the fraction of requests for insurance premium increases of 10 percent or more has dropped dramatically, from 75 percent to 14 percent nationally. To date, the rate review program has helped save Americans an estimated $1 billion.
The law bans insurance companies from imposing lifetime dollar limits on health benefits – freeing cancer patients and individuals suffering from other chronic diseases from having to worry about going without treatment because of their lifetime limits. Already, 4,582,000 people in Pennsylvania, including 1,769,000 women and 1,136,000 children, are free from worrying about lifetime limits on coverage. The law also restricts the use of annual limits and bans them completely starting in 2014.
The health care law requires many insurance plans to provide coverage without cost sharing to enrollees for a variety of preventive health services, such as colonoscopy screening for colon cancer, Pap smears and mammograms for women, well-child visits, and flu shots for all children and adults.
Because of the Affordable Care Act, 76 million Americans with private health insurance gained preventive service coverage with no cost-sharing, including 3,368,000 in Pennsylvania. And women can now get coverage without cost-sharing of even more preventive services they need. Of the 76 million Americans with expanded access to free preventive services, 29.7 million are women, including 1,338,000 in Pennsylvania receiving expanded preventive services without cost-sharing.
The Affordable Care Act increases the funding available to community health centers nationwide. Health Center grantees in Pennsylvania have received $156,965,721 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.
Of the $156,965,721 awarded to Pennsylvania, $6,390,303 was awarded to Pennsylvania health centers to help enroll uninsured Americans in the Health Insurance Marketplace. Pennsylvania health centers used these funds to train 330 outreach and enrollment assistance workers who helped more than 103,550 Pennsylvania residents with enrollment into affordable health insurance coverage. These investments ensure that health centers continue to be a trusted resource for assistance with enrollment in the Marketplace, Medicaid and CHIP in Pennsylvania.
In Pennsylvania, 42 health centers operate 257 sites, providing preventive and primary health care services to 680,017 Pennsylvanians, including 99,963 Latinos and 199,207 African Americans.
As a result of historic investments through the health care law and the Recovery Act, the numbers of clinicians in the National Health Service Corps are near all-time highs with 8,900 Corps clinicians providing care to more than 9.3 million people who live in rural, urban, and frontier communities. The National Health Service Corps repays educational loans and provides scholarships to primary care physicians, dentists, nurse practitioners, physician assistants, behavioral health providers, and other primary care providers who practice in areas of the country that have too few health care professionals to serve the people who live there. As of September 30, 2013, there were 206 Corps clinicians providing primary care services in Pennsylvania, compared to 62 in 2008.
Through Fiscal Year 2013, Pennsylvania has received $45,571,604 in grants from the Prevention and Public Health Fund created by the health care law. This fund was created to support effective policies in Pennsylvania and nationwide, such as initiatives focused on tobacco cessation, obesity prevention, health coverage enrollment assistance, and increasing the primary care and public health workforce, so that all Americans can lead longer, more productive lives.
A Stronger Medicare Program
In Pennsylvania, people with Medicare have saved nearly $732,202,720 on prescription drugs because of the Affordable Care Act. In 2013 alone, 261,793 individuals in Pennsylvania saved over $238,893,931, or an average of $913 per beneficiary. In 2014, people with Medicare in the “donut hole” received a 53 percent discount on covered brand name drugs and a 28 percent discount on generic drugs. And thanks to the health care law, coverage for both brand name and generic drugs will continue to increase over time until the coverage gap is closed. Nationally, over 8.2 million people with Medicare have saved over $11.5 billion on prescription drugs since the law’s enactment, for an average savings of $1,407 per beneficiary.
With no deductibles or co-pays, cost is no longer a barrier for seniors and people with disabilities who want to stay healthy by detecting and treating health problems early. In 2013 alone, an estimated 37.2 million people benefited from Medicare’s coverage of preventive services with no cost-sharing. In Pennsylvania, 1,763,689 individuals with Medicare used one or more free preventive service in 2013.
Medicare is stronger today because of the Affordable Care Act. The Medicare Trustees projected that the trust fund that finances Medicare’s hospital insurance coverage will remain solvent until 2030, four years beyond what was projected in last year’s report. Just a few years ago, the Medicare Trust Fund was projected to run out of money by 2017.
The health care law helps stop fraud with tougher screening procedures, stronger penalties, and new technology. Over the last five years, the administration’s fraud enforcement efforts have recovered $19.2 billion from fraudsters. For every dollar spent on health care-related fraud and abuse activities in the last three years the administration has returned $8.10.
Content created by Assist. Sec./Public Affairs - Digital Communications Division
Content last reviewed on September 22, 2014