The Affects of the Health Care Law for the People of Oregon
Posted On November 20, 2015
As a certified agent for Cover Oregon and the federal marketplace, I get a lot of questions about the new health care law. Many people have asked how this law affects them and their community. In this post I want to share some of the ways that the law is already affecting Oregonians as provided by healthcare.gov.
At the end of the first annual open enrollment period, enrollment in the Marketplace surged to eight million people nationwide. In Oregon alone, 68,308 individuals selected a Marketplace plan between October 1, 2013 and March 31, 2014 (including additional special enrollment period activity through April 19, 2014).
Of the 68,308 Oregonians who selected a plan:
- 57% are female and 43% are male;
- 27% are under age 35;
- 22% are between the ages of 18 and 34;
- 66% selected a Silver plan, while 22% selected a Bronze plan; and,
- 80% selected a plan with financial assistance.
Oregon has received $305,206,587 in grants for research, planning, information technology development, and implementation of its Marketplace.
Enrollment in Medicaid and CHIP is open year round. An additional 273,681 Oregonians enrolled in Medicaid and CHIP through the end of March 2014, compared to enrollment before the Marketplace opened October 1, 2013. Twenty-six states and Washington, D.C. have expanded Medicaid so far, with the federal government providing 100 percent of the funds for the newly eligible population for the next three years, and never less than 90 percent after that. Oregon has taken advantage of the new opportunity to expand Medicaid coverage under the Affordable Care Act.
The Affordable Care Act increases access to comprehensive coverage by requiring most health plans to cover ten essential health benefit categories, to include hospitalization, prescription drugs, maternity and newborn care, and mental health and substance use disorder services. The health care law expands mental health and substance use disorder benefits and federal parity protections for 62 million Americans nationwide, including 817,160 Oregonians.
New coverage options for young adults
Under the health care law, if your plan covers children, you can now add or keep your children on your health insurance policy until they turn 26 years old. Thanks to this provision, over 3 million young people who would otherwise have been uninsured have gained coverage nationwide, including 43,000 young adults in Oregon.
Ending discrimination for pre-existing conditions
As many as 1,692,205 non-elderly Oregonians have some type of pre-existing health condition, including 206,964 children. Today, most insurers can no longer deny coverage to anyone because of a pre-existing condition, like asthma or diabetes, under the health care law. And they can no longer charge women more because of their gender.
Providing better value for your premium dollar through the 80/20 Rule
Health insurance companies now have to spend at least 80 cents of your premium dollar on health care or improvements to care, rather than administrative costs like salaries or marketing, or they have to provide you a refund. This means that 22,346 Oregonians with private insurance coverage benefited from $2,928,540 in refunds from insurance companies in 2012, for an average refund of $206 per family covered by a policy.
Scrutinizing unreasonable premium increases
In every State and for the first time under Federal law, insurance companies are required to publicly justify their actions if they want to raise rates by 10 percent or more. Oregon has received $8,635,586 under the new law to help fight unreasonable premium increases. Since implementing the law, the fraction of requests for insurance premium increases of 10 percent or more has dropped dramatically, from 75 percent to 14 percent nationally. To date, the rate review program has helped save Americans an estimated $1 billion.
Removing lifetime limits on health benefits
The law bans insurance companies from imposing lifetime dollar limits on health benefits – freeing cancer patients and individuals suffering from other chronic diseases from having to worry about going without treatment because of their lifetime limits. Already, 1,356,000 people in Oregon, including 529,000 women and 342,000 children, are free from worrying about lifetime limits on coverage. The law also restricts the use of annual limits and bans them completely starting in 2014.
Covering preventive services with no deductible or co-pay
The health care law requires many insurance plans to provide coverage without cost sharing to enrollees for a variety of preventive health services, such as colonoscopy screening for colon cancer, Pap smears and mammograms for women, well-child visits, and flu shots for all children and adults.
In 2011 and 2012, 71 million Americans with private health insurance gained preventive service coverage with no cost-sharing, including 907,000 in Oregon. And women can now get coverage without cost-sharing of even more preventive services they need. Approximately 47 million women, including 633,784 in Oregon will now have guaranteed access to additional preventive services without cost-sharing.
Increasing support for community health centers
The health care law increases the funding available to community health centers nationwide. In Oregon, 30 health centers operate 213 sites, providing preventive and primary health care services to 311,298 people. Health Center grantees in Oregon have received $133,134,731 under the health care law to support ongoing health center operations and to establish new health center sites, expand services, and/or support major capital improvement projects.
Community Health Centers in all 50 states also received a total of $150 million in federal grants to help enroll uninsured Americans in the Health Insurance Marketplace, including $3,584,396 awarded to Oregon health centers. Oregon health centers anticipated using these funds to hire 457 additional workers who would assist 96,477 Oregonians with enrollment into affordable health insurance coverage.
Investing in the primary care workforce
As a result of historic investments through the health care law and the Recovery Act, the numbers of clinicians in the National Health Service Corps are near all-time highs with 8,900 Corps clinicians providing care to more than 9.3 million people who live in rural, urban, and frontier communities. The National Health Service Corps repays educational loans and provides scholarships to primary care physicians, dentists, nurse practitioners, physician assistants, behavioral health providers, and other primary care providers who practice in areas of the country that have too few health care professionals to serve the people who live there. As of September 30, 2013, there were 221 Corps clinicians providing primary care services in Oregon, compared to 49 in 2008.
Preventing illness and promoting health
Through Fiscal Year 2013, Oregon has received $27,075,484 in grants from the Prevention and Public Health Fund created by the health care law. This fund was created to support effective policies in Oregon and nationwide, such as initiatives focused on tobacco cessation, obesity prevention, health coverage enrollment assistance, and increasing the primary care and public health workforce, so that all Americans can lead longer, more productive lives.
Making prescription drugs affordable for seniors
In Oregon, people with Medicare have saved nearly $101,228,724 on prescription drugs because of the Affordable Care Act. In 2013 alone, 44,617 individuals in Oregon saved over $36,364,574, or an average of $815 per beneficiary. In 2013, people with Medicare in the “donut hole” received a 52.5 percent discount on covered brand name drugs and a 21 percent discount on generic drugs. And thanks to the health care law, coverage for both brand name and generic drugs will continue to increase over time until the coverage gap is closed. Nationally, over 7.9 million people with Medicare have saved over $9.9 billion on prescription drugs since the law’s enactment.
Covering preventive services with no deductible or co-pay
With no deductibles or co-pays, cost is no longer a barrier for seniors and people with disabilities who want to stay healthy by detecting and treating health problems early. In 2013 alone, an estimated 37.2 million people benefited from Medicare’s coverage of preventive services with no cost-sharing. In Oregon, 460,704 individuals with Medicare used one or more free preventive service in 2013.
Protecting Medicare’s solvency
The health care law helps stop fraud with tougher screening procedures, stronger penalties, and new technology. Over the last five years, the administration’s fraud enforcement efforts have recovered $19.2 billion from fraudsters. For every dollar spent on health care-related fraud and abuse activities in the last three years the administration has returned $8.10.