What Does the New Health Care Law Do for Me?

By Jill Rathbun

On March 23, 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act (PPACA). This is also known to many as the health care reform law. Much of what this is about is health insurance coverage and whether all Americans should have it. A major goal that members of Congress and the President wanted to accomplish was to allow the public to achieve the goal of good health. To do this, the Act is designed to create more resources and tools for prevention of disease that could help individuals, health care providers, states and communities. Some of these new activities and programs will be available this year. Others will start over the next few years.

Co-payments

People often do not get the recommended screenings and preventive care for many diseases, such as diabetes, heart disease, and osteoporosis. This can be because they are worried about having to pay for part of the service themselves. This “cost-sharing” is often called a “co-pay or co-payment.” This payment is what you have to pay out of pocket. It is usually a flat fee or a percentage of the overall payment for cost of the service. As of 2010, the health care reform law states that all new health plans are required to cover proven prevention services without asking you or your family to pay for any part of the service. To learn what services will be available to you at no cost, contact your human resources department or your health plan.

If you are 65 years of age or older and your primary insurance is Medicare, you will have to wait till January 1, 2011, to not have to pay a co-pay for proven preventive services.

Annual Wellness Visit with Personalized Prevention Plan for Those Over 65

The health care reform law allows those with Medicare (people over 65 years old or disabled) to receive personalized prevention planning services at no cost to the patient. This annual wellness visit would allow Medicare patients to receive a personalized prevention plan. This plan includes a health risk assessment and other elements, such as updating family history, listing of specialists, body mass index measurement, and tracking of regular screenings and other risk factors. This new service will be available starting January 1, 2011, for those with Medicare.

Prevention and Health Promotion

The new law states that a fund must be created to support programs at the state and local level. These programs must support prevention research and health screenings and initiatives. For example, funding could be given for education and outreach campaigns for preventive benefits and immunizations. For 2010, this fund has $500 million to spend on Federal, state, and local programs. By 2015, the size of the fund is scheduled to grow to $2 billion a year. One possible outcome of this fund is a national education and outreach campaign to raise public awareness of health improvement across a person’s life. Also, an Internet-based tool may be developed that would allow people to create their own prevention plans.

Obesity and Diabetes Prevention

Health care has been focused on “sick care” and is changing to a system of “well care.” As part of this new direction, as of 2010, the health care reform bill has set up and is funding programs to help with fighting childhood obesity. The plan is to provide money to schools, community health groups, and health care systems to develop programs to help children and their families to reduce childhood obesity. If the programs that get funded work well, then they may be expanded to other communities in 2015.

Also, under a section of the health care reform law entitled “Better Diabetes Care,” the Federal government will be required to issue a report card regarding prevention and care for people with diabetes. Every two years the country will get a “national diabetes report card.” This will educate all of us on how we are doing regarding the number of people who have diabetes and how well we are getting people with diabetes appropriate care and resources. People need help to control their weight and manage complications such as diabetes and heart disease that come from being overweight or obese. Starting in 2011 the health care reform law states that there must be nutrition labeling of standard menu items at chain restaurants. The nutrition labeling will reveal calories, amount and types of fats, cholesterol, sodium, carbohydrates, sugars, dietary fiber, and protein in the menu items. So, look for this type of information at your favorite local restaurant starting later this year.

Learn More About New Resources for Prevention and Wellness

Many resources are available to you to look up all the new programs that were created by the health care reform law. You can find out if they have been funded and when they will be starting. Please visit the web sites below to stay up to date.

http://www.whitehouse.gov/issues/health-care
http://www.cdc.gov/HealthyLiving/
http://ndep.nih.gov/
http://healthreform.kff.org/
http://www.prevent.org/
http://healthyamericans.org/

Ms. Jill Rathbun has more than 19 years experience in consulting with life sciences (including biotechnology) and healthcare organizations, from start-ups to Fortune 500, both the public and private sector. Her areas of expertise include research and development funding, reimbursement strategy and pricing, market development, product launch and positioning, government and regulatory affairs, and strategic alliances. Ms. Rathbun is a published author and noted facilitator in health care policy and delivery, market development, communication, leadership and team building, formal and informal power, and customer relationship management.