Cracks Down on Insurance Company Abuses
- Insurers can no longer deny children with pre-existing conditions coverage or offer them plans that don’t cover care for those conditions. Thanks to health reform, the 94,700 Wisconsin children who have been diagnosed with conditions that could have resulted in denials of coverage in the individual market before reform are now protected.[i]
- Beginning in 2014, insurers will no longer be able to deny adults coverage or charge them higher premiums because of pre-existing conditions. In Wisconsin, this will protect the nearly one in three adults (more than 1.0 million people) who have been diagnosed with pre-existing conditions that could result in denials of coverage in the individual market.[ii]
- Insurers will no longer be able to charge higher premiums based on gender or health status. Currently, each and every one of Wisconsin’s most popular insurance plans charges a 40-year-old, non-smoking woman more for coverage than a 40-year-old, non-smoking man. Thanks to health reform, charging people more based on gender or health status will be made illegal in 2014.[iii]
- Wisconsinites have been paying more for coverage and getting less. Insurers will finally be required to spend at least a set share of premium dollars on actual medical care rather than salaries, profits, and marketing.
Provides New Health Insurance Marketplaces and Coverage Options
- Uninsured Wisconsinites will be able to gain coverage through a competitive marketplace called an “exchange.” By forcing insurance companies to compete, exchanges will drive down costs, guarantee choice, and put consumers in control.
- In addition, people with moderate incomes (for example, a family of four making up to about $90,000) will get tax credits to help with the cost of health insurance through these new exchanges. In Wisconsin, about 476,900 people will be eligible for these new tax credits in 2014.[iv]
- The Affordable Care Act also ensures that young adults, who were previously the most likely to be uninsured, have access to coverage. Young adults can now stay on their parents’ health plans up to the age of 26. In Wisconsin, 40,200 young adults are eligible to remain on their parents’ coverage.[v]
Extends Help to Small Businesses
- Small businesses will also be able to buy coverage through the new exchanges, and they will benefit from being able to join with other small businesses and buy coverage together.
- Small businesses with fewer than 25 employees and average wages of less than $50,000 now qualify for tax credits to help with the cost of coverage for their workers. In 2011, 62,800 Wisconsin businesses (70.1 percent of all businesses with 25 or fewer employees) qualified for a tax credit.[vi]
- These tax credits currently cover up to 35 percent of the cost of coverage, and the maximum value of these credits will increase to 50 percent in 2014.
Provides Financial Security and Stability for Seniors and People with Disabilities
- Wisconsin’s 918,300 seniors and people with disabilities on Medicare now have access to free preventive services, such as mammograms and colonoscopies.[vii] More than two-thirds (68.8 percent) of Wisconsinites with Medicare received at least one free preventive service between January and November of 2011.[viii]
- In addition, many seniors and people with disabilities who rely on Medicare now get more help with the cost of prescription drugs. In 2010, 64,000 Wisconsinites got a rebate check for their prescription drugs thanks to the Affordable Care Act.[ix]
- In 2011, a similar number received even larger discounts on their prescriptions—an average of $639 per person and up to $1,084 per person—when they were in the Part D coverage gap known as the “doughnut hole.”[x]
Provides Financial Security and Stability for Individuals and Families
- Health reform limits what families will have to spend on health care out of their own pockets (on copayments, deductibles, etc.) each year. In 2011, 303,000 Wisconsinites were in families that spent more than these new caps.[xi] Thanks to the Affordable Care Act, these families will be protected from catastrophic health care costs.
- In addition, insurers will no longer be able to put yearly or lifetime limits on how much they will pay for care.
- Thanks to these new protections, along with measures that will reduce the growth in health care costs, the Affordable Care Act will make Wisconsin’s families better off. By 2019, each Wisconsin household will be an average of $1,467 better off.[xii]
[i] Estimates based on pre-existing conditions diagnosed or treated in 2007, prepared by The Lewin Group for Families USA. For more information, see Christine Sebastian, Kim Bailey, and Kathleen Stoll, Health Reform: Help for Americans with Pre-Existing Conditions (Washington: Families USA, May 2010).
[ii] Estimates based on pre-existing conditions diagnosed or treated in 2007, prepared by The Lewin Group for Families USA, op. cit.
[iii] National Women’s Law Center, Still Nowhere to Turn: Insurance Companies Treat Women Like a Pre-Existing Condition (Washington: National Women’s Law Center, 2009).
[iv] Jenny Sullivan and Kathleen Stoll, Lower Taxes, Lower Premiums: The New Health Insurance Tax Credit in Wisconsin (Washington: Families USA, September 2010).
[v] Estimate of the number of uninsured young adults who are eligible to remain on their parents’ plan is from interim final rules for the dependent coverage provision (May 13, 2010), distributed across the states based upon the proportion of all uninsured young adults (ages 19-25) in the U.S. living in the state.
[vi] Estimates prepared by The Lewin Group for Families USA. Data are on file with Families USA. More details are available upon request.
[vii] Kaiser State Health Facts Online, Total Number of Medicare Beneficiaries, 2011, available online at http://www.
statehealthfacts.org/comparemaptable.jsp?ind=290&cat=6, accessed on February 22, 2012.
[viii] U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, Beneficiaries Utilizing Free Preventive Services by State, Year-to-Date 2011, through Week 47 of 2011, last modified on December 6, 2011, available online at http://www.cms.gov/NewMedia/02_preventive.asp, accessed on February 22, 2012.
[ix] Healthcare.gov, Medicare Beneficiaries Who Received a $250 Rebate Check, by State, available online at http://www.healthcare.gov/law/resources/reports/donuthole03222011a.html, accessed on February 22, 2011.
[x] Centers for Medicare and Medicaid Services, 3.5 Million in Medicare Saved More than $2.1 Billion on Prescription Drugs in the Donut Hole in 2011, available online at http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4257&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=6&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date, accessed on February 22, 2012.
[xi] Kim Bailey, Elisabeth Rodman, and Kathleen Stoll, Worry Less, Spend Less: Out-of-Pocket Spending Caps Protect Families in Wisconsin (Washington: Families USA, February 2011).
[xii] Kim Bailey and Kathleen Stoll, The Bottom Line: How the Affordable Care Act Helps Wisconsin Families (Washington: Families USA, October 2011).