Health Care Reform and You

Updated:Dec 17,2015

On March 23rd, 2010, the Affordable Care Act was signed into law, making health care coverage more available, affordable, and adequate for patients with heart disease and stroke.

As the provisions of the new law are implemented, over the next weeks, months, and years, it is critical for heart disease and stroke patients, and their families, to understand what options and protections are available to them under the new law.

To understand what the health care law means to heart disease and stroke patients, learn about:

Health Care Availability

The health reform law prohibits insurance companies from refusing coverage because of someone’s medical history or health risk. Insurers are now required to renew a policy as long as the policy holder pays their premium in full – and are 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 have the peace of mind of knowing that they can purchase affordable private health insurance coverage through new Health Insurance Marketplaces that opened in every state on October 1, 2013. The Marketplaces provide a single location where individuals, families, and small businesses who need coverage can more easily shop for and compare plans and apply for coverage. Learn more about the Marketplaces or find your state’s Marketplace at www.healthcare.gov. 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 prohibits insurance companies from refusing coverage because of someone’s medical history or health risk. Insurers are now required to renew a policy as long as the policy holder pays their premium in full – and are 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 have the peace of mind of knowing that they can purchase affordable private health insurance coverage through new Health Insurance Marketplaces that opened in every state on October 1, 2013. The Marketplaces provide a single location where individuals, families, and small businesses who need coverage can more easily shop for and compare plans and apply for coverage. Learn more about the Marketplaces or find your state’s Marketplace at www.healthcare.gov. 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 helps to make coverage more affordable for millions of Americans. The law: 

  • Prohibits insurance companies from charging people, including heart disease and stroke patients, higher premiums because of their medical condition, starting January 1, 2014;
  • Prohibits insurance companies from charging women higher premiums for their coverage, starting January 1;
  • Strictly limits the premiums that older Americans are forced to pay;
  • Makes new financial assistance available, in the form of a Health Insurance Premium Tax Credit, to low and middle-income families who don’t receive coverage from their employers. People can use the tax credit to buy the insurance plan that best meets their family’s needs and budget through the Health Insurance Marketplaces. 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;
  • Provides protection from catastrophic out-of-pocket costs by requiring plans purchased through the Health Insurance Marketplaces to limit out-of-pocket costs to approximately $6,350 for an individual and $12,700 for families; and
  • Requires insurance companies to comply with the “80/20 rule.” Under this rule, insurance plans must spend at least 80% of premium dollars on medical claims and improving health care quality, rather than on administrative expenses, or provide consumers with a rebate.

The health care reform law requires health plans to cover a range of essential health benefits without lifetime or annual caps and eliminates financial barriers to preventive care in most private health plans and Medicare. Insurance companies are also now required to provide new, easy-to-understand and uniform information about health insurance benefits and costs, called the Summary of Benefits and Coverage, to make certain that consumers know what their coverage provides and to make it easier to shop for and compare health plan options.




Specific cardiovascular disease patient populations who may have struggled to access and afford the quality care that they need, will now have more options available to them.


Learn what health care reform means for:

Middle-aged Persons with Pre-existing Conditions

Coverage for all individuals – regardless of health status – is available through the Health Insurance Marketplaces that will provide consumers with the benefit of group insurance rates. The uninsured will be able to obtain insurance through the Marketplace in their state, 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 today, the insurance available through the Marketplaces 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 more for their insurance policies, but the plans will be required to make smoking cessation services available for no extra charge. 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.

Coverage for all individuals – regardless of health status – is available through the Health Insurance Marketplaces that will provide consumers with the benefit of group insurance rates. The uninsured will be able to obtain insurance through the Marketplace in their state, 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 today, the insurance available through the Marketplaces 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 more for their insurance policies, but the plans will be required to make smoking cessation services available for no extra charge. 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.

Seniors over age 65 and the permanently disabled will continue to receive their coverage through Medicare. Health reform is not designed to make major changes to the Medicare program, but the reform law does make several changes that improve Medicare 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 of the Medicare prescription drug “doughnut hole” for the more than 8 million seniors that face a gap in drug coverage.
  • More affordable generic drugs and cutting-edge biologic drugs.
  • Coverage of clinical preventive services with no deductibles or cost-sharing, beginning January 1, 2011.
  • Coverage for a new annual, individually-tailored wellness exam in Medicare, beginning 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 prohibits plans from charging women more than men of the same age for the same insurance policy, beginning January 1, 2014. It has also eliminated co-pays and other cost-sharing for mammograms and other preventive services through most private health insurance plans and Medicare. In addition – since fewer than 50% of women have the option of obtaining health insurance through their own employer – the Health Insurance Marketplaces guarantee that women can obtain insurance if they lose coverage through their spouse or another source. And because insurers are 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 are in place to help those people with a serious illness or disability, including stroke. Insurance companies are no longer able to discriminate against people with a preexisting condition or deny coverage based on a person’s underlying health status. The reform law prohibits lifetime or annual dollar caps on covered services and requires that health plans sold through the Health Insurance Marketplaces limit out-of-pocket costs and provide coverage for essential medical care, including rehabilitative and habilitative care.

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

Health reform also closes the Medicare prescription drug “doughnut hole” or gap in coverage starting immediately (and completing the job by 2020). The law 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 can be denied coverage due to a preexisting condition. Young people, including those with congenital heart disease can stay on their parents’ policy until age 26. In addition, coverage through the private insurance plans offered through the Health Insurance Marketplaces that opened October 1, 2013 will be made affordable through tax credits for those with moderate incomes.

Reform also prohibits the imposition of lifetime or annual dollar caps on covered services and limits out-of-pocket costs for health plans sold through the Health Insurance Marketplace. The 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 are all significantly helping racial and ethnic minorities obtain health insurance.

Provisions in the law that will make preventive care available at no cost through private health insurance and Medicare are 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 the Health Insurance Marketplace, and limiting the maximum out-of-pocket costs that families can be expected to pay 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 improves 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 provide training in cultural and linguistic competence for health care professionals.




To learn more about any of the provisions mentioned here, visit www.healthcare.gov.