With last week’s Supreme Court ruling confirming the constitutionality of the Patient Protection and Affordable Care Act (PPACA), informally referred to as Obamacare, it’s now time to start looking forward to the parts of PPACA that have not yet taken effect and analyze the repercussions. While it may not directly affect the disability insurance market, the PPACA will affect every individual currently receiving benefits. Health insurance is an important part of physical and financial well-being, and the PPACA dramatically changes how we view health insurance in this country. In the opinion of our firm, the PPACA helps most individuals, especially those people who are experiencing substantial medical problems in their lives. Today I am going to break down the PPACA into its 10 Titles and touch on how each title may affect disabled individuals and specifically how they relate to disability insurance claims.
This article is our opinion and does not constitute legal advice or the practice of law. Please contact a licensed attorney with any legal questions.
- Title I: Quality, Affordable care for All Americans
Title I may dramatically change the way health insurance is viewed in this country. Starting in 2014, the medical history of an individual can’t have an effect on premium rates offered by an health insurance company. Insurance will become compulsory for most Americans, and subsidies will be made available to help those with lower income afford health insurance coverage. This title also allows adult children to remain on their parents’ policies until age 26 and bans lifetime and annual benefit limits, which already started in 2010. Title I has a profound impact on individuals collecting disability benefits. Many of these individuals have severe medical conditions which can cost large amounts of money to treat. In addition, many of these individuals are fearful of losing their current health insurance because they couldn’t get other coverage. This title provides much-needed coverage for disabled individuals by providing more coverage for those who already have insurance and much-needed affordable access for those without.
- Title II: The Role of Public Programs
Title II dramatically changes the Medicaid program, expanding it to more low-income Americans and not just those who fit into certain categories (e.g. disabled, children, parents). Although most low-income disabled individuals were already eligible for Medicaid, Title II simplifies the approval process and adds needed quality improvement requirements for the Medicaid program.
- Title III: Improving the Quality and Efficiency of Healthcare
Title III establishes new mechanisms to create more efficient, effective, and patient-centered healthcare. New preventative benefits will be added to Medicare, and the rate of Medicare growth both in terms of number of eligible people and the reimbursement rates will be lowered to help pay for the overall cost of PPACA. The Medicare Part D drug benefit will be improved by closing the reimbursement gap commonly called the “donut hole.” Title III should help disabled individuals through improvements in doctor’s visits and the quality of care. Individuals dealing with chronic medical conditions usually have appointments at least once a month, if not more often. Improving these visits should reduce stress and increase treatment clarity as well as increase the likelihood of a better diagnosis and treatment plan by the treating physician.
- Title IV: Prevention of Chronic Disease and the Improvement of Public Health Title IV enacts a National Prevention, Health Promotion, and Public Health Council to devise a national strategy to prevent chronic health problems and diseases. These prevention strategies will be passed along to consumers in most health insurance policies at no cost. Title IV also requires chain restaurants to prominently display the calorie content of all their foods. This title may have the most dramatic but indirect impact on disability insurance, both current and future. Many individuals have become disabled due in part to potentially preventable conditions. This Council aims to resolve many of these issues before the diseases or conditions ever become so prevalent or chronic as to become disabling in addition to finding better ways to help those who are already experiencing problems. In short, a healthier America means that fewer people will become disabled.
- Title V: Healthcare Workforce Title V establishes a National Healthcare Workforce Commission to analyze and plan workforce needs and to make legislative recommendations to the Federal government, facilitating expansion of the healthcare workforce, especially in the area of primary care. This title may not have a dramatic effect on disability insurance, but should ease medical professional shortages, providing disabled people with easier and broader access to medical facilities and doctors.
- Title VI: Transparency and Program Integrity Title VI provides new authority for state and Federal agencies to combat fraud and abuse in Medicare, Medicaid, and private insurance. Title VI also requires drug companies and medical suppliers to publicly report gifts to doctors. New agencies will be formed to support clinical research and help protect senior citizens. This title helps fight illegal or unscrupulous business practices. Patients should be better assured that they’re receiving appropriate care and not paying for bogus or inappropriate charges. It also supports further research on many diseases that still need cures or advances in treatment. This should help many disabled people.
- Title VII: Improving Access to Innovative Medical Therapies Title VII directs the FDA to develop a regulatory pathway to permit development, manufacture, and sale of generic bio-pharmaceutical drugs. This title also prevents anti-competitive efforts to keep generic drugs off the market and provides discounts to facilities that serve low-income patients. This title will help many disabled people have better and more affordable access to the drugs, treatments, and other medications they need to help keep their conditions under control.
- Title VIII: CLASS: Community Living Assistance Supports and Services Title VIII was repealed and is not in force.
- Title IX: Revenue Provisions Title IX covers the cost of almost half of the PPACA. This Title includes elimination of the Medicare tax income cap, plus increased taxes on pharmaceutical manufacturers, health insurance providers, and medical device manufacturers. It also includes an excise tax on high cost-high benefit employer health plans, reductions to medical expense deductions, and changes to Health Savings Accounts. This title is administrative and doesn’t affect the contents of the other titles. However, this Title pays for much of the PPACA.
- Title X: Strengthening Affordable Healthcare for All Americans The final Title of the PPACA includes amendments and additions to the previous titles, reflecting the long and winding process to pass the PPACA. Title X also authorizes the Indian Health Care Improvement Act, which provides health care to Native American tribes. Title X is mainly administrative and affects the PPACA for only a few disabled insureds.
Health care needs reform and will continue to be debated and discussed for months and years to come. No one will know the final outcome of the PPACA for a long time. What we do know is that the PPACA attempts to put more power back in the hands of disabled insureds while balancing the effects on insurance companies and medical providers. Insurance and pharmaceutical companies that have controlled much of the health care market are being subjected to new regulations to provide more efficient, effective, and affordable health care to more people, rather than remaining focused on trying to figure out how much people will pay for health care. While others may disagree with our thoughts, the good outweighs the bad in the PPACA, and a majority of disabled Americans should see dramatic improvements in their medical care and treatments because of the PPACA.
Our firm believes in empowering the lives of not only our clients but also of all disabled people. The PPACA adds more weapons and tools for disabled people to make sure this happens. If you have any questions about how the new reforms in health care law may affect your disability, please do not hesitate to contact our offices toll-free at (855) 828-4100. If you would like help with your disability claim, please sign up for a free consultation. And as always, please feel free to comment below!