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Health Care Reform: A Patient’s Primer

The passage of the Patient Protection and Affordable Care Act — otherwise known as health care reform — in March 2010 was a milestone in the history of American health care. Now, you’re probably wondering what practical effect it will have on your life.

"Without reform, hospitals could have expected a greater volume of uninsured individuals seeking care at their emergency departments, which would have led to lower Medicare and Medicaid payments and an increased shift in the costs of care to private and commercially insured patients,” says Joel Ballew, director of Government Affairs and Advocacy for Texas Health Resources. “The new law isn’t perfect, but many aspects of it hold great benefits for patients, particularly when it comes to insurance reform. Texas Health will continue to work with key policymakers and stakeholders on modifications, which will certainly be required given the broad scope of this reform effort.”

Consider the following key parts of the law that may impact your life.

• A Health Insurance Exchange will create a marketplace in which individuals and owners of small businesses can compare prices of public and private insurers. The Exchange will work with state insurance departments to protect consumers, aid enrollment, and help low- and middle-income families purchase affordable insurance.

• A public, self-sustaining health insurance option will be available via the Exchange, enabling more people to obtain insurance coverage.

• Insurance companies will no longer be able to exclude coverage based on pre-existing conditions and will be prohibited from placing lifetime and annual limits on benefits.

• Out-of-pocket spending will be capped.

• Individuals will be required to obtain and maintain health insurance (except in cases of hardship) or pay a penalty of 2.5 percent of modified adjusted gross income above a specified level.

• Employers will have the option of providing health insurance to workers or contributing funds on their behalf.

• Greater support of prevention and wellness programs, including the expansion of community health centers and
of the health care workforce, will be made possible through increased funding via the National Health Service Corps.

(Fall/Winter 2010)

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