Federal Law's Provisions:
Children up to age 26: State law now allows children up to age 26 to stay on their parents' insurance plans, similar to the popular provision in the Affordable Care Act (ACA). But the federal law also covers self-insured companies — most of the state's large employers.
Children with pre-existing conditions: The federal law prohibits insurers from refusing to cover children up to age 19 with pre-existing conditions.
Insurance for high-risk patients: Washington has two insurance pools for state residents with pre-existing health conditions who have been denied insurance. The state high-risk pool, established in the 1990s after insurers stopped offering individual plans in the state, will still exist. The federal pool, created by the ACA for people who had been without insurance for at least six months, will vanish in 2014, when such patients become eligible for other coverage.
Lifetime limits: Insurers typically impose lifetime limits on medical expenses; the federal law removes those limits.
Independent review of denials: People denied a particular treatment by commercial insurers already have the right of third-party review in Washington, which adopted a patients' bill-of-rights law in 2001. The federal law extends that to all insurance plans, including those offered by self-insured companies.
Canceled coverage: The federal law bars insurers from canceling coverage after a patient gets sick, unless there is outright fraud on the patient's part.
Preventive services: The federal law removes patient co-pays for many preventive services, including those covered in Medicare plans.
Seniors on Medicare: Those with large prescription-drug expenses received a check for $250 after the law passed, and now get a 50 percent discount on brand-name drugs if they hit the so-called "donut hole," where they must pay their own way until out-of-pocket costs trigger coverage again; the law calls for the gap to be eliminated by 2020.
Medical-loss ratios: One of the most controversial parts of the law requires insurers, starting in 2011, to spend most of what they collect in premiums on actual care or quality-improvement efforts. Some states, such as Washington, have similar — but less stringent — requirements. The ACA's spending requirement, which a Forbes magazine columnist predicted would amount to a "death panel" for some for-profit insurers, was 85 percent for large groups, 80 percent for others.
Help for small businesses: Tax credits in the ACA, which began in 2010, aim to help small businesses with low-wage employees afford health coverage.
Patient safety provisions: Those include a new patient-safety center, regulations requiring more reporting of hospital-acquired infections and other injuries, and incentives for providers to improve care. |
