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A New Era in Health Care Begins

  • Karen Davis

    Professor Emerita in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health

  • Karen Davis

    Professor Emerita in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health

This morning, millions of Americans gained access to more stable and comprehensive health insurance, thanks to important provisions of the new health reform law—also known as the Affordable Care Act—that take effect today. These changes could not have come soon enough. New census data show that a record-breaking 50.7 million Americans—from all income levels, but many of them firmly in the middle-class—lacked health insurance in 2009. That's a spike of over 4 million in one year, driven by a recession that has left millions without jobs. Last year, nearly 7 million people lost insurance they had previously obtained through an employer.

The reform provisions that go into effect today will bring coverage, financial relief and health security to many, and will also impose important new rules on the insurance industry to prevent future abuses.

As of today, young adults up to age 26 will have the option to enroll in a parent's health plan. Young adults between the ages of 19 and 29 are one of the largest segments of the uninsured; 14.8 million lacked coverage in 2009. Young adults often lose coverage when they age out of their parents' coverage upon graduating from high school or college, or when they become ineligible for public programs like Medicaid and the Children's Health Insurance Program at age 19. One million young adults (and their parents) are likely to take advantage of this important change. In addition, in 2014, young adults will also be able to gain coverage under Medicaid expansion or through state health insurance exchanges with subsidized coverage for people with low or moderate incomes.

As of today, insurers can no longer place lifetime limits on benefits, and annual limits are severely curtailed. More than 100 million people currently have lifetime limits on the amount that their health insurance will pay, and 18 million have annual limits.

As of today, insurers can no longer retroactively cancel, or rescind, coverage. In what often becomes a nightmare scenario for ill patients and their families, more than 10,000 people each year have their coverage rescinded—frequently just at the moment they need the coverage the most. Rescissions are no longer allowed.

As of today, there are new options for as many as 400,000 people with preexisting health conditions, who will immediately be able to enroll in new state-based insurance plans. In addition, thousands of children with preexisting conditions can no longer be denied health insurance.

Medicare beneficiaries who hit the prescription drug coverage gap or "doughnut hole" this year have already begun receiving $250 rebates. Next year, Medicare will eliminate cost-sharing for preventive care, and will provide for an annual wellness visit with no copayment, and provide a 50 percent discount on brand-name drugs to Medicare Part D enrollees who spend enough on prescription drugs to enter the doughnut hole. Additional discounts on brand-name and generic drugs will be phased in to completely close the doughnut hole for all Part D enrollees by 2020.

A new era in American health care begins today, one that will usher in a newfound health and economic security for millions who have struggled too long. But even with all the relief that will come starting today, the record losses in coverage experienced by millions of middle-income families point to the need to accelerate implementation of health reform to provide help faster. The nation cannot afford to ignore the plight of millions of Americans whose health is at risk, and whose health and productivity are key to revitalizing the American economy.

This post originally appeared on The Huffington Post.

Publication Details



K. Davis, A New Era in Health Care Begins Today, The Commonwealth Fund Blog, September 2010.