Kaiser Foundation Marks Third Anniversary of ACA

To mark the three-year anniversary of the Affordable Care Act (ACA), which was signed into law on March 23, 2010, the Kaiser Family Foundation has released an issue brief that summarizes tangible benefits and policy changes already “on the ground,” even though the date for full implementation of most ACA provisions is January 1, 2014. The issue brief summarizes changes that have already been made in in the areas of private insurance and health exchanges, Medicaid coverage, access to primary and preventive care, Medicare, and beneficiaries dually eligible for Medicaid and Medicare. Each summary is accompanied by links to other Kaiser resources that provide more detailed information.

In the area of private insurance and exchanges, the ACA provision that permits qualifying young adults to remain on their parents' insurance policy until age 26 reduced the number of uninsured Americans in 2011 by 1.3 million. Currently, 17 states and the District of Columbia are establishing state-based health insurance exchanges, and another seven have agreed to partner with the federal government to run their exchanges. The law prohibited private insurers, effective September 23, 2010, from using coverage exclusions for children with preexisting conditions—a protection that will take effect for adults in 2014.

In the area of Medicaid coverage, more than half the governors have announced support for the Medicaid expansion—27 governors intend to implement it, and another seven are weighing their options. Seventeen governors oppose the expansion. Seven states have used the ACA option to expand Medicaid before 2014, shoring up the very limited base of coverage currently available to low-income adults. Nearly all states are modernizing and streamlining Medicaid enrollment systems, taking advantage of a time-limited 90% federal match rate for systems development. Ten states have adopted the ACA option that provides health homes for persons with chronic conditions or serious mental illness, and another five states plan to implement health homes.

Access to primary care has already been enhanced by the ACA. Primary care providers receive increased Medicare and Medicaid payment rates under the ACA, which from 2011 through 2015 provides for a 10% bonus payment on top of the regular Medicare fee schedule amount for many services. In addition, the ACA's five-year $11 billion investment in the health center program—the Health Center Trust Fund—has increased patient capacity at the centers, which now serve an additional 1.5 million patients. To expand the primary care workforce, the ACA has increased the number of graduate medical education residency programs, including the establishment of 11 “teaching health centers.” The ACA has also provided an additional $1.5 billion in funds for the National Health Service Corps (NHSC), which provides loan repayment to medical students and others in exchange for service in underserved communities. As a result of the ACA investment and earlier investments by the American Reinvestment and Recovery Act of 2009, the number of NHSC clinicians is at an all-time high—triple the number in 2008.

Preventive benefits with no patient cost-sharing are now required in Medicare and private insurance (except for grandfathered plans). It is estimated that as a result of the ACA, 71 million children and adults with private insurance and 34 million Medicare beneficiaries have received no-cost preventive care. The ACA supports population-based prevention activities through a new Prevention and Public Health Fund, which has already invested more than $1 billion in critical programs aimed at reducing the burden of chronic disease and improving the overall health of communities.

Medicare beneficiaries who are enrolled in Part D drug plans have been receiving additional help with “doughnut hole” prescription drug costs since 2011, when the ACA required drug manufacturers to offer a 50% discount on drugs during this coverage gap and required Part D plans to provide additional coverage for drugs for patients who reach the gap. The ACA established a new Center on Medicare and Medicaid Innovation charged with reducing costs. The center has already approved more than 250 accountable care organizations (ACOs) in 47 states and territories to participate in the Medicare Shared Savings Program; these ACOs cover more than four million beneficiaries in traditional Medicare.

For the vulnerable population that is eligible for both Medicare and Medicaid—about 9 million seniors and younger people with significant disabilities—many states have responded to the ACA initiative to develop and test models that align financing for this population. A total of 26 states have approved or pending proposals to test alignment models.

The issue brief, The Affordable Care Act Three Years Post-Enactment, is available on the Kaiser Foundation Web site at www.kff.org/healthreform/upload/8429.pdf.

Another newly released Kaiser resource on the ACA is a Webinar, “Translating The Medicaid Expansion Into Increased Coverage: The Role of Application Assistance.” In the hour-long Webinar, four experts examine the role of application assistance in ensuring that eligible individuals can navigate the new technology-driven enrollment systems for Medicaid, the Children’s Health Insurance Program, and the new health insurance exchange marketplaces (www.kff.org/medicaid/webinar_medicaid_expansion.cfm).

Currently, more than 1,100 federally funded community health centers help ensure access to care for low-income individuals in medically underserved communities. As noted, the ACA provides $11 billion over five years to expand the capacity of these centers to prepare for newly covered populations. An 11-page report, Community Health Centers in an Era of Health Reform: An Overview and Key Challenges to Health Center Growth, offers a current snapshot of health centers and discusses developments that are expected to have a significant impact on their future growth (www.kff.org/uninsured/8098.cfm).

Finally, because a key ACA goal is to reduce the number of uninsured Americans and because people of color are at disproportionate risk of being uninsured, ACA's coverage expansions can particularly benefit communities of color and advance efforts to eliminate disparities. An 11-page brief, Health Coverage by Race and Ethnicity: The Potential Impact of the Affordable Care Act, gives an overview of health disparities by race and ethnicity and offers insights into the potential impacts of the ACA coverage expansions for people of color (www.kff.org/minorityhealth/upload/8423.pdf).