The health reform law will prohibit insurance companies from refusing coverage because of someone’s medical history or health risk, beginning immediately for children and in 2014 for adults. Insurers will be required to renew a policy as long as the policy holder pays their premium in full – and will be prohibited from dropping or watering down insurance coverage for those who become ill.

Those who lose a job, switch jobs, or start a small business will have the peace of mind of knowing that they’ll be able to purchase affordable private health insurance coverage through state-based insurance exchanges, beginning in 2014. Beginning this year and until the state exchanges are up and running, the law makes funds available for coverage for the uninsured who have pre-existing conditions through new Preexisting Condition Insurance Plans. Heart disease and stroke survivors – and those at risk for developing cardiovascular disease – need access to affordable coverage in order to get the medical care and medications that will allow them to remain productive and contributing members of society.

The health reform law will prohibit insurance companies from refusing coverage because of someone’s medical history or health risk, beginning immediately for children and in 2014 for adults. Insurers will be required to renew a policy as long as the policy holder pays their premium in full – and will be prohibited from dropping or watering down insurance coverage for those who become ill.

Those who lose a job, switch jobs, or start a small business will have the peace of mind of knowing that they’ll be able to purchase affordable private health insurance coverage through state-based insurance exchanges, beginning in 2014. Beginning this year and until the state exchanges are up and running, the law makes funds available for coverage for the uninsured who have pre-existing conditions through new Preexisting Condition Insurance Plans. Heart disease and stroke survivors – and those at risk for developing cardiovascular disease – need access to affordable coverage in order to get the medical care and medications that will allow them to remain productive and contributing members of society.

Health insurance coverage must be affordable in order to be truly accessible. The health care reform law will help to make coverage more affordable for millions of Americans. Beginning in 2014, health care reform will:

• prohibit insurance companies from charging people, including heart disease and stroke patients, higher premiums because of their medical condition;
• will strictly limit the premiums that older Americans are forced to pay; and
• provide protection from catastrophic out-of-pocket costs by requiring plans purchased through the health insurance exchange to limit out-of-pocket costs to approximately $5,800 for an individual and $11,600 for families.

Families with low- and middle-incomes that don’t receive coverage through their employer will receive tax credits, based on their financial need, to purchase affordable coverage through state insurance exchanges, beginning in 2014. No family qualifying for a tax credit will have to pay more than 9.5 percent of their income on health insurance premiums, with lower income families paying lower premiums.

The health care reform law will require health plans to cover a range of essential benefits without lifetime or annual caps and will eliminate financial barriers to preventive care in most private health plans and Medicare. The ban on lifetime caps will begin this year; annual caps will be phased out beginning this year, with annual dollar limits on covered benefits completely prohibited for all plans beginning in 2014. The law will also require health plans to have adequate provider networks and require plans to provide comparable information about health insurance benefits, costs, and quality to make certain that consumers know what their coverage provides.

Coverage for all individuals – regardless of health status – will be available through a state exchange that will provide consumers with the benefit of group insurance rates, beginning in 2014. The uninsured will be able to obtain insurance through an insurance exchange, providing security for those who may at some point lose their employer-sponsored coverage or decide to start their own business. Tax credits will be available to those with moderate incomes to make the coverage they buy affordable. Unlike some policies offered through employers or in the individual market today, the insurance available through the exchange will cover all essential services and cap out-of-pocket costs.

Consumers will be given easily understandable information about their health insurance benefits so that they know what they are getting. Smokers may pay slightly more for their insurance policies, but the plans would be required to provide “first dollar” coverage (with no deductible or co-pays) for smoking cessation services. Middle-aged people may also be charged higher premiums due to their age, but those premiums will be capped and those with moderate incomes will receive tax breaks to help ensure the coverage is still affordable. Starting this year until the state exchanges are up and running in 2014, the reform law provides funding to encourage employers to continue providing health benefits for early retirees and for new Preexisting Condition Insurance Plans to provide coverage to the uninsured with preexisting conditions.

Coverage for all individuals – regardless of health status – will be available through a state exchange that will provide consumers with the benefit of group insurance rates, beginning in 2014. The uninsured will be able to obtain insurance through an insurance exchange, providing security for those who may at some point lose their employer-sponsored coverage or decide to start their own business. Tax credits will be available to those with moderate incomes to make the coverage they buy affordable. Unlike some policies offered through employers or in the individual market today, the insurance available through the exchange will cover all essential services and cap out-of-pocket costs.

Consumers will be given easily understandable information about their health insurance benefits so that they know what they are getting. Smokers may pay slightly more for their insurance policies, but the plans would be required to provide “first dollar” coverage (with no deductible or co-pays) for smoking cessation services. Middle-aged people may also be charged higher premiums due to their age, but those premiums will be capped and those with moderate incomes will receive tax breaks to help ensure the coverage is still affordable. Starting this year until the state exchanges are up and running in 2014, the reform law provides funding to encourage employers to continue providing health benefits for early retirees and for new Preexisting Condition Insurance Plans to provide coverage to the uninsured with preexisting conditions.

Health reform is not designed to address every concern with the Medicare program, but the new reform law makes several changes that improve benefits and reduce the burden on individuals with heart disease or stroke. The new law also does not cut Medicare benefits or raise costs for beneficiaries. The cuts in Medicare that are made are designed to reduce waste and curb overpayments and will strengthen the long-term financial health of the program. Specific changes that will help patients with cardiovascular disease include:

• Elimination over time of the Medicare prescription drug “doughnut hole” for the more than 8 million seniors that face a gap in drug coverage. Seniors facing a drug coverage gap this year will receive a $250 rebate.
• More affordable generic drugs and cutting-edge biologic drugs.
• First-dollar coverage of clinical preventive services, beginning January 1, 2011.
• Coverage for a new annual, individually-tailored wellness exam in Medicare, beginning next year (January 1, 2011).
• Innovations in chronic disease management (for conditions such as heart disease, diabetes, and cancer) that can help seniors stay healthier, longer, including better care after a hospital discharge.
• Strong medical safety measures aimed at reducing medical errors and hospital-acquired infections that can often be more deadly than the disease that caused the initial hospitalization.

Health reform will prohibit plans from charging women more than men of the same age for the same insurance policy, beginning in 2014. It will also eliminate co-pays and other cost-sharing for mammograms and other preventive services beginning this year for new private plans and Medicare and make health care more affordable across-the-board. In addition – since fewer than 50% of women have the option of obtaining health insurance through an employer – state-based insurance exchanges will guarantee that women can obtain insurance if they lose coverage through their spouse or another source, beginning in 2014. And because insurers will no longer be able to drop coverage for those who are seriously ill, women will know that their coverage is secure.

With health care reform, new protections will be put in place to help those people with a serious illness or disability, including stroke. Insurance companies will not be able to discriminate against people with a preexisting condition or deny coverage based on a person’s underlying health status, beginning in 2014 for adults. The reform law prohibits lifetime or annual caps, and will require that health plans sold through an exchange cap out-of-pocket costs and provide coverage for essential medical care, including rehabilitative and habilitative care.

In addition to implementing insurance reforms, premium assistance will be provided in the form of tax credits to individuals with low or moderate incomes, beginning in 2014. By providing this assistance to make health insurance more affordable, people having experienced a stroke will be able to access affordable health insurance even if they are not able to work and are not yet eligible for Medicare.

Health reform also immediately extends the process that allows Medicare patients to receive medically necessary outpatient therapy without arbitrary limits and closes the Medicare prescription drug “doughnut hole” or gap in coverage starting this year (completing the job by 2020). The new law expands Medicaid for low income families and individuals in 2014, improves care coordination after being discharged from the hospital, and implements Medicare reforms to reduce hospital readmissions.

Health care reform offers a number of advantages to a congenital heart disease survivor. First, no person will be denied coverage due to a preexisting condition, beginning this year for children and in 2014 for adults. Young people, including those with congenital heart disease, will be able to stay on their parents’ policy until age 26, beginning this year. In addition, coverage through the private plans offered by state-based health exchanges that begin in 2014 will be made affordable through tax credits for those with moderate incomes.

Reform will also prohibit the imposition of lifetime or annual caps, require health plans to provide adequate networks of providers, and cap out-of-pocket costs for health plans sold through an insurance exchange. The new law also includes the provisions of the Congenital Heart Futures Act, which will improve the nation’s surveillance, research, and education efforts to fight congenital heart disease.

Guaranteeing the availability of health insurance coverage, preventing denial of coverage for those with pre-existing medical conditions, and providing extra assistance to those with low and moderate incomes to make insurance coverage affordable should all significantly help racial and ethnic minorities obtain health insurance.

Provisions in the new law that will make preventive care available at no cost through private health insurance and Medicare will also be particularly helpful to minorities. Prohibiting annual or lifetime caps on covered benefits, providing cost-sharing assistance for those with low and moderate incomes purchasing coverage through an exchange, and limiting the maximum out-of-pocket costs that families can be expected to pay will also help to make health care more adequate and affordable for minorities.

The reform law also contains provisions throughout intended to help eliminate racial and ethnic health disparities. For instance, the law will improve the collection of key health data by race, ethnicity, primary language and other indicators to better identify and address health disparities. Workforce provisions will help increase the diversity of the health care workforce and will provide training in cultural and linguistic competence for health care professionals.