Major Components of Healthcare Reform Take
September 23 was the six-month
anniversary of the passage of the Patient Protection and
Affordable Care Act. Several significant components of
healthcare reform went into effect. Among
the changes to expect: Insurers Will No Longer Be Able To:
- Deny coverage to kids with pre-existing conditions.
Health plans cannot limit or deny benefits or deny
coverage for a child younger than age 19 simply
because the child has a pre-existing condition like
- Put lifetime limits on benefits. Health plans can no
longer put a lifetime dollar limit on the benefits of
people with costly conditions like cancer
- Cancel your policy without proving fraud. Health
plans can’t retroactively cancel insurance coverage– often at the time you need it most - solely
because you or your employer made an honest
mistake on your insurance application.
- Deny claims without a chance for appeal. In new
health plans, you now have the right to demand
that your health plan reconsider a decision to deny payment for a test or treatment. That also includes
an external appeal to an independent reviewer.
Consumers in New Health Plans Will Be Able to:
- Receive cost-free preventive services. New health plans must give you access to recommended preventive
services such as screenings, vaccinations
and counseling without any out-of-pocket costs to
- Keep young adults on a parent’s plan until age
26. If your health plan covers children, you can
now most likely add or keep your children on your
health insurance policy until they turn 26 years old
if they don’t have coverage on the job.
- Choose a primary care doctor, ob/gyn and pediatrician.
New health plans must let you choose the
primary care doctor or pediatrician you want from
your health plan’s provider network and let you see
an OB-GYN doctor without needing a referral from
- Use the nearest emergency room without penalty.
New health plans can’t require you to get prior
approval before seeking emergency room services
from a provider or hospital outside your plan’s network– and they can’t require higher copayments or
co-insurance for out-of-network emergency room
To learn more about the health reform bill and how it will
change your health insurance and that of you employees
and patients visit www.healthcare.gov.
Health Insurance Reform - What it Means for Community Health Health Centers
On March 23, 2010 President Barrack Obama signed into law health insurance reform legislation that will significantly increase the funding for community health centers and supporting programs like the National Health Service Corps and Medicaid over the next five years. In the current form, the program will receive $1 billion in guaranteed additional Community Health Center funding for fiscal years 2011, which begins October 1, 2010. The total funding level for community health centers under this legislation will increase by $9.5 billion over the next five years. In addition, the bill also provides $1.5 billion for facility and capital funding costs that will be essential in helping health centers cover expansion costs.
In 2009 over 1,000 FQHC organizations across the nation received approximately $1.9 billion in funding and served over 17 million patients, the majority of whom were low-income or did not have health care coverage(1). This new funding will create many new opportunities for existing health centers, FQHC-Look Alike centers, and communities in need to increase access to primary care, dental, mental health and substance abuse services.
MACHC will be updating this site on the direction of the Health Resources and Services Administration and this legislation.
Click here to download the Delaware Press Release on Health Insurance Reform (PDF)
Click here to download the Maryland Press Release on Health Insurance Reform (PDF)
(1) Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, 2008 Uniform Data System.
Page last updated October 5, 2011 by M. Alexander