California Health Benefit Exchange is now called “Covered California” which is the primary individual health insurance marketplace in California starting in 2014. Covered California has the potential to greatly expand coverage and to significantly improve the quality and affordability of health care coverage in California.
On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act, and a week later on March 30, 2010, the Health Care and Education Reconciliation Act was signed into law. Together, these two bills are referred to as the Affordable Care Act (ACA). The provisions contained within these two massive pieces of legislation truly overhaul the entire health insurance industry.
ACA Goals
Healthcare reform has several underlying goals to it. The ACA attempts to do the following:
- expand access to healthcare coverage for all citizens
- make healthcare coverage affordable for all citizens
- improve the quality of care that consumers receive
- promote preventive care and wellness
- increase transparency in the healthcare system
- shift the burden of rising healthcare costs away from the American consumer
ACA Implementation
The specific provisions of the ACA extend on a timeline from 2010 through 2018. Some important provisions have already been implemented.
- Elimination of lifetime dollar maximums on essential health benefits
- Dependent coverage extension to age 26 extension
- Elimination of pre-existing condition restrictions on children under age 19
- Prohibition on retroactive coverage rescissions except in cases of fraud
- Prohibition on cost-sharing for preventive care services
- Small Business Health Care Tax Credit
- Established Pre-existing Conditions Insurance Plan (PCIP) to provide health coverage for individuals who cannot get coverage elsewhere due to pre-existing conditions
Provisions Taking Effect in 2012
- Four-Page Summary of Benefits
- W-2 Reporting—employers must include aggregate cost of employer-sponsored health coverage on annual W-2 form (informational only)
- Quality of Care Reporting
Provisions Taking Effect in 2013
- Employee notice of State Exchanges provided by employer
- $2,500 cap on FSA contributions
- Creation of Consumer Operated and Oriented Plan (CO-OP) programs which will create nonprofit health insurance companies that will operate in the states
- New HIPAA electronic standards
- Increase in medical deduction threshold
Provisions Taking Effect in 2014
- Individual mandate that all U.S. citizens and legal aliens get health insurance
- Operation of health benefit exchanges where there will be cost sharing subsidies for people between the 133% and 400% of the federal poverty level
- Health benefit exchanges will be required to offer 4 tiers of coverage plans (bronze, silver, gold, and platinum) and a catastrophic plan
- Required guaranteed issue and renewability and allow rating variation based on age, geographic location, family composition and tobacco use
- Elimination of annual dollar maximums on essential health benefits
- Elimination of waiting periods exceeding 90 days
- Elimination of pre-existing condition restrictions for all enrollees
- Automatic Enrollment of employees where the employer has over 200 employees
- No more underwriting based on health-status factors (medical underwriting)
- Transparency in coverage reporting
- Fair health insurance premiums
- Play-or-pay tax
- Coverage for clinical trials
- Comprehensive health insurance coverage
