Two Years Later: The Benefits of the Affordable Care Act for Pennsylvania

For too long, too many hardworking Americans paid the price for policies that handed free rein to insurance companies and put barriers between patients and their doctors. The Affordable Care Act gives hardworking families in Pennsylvania the security they deserve. The new health care law forces insurance companies to play by the rules, prohibiting them from dropping your coverage if you get sick, billing you into bankruptcy because of an annual or lifetime limit, or, soon, discriminating against anyone with a pre-existing condition. 

All Americans will have the security of knowing that they don’t have to worry about losing coverage if they’re laid off or change jobs.  And insurance companies now have to cover your preventive care like mammograms and other cancer screenings.  The new law also makes a significant investment in State and community-based efforts that promote public health, prevent disease and protect against public health emergencies. 

Health reform is already making a difference for the people of Pennsylvania by:

Providing new coverage options for young adults
Health plans are now required to allow parents to keep their children under age 26 without job-based coverage on their family’s coverage, and, thanks to this provision, 2.5 million young people have gained coverage nationwide. As of June 2011, 64,798 young adults in Pennsylvania gained insurance coverage as a result of the new health care law.

Making prescription drugs affordable for seniors
Thanks to the new health care law, 247,686 people with Medicare in Pennsylvania received a $250 rebate to help cover the cost of their prescription drugs when they hit the donut hole in 2010. In 2011, 235,820 people with Medicare received a 50 percent discount on their covered brand-name prescription drugs when they hit the donut hole. This discount resulted in an average savings of $662 per person, and a total savings of $156,108,903 in Pennsylvania. By 2020, the law will close the donut hole.

Covering preventive services with no deductible or co-pay
In 2011, 1,509,076 people with Medicare in Pennsylvania received free preventive services – such as mammograms and colonoscopies – or a free annual wellness visit with their doctor. And 54 million Americans with private health insurance gained preventive service coverage with no cost-sharing, including 236,3000 in Pennsylvania.

Providing better value for your premium dollar through the 80/20 Rule
Under the new health care law, insurance companies must provide consumers greater value by spending generally at least 80 percent of premium dollars on health care and quality improvements instead of overhead, executive salaries or marketing. If they don’t, they must provide consumers a rebate or reduce premiums. This means that 3,421,000 Pennsylvania residents with private insurance coverage will receive greater value for their premium dollars.

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. Pennsylvania has received $5.3 million under the new law to help fight unreasonable premium increases.

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, 4,582,000 residents, including 1,769,000 women and 1,136,000 children, are free from worrying about lifetime limits on coverage. The law also restricts the use of annual limits and bans them completely in 2014.

Creating new coverage options for individuals with pre-existing conditions
As of the end of 2011, 4,567 previously uninsured residents of Pennsylvania who were locked out of the coverage system because of a pre-existing condition are now insured through a new Pre-Existing Condition Insurance Plan that was created under the new health reform law. To learn more about the plan available in Pennsylvania, check here.

Supporting Pennsylvania’s work on Affordable Insurance Exchanges
Pennsylvania has received $34.8 million in grants for research, planning, information technology development, and implementation of Affordable Insurance Exchanges.

• $1 million in Planning Grants:  This grant provides Pennsylvania the resources needed to conduct the research and planning necessary to build a better health insurance marketplace and determine how its exchange will be operated and governed. Learn how the funds are being used in Pennsylvania here. 
• $33.8 million in Exchange Establishment Grants:  These grants are helping States continue their work to implement key provisions of the Affordable Care Act. Learn how the funds are being used in Pennsylvania here.

Preventing illness and promoting health
Since 2010, Pennsylvania has received $29.6 million in grants from the Prevention and Public Health Fund created by the Affordable Care Act. This new fundwas created to support effective policies in Pennsylvania, its communities, and nationwide so that all Americans can lead longer, more productive lives.

Increasing support for community health centers
The Affordable Care Act increases the funding available to community health centers in all 50 states, including the 236 existing community health centers in Pennsylvania. Health centers in Pennsylvania have received $34.2 million to create new health center sites in medically underserved areas, enable health centers to increase the number of patients served, expand preventive and primary health care services, and support major construction and renovation projects. 

Strengthening partnerships with Pennsylvania
The law gives states support for their work to build the health care workforce, crack down on fraud, and support public health.  So far, Pennsylvania has received more than $128.2 million from the Affordable Care Act. Examples of Affordable Care Act grants not outlined above to Pennsylvania include:

• $312,000 to support the National Health Service Corps,by assisting Pennsylvania in repaying educational loans of health care professionals in return for their practice in health professional shortage areas.
• $6.8 million for health professions workforce demonstration projects, which will help low income individuals receive training and enter health care professions that face shortages.
• $880,000 to support teaching health centers, creating new residency slots in community health centers.
• $3.3 million for the expansion of the Physician Assistant Training Program (PDF – 66 KB), a five-year initiative to increase the number of physician assistants in the primary care workforce.
• $2.5 million for school-based health centers, to help clinics expand and provide more health care services such as screenings to students.
• $1 million to support outreach to eligible Medicare beneficiaries about their benefits.
• $191,000 for Family-to-Family Health Information Centers, organizations run by and for families with children with special health care needs.
• $933,000 to support the Personal Responsibility Education Program,to educate youth on both abstinence and contraception for the prevention of pregnancy and sexually transmitted infections, including HIV/AIDS.
• $5.2 million for Maternal, Infant, and Early Childhood Home Visiting Programs. These programs bring health professionals to meet with at-risk families in their homes and connect families to the kinds of help that can make a real difference in a child’s health, development, and ability to learn - such as health care, early education, parenting skills, child abuse prevention, and nutrition.