Health Care Reform and Its Impact on People with PKD
April 01, 2010 |
Advocacy
The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act were recently signed into law to overhaul our nation’s health care system. While the PKD Foundation remained silent on the reform debate and took no position on any bills, we deem it appropriate to provide our constituents with a broad outline of provisions in the new laws that may benefit to PKD patients and families.
SUPPORT FOR PKD PATIENTS
Provision: Immediate access to insurance for uninsured individuals with a pre-existing condition through high- risk pools
What It Means for You: Helps patients, who do not have health insurance because of a pre-existing condition gain access to health insurance Effective Date: Immediate (Within 90 days)
Citation: P.L. 111-148; Title I; Sec. 1101
Provision: Prohibits pre-existing condition exclusions
What It Means for You: Prevents health insurance plans from not covering services, procedures or medications related to your pre-existing condition
Effective Date: January 1, 2014
Citation: P.L. 111-148; Title I; Sec. 2704.
Provision: Prohibits discrimination against individual participants and beneficiaries based on health status (includes protections against use of genetic information)
What It Means for You: Helps protect people with genetic diseases, such as PKD, from discrimination in premiums and types of health insurance plans available for purchase
Effective Date: January 1, 2014
Citation: P.L. 111-148; Title I; Sec. 2705.
Provision: Provides coverage for individuals participating in approved clinical trials
What It Means for You: Ensures your health insurance will still pay for services, procedures and medications related to an approved clinical trial
Effective Date: Immediate (Within 90 days)
Citation: P.L. 111-148; Title I; Sec. 2709.
Provision: Eliminates lifetime or annual benefit caps
What It Means for You:: Removes arbitrary annual and lifetime benefit limits that insurance companies can impose
Effective Date: Within six months; (There are exceptions.)
Citation: P.L. 111-148; Title I; Sec. 2711.
Provision: Closing the Medicare prescription drug (Part D) coverage gap or donut hole
What It Means for You: If you are currently enrolled in a Medicare Part D plan and you hit the coverage gap in 2010, Medicare will provide a $250 rebate. There will be a phase down of the Part D coverage gap from 100 percent to 25 percent by 2020.
Effective Date: Rebate in 2010; Phase down through 2020
Citation: H.R. 4872; Title I; Sec. 1101.
RESEARCH ENHANCEMENT
Provision: Establishes the Cures Acceleration Network (CAN)
What It Means for You: The CAN will conduct and support advances in basic research, translating scientific discoveries to help bridge the research “valley of death.”
Effective Date: Immediate upon appropriations
Citation: P.L. 111-148; Title X; Sec. 10409.
Provision: Government Accountability Office (GAO) will study and report on dialysis services
What It Means for You: The study will help us better understand Medicare beneficiary access to high-quality dialysis services.
Effective Date: Within one year
Citation: P.L. 111-148; Title X; Sec. 10336.
The above charts are meant to serve as a basic resource. Provisions under the new laws will impact each person differently. For more information, please view the public laws directly by clicking on the links below.