Healthcare Reform

The health reform law, The Patient Protection and Affordable Care Act of 2010 (commonly referred to as the “Affordable Care Act” or “ACA”), represents the broadest reform to the United States’ health care system since the 1960s.

Background

The Affordable Care Act was signed into law on March 23, 2010 after a two year process by Congress and the President. Subsequent challenges to the law were brought before the Supreme Court, the decisions in these cases also shaped the law into its current form.

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Individual Mandate:

The law requires that starting in 2014, all citizens obtain health coverage or face tax penalties. If individuals are already offered health insurance coverage by an employer or other option, they do not have to alter their insurance. For those who do not have coverage, the ACA offers new options to obtain it.

Learn moreIndividual Mandate

Essential Health Benefits:

The law specified new “essential health benefits” that must be covered for all patients by their insurer.

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New Health Coverage Options:

Pre-Existing Condition Insurance Plan (PCIPs)

The ACA required that every state make health insurance available to people who have had a problem getting insurance due to a pre-existing conditions, in the interim between enactment of the law and implementation of the Medicaid Expansion and availability of the state Insurance Exchanges in 2014.

State Insurance Exchanges

The ACA established new Insurance Exchanges in every state, to offer those who lack insurance coverage affordable individual and small group plans. The Exchanges are either state-run, federally-run, or run through a state-federal partnership. Insurers offer various plans at different price and benefit levels. Tax credits are available to low-income patients. Insurers are required to include Essential Community Providers, like HIV providers, in their networks.

Learn moreState Insurance Exchanges

Changes to Existing Government Payer Programs:

Medicaid

One of the biggest changes in the ACA is the available expansion of the Medicaid program in every state to many new beneficiaries and low-income individuals. This provision has not yet been implemented in every state.

Learn moreHealth Reform & Medicaid

Ryan White

Starting in 2014 many of Ryan White patients will be eligible to obtain coverage through Medicaid or the state Insurance Exchanges. This shift brought about many changes for the Ryan White program in every state, as well as changes for grantees and beneficiaries.

Learn moreHealth Reform & Ryan White

Medicare

The law eliminates the so-called “donut hole” in the Medicare Part D prescription drug benefit incrementally by 2020 and created an important change for the Ryan White ADAP program.

Learn moreMedicare

Patient Enrollment

Millions of Americans enrolled in new coverage during the first open enrollment period beginning in 2013. The second open enrollment period begins November 15, 2014.

The law also created opportunities to offer trained assistance for patients through the Patient Navigator Program, and other enrollment counselor opportunities.

Learn morePatient Enrollment

My State

Many of the provisions of the law were implemented at the state level. Each state had a different experience with establishing their state Insurance Exchange and Medicaid Expansion status. The ACA implementation is unique to each state.

Learn moreState Implementation

 

Each state has its own unique state Insurance Exchange, and state Medicaid program, and also Ryan White wrap-around. It is important for both patients and providers to know how the ACA is being implemented in your state.

Learn moreHealth Reform in My State

Our Advocacy Efforts

To learn about AAHIVM’s advocacy efforts on behalf of our members during the law’s development, or since its passage, visit Our Advocacy Efforts page