Though the Supreme Court is preparing to hear arguments about its constitutionality, the Patient Protection and Affordable Care Act is law, and more provisions are set to go into effect this coming year and in 2013. With that in mind—and to brush up on the basics before the Court digs in—we asked healthcare scholar Janet Golden to give us a quick roundup of information that’s easily available online. —Ed.
On March 23, 2010 President Obama signed into law the Patient Protection and Affordable Care Act. (If you’ve got hours and hours of time to kill you can read the whole thing online. Before, during, and after the debate over this legislation, it’s been deemed everything from a sell-out to big business as usual to a socialist plot. But with more of its provisions going into effect in 2012, it’s worth taking a closer look at what’s in it for over-40 women and their families.
A key provision is the mandate requiring individuals to be covered by health insurance. It provides subsidies for low- and moderate-income individuals to purchase coverage, mandates a basic set of benefits, and prohibits exclusions based on pre-existing conditions. The logic of the mandate is simple: for the Affordable Care Act to effectively lower health care costs while covering those with expensive chronic conditions, we all need to participate. It simply isn’t fair for someone to avoid insurance premiums for decades and then, when needing millions in care, to jump into the coverage pool. Moreover, if only those needing care get coverage, insurance rates will be unaffordable. In a 2009 commentary on CBS News Moneywatch, one economist offered a simple explanation of the need for the individual mandate.
So what exactly is in this law—which I’ll call the Affordable Care Act—and how do you get accurate information about the phase-in of benefits? And which provisions directly affect women over 40? The answers can be found at a number of easily understood websites.
The federal government website Healthcare.gov offers a timeline explaining the implementation of the numerous provisions in the law. For example, women who run small businesses or who lead small nonprofit groups became eligible for tax credits for their contributions to their employees’ health insurance retroactive to January 1, 2010. Women over 65 on Medicare who hit the “donut hole” in their prescription-drug coverage received a one-time rebate check for $250, with additional coverage and discounts being phased-in. The website also has a list of the preventive services for women, mandated under the law, that are covered. Notably, mammography, cervical cancer screenings, and well-woman visits are covered. Funds for prevention—including those aimed at smoking and obesity—are increased under the law. It’s worth scrolling through the timeline and looking at the phase-in of various reforms. (Perhaps you’ve gone to the doctor this year and been pleased to find that you don’t have a co-pay for these services!) You’ll find additional information in Healthcare.gov factsheets.
Of the many sites offering information, my personal favorite is the one supported by the Commonwealth Fund, a private foundation that funds research on healthcare issues and grant programs aimed at improving healthcare practice and policy. Their timeline and “health reform provisions” tool are the most clearly written and easiest to navigate of any that I’ve found.
Another rich source of information is the Kaiser Family Foundation website. The foundation, which is not affiliated with Kaiser Permanente or Kaiser Industries, aims to provide independent, factual information on health issues. They have a dedicated discussion of health reform, and if you’d rather watch than read, they produced a short video on the topic narrated by Cokie Roberts. If you think you know all you need to about the Affordable Care Act, you can take their ten-question online quiz and determine your knowledge of the new law. (For the record, I scored 9 out of 10—better than 97 percent of all Americans!)
The Patient Protection and Affordable Care Act required the Department of Health and Human Services (HHS) to determine the minimum set of benefits to be provided by all insurers. The Department asked the Institute of Medicine—an arm of the National Academy of Sciences that provides “unbiased and authoritative advice to decision makers and the public”—to propose criteria and methods for deciding what benefits should be covered. You guessed it—the IOM report is available online, too.
The Trust for America’s Health, a non-profit, non-partisan organization focused on public health and disease prevention, also has a website on the implementation of the Affordable Care Act. The TFAH does an excellent job of pointing to the health-promotion and disease-prevention funding that comes out of the legislation, including better nutrition in schools, injury-prevention programs, smoking-cessation efforts and nutrition labeling in chain restaurants.
As I’ve tried to suggest, the Patient Protection and Affordable Care Act has numerous provisions and a phase-in period of several years. It is aimed at not only providing access to care through insurance, but promoting health through other initiatives. It is complex, but good sources of information are available.
Now, the Supreme Court is getting ready to hear arguments about the law in the wake of conflicting federal court rulings about various provisions. If you’d like to keep up with the news about this and other key health care debates, visit, or sign up for email delivery of Kaiser Health News. Your access to health services and public health efforts in your community, now and in the years to come, may depend upon the Supreme Court’s ruling, so it’s a good idea to stay informed.