6 Lesser-Known Obamacare Provisions That Could Evaporate
The outcome of the repeal-and-replace Obamacare debate could affect more than you might think, depending on just how the GOP congressional majority pursues its goal.
Beyond the Affordable Care Act's marquee achievements like guaranteeing health coverage for people with pre-existing conditions and allowing children to stay on parents' plans until age 26, the roughly 2,000-page law created a host of other provisions that affect the health of nearly every American.
Some of these measures are evident every day. Some enjoy broad support, even though people often don't always realize they spring from the statute.
Here's a sampling of sleeper provisions that could potentially land on the cutting-room floor:
1. Calorie counts at restaurants and fast-food chains
Feeling hungry? The law tries to give you more information about what that burger or muffin will cost you in terms of calories, part of an effort to combat the ongoing obesity epidemic. Under the ACA, most restaurants and fast food chains with at least 20 stores must post calorie counts of their menu items. Several states, including New York, already had similar rules before the law.
Although there was some pushback, the rule had industry support, possibly because posting calories was seen as less onerous than such things as taxes on sugary foods or beverages. The final rule went into effect in December after a one-year delay.
One thing is still not clear: Does simply seeing that a particular muffin has more than 400 calories cause consumers to choose carrot sticks instead? Results are mixed. One large meta-analysis done before the law went into effect didn't show a significant reduction in calorie consumption, although the authors concluded that menu labeling is "a relatively low-cost education strategy that may lead consumers to purchase slightly fewer calories."
2. Private breast-milk pumping space at work
Breast-feeding, but going back to work? The law requires employers to provide women break time to express milk for up to a year after giving birth and provide someplace other than a restroom to do so in private. In addition, most health plans must offer breast-feeding support and equipment, such as pumps, without a patient copayment.
3. Limits on surprise medical bills from ER visits
If you find yourself in an emergency room, short on cash, uninsured or not sure if your insurance covers costs at that hospital, the Affordable Care Act provides some limited assistance. If you are in a hospital that is not part of your insurer's network, the law requires all health plans to charge consumers the same copayments or co-insurance for out-of-network emergency care as they do for hospitals within their networks. Still, the hospital could "balance bill" you for its costs, including ER care, that exceed what your insurer reimburses it.
If it's a nonprofit hospital, and about 78 percent of all hospitals are, the law requires it to post online a written financial assistance policy, spelling out whether it offers free or discounted care and the eligibility requirements for such programs. While not prescribing any particular set of eligibility requirements, the law requires hospitals to charge lower rates to patients who are eligible for their financial assistance programs. That's compared with their gross charges, also known as chargemaster rates.
4. Community health support from nonprofit hospitals
The health law also requires nonprofit hospitals to justify the billions of dollars in tax exemptions they receive by documenting how they go about trying to improve the health of the community around them.
Every three years, these hospitals have to perform a community needs assessment for the area the hospital serves. They also have to develop strategies to meet these needs and update them annually. The hospitals then must provide documentation as part of their annual reporting to the Internal Revenue Service. Failure to comply could leave them liable for a $50,000 penalty.
5. A woman's right to choose her OB-GYN
Most insurance plans must allow women to seek care from an obstetrician-gynecologist without having to get a referral from a primary care physician. While the majority of states already had such protections in place, those laws did not apply to self-insured plans, which are the type often offered by large employers. The health law extended the rules to all new plans. Proponents say direct access makes it easier for women to seek not only reproductive health care, but also screening for such things as high blood pressure or cholesterol.
6. Expanded therapy coverage for children with autism
Advocates for children with autism and people with degenerative diseases argued that many insurance plans did not provide care their families needed. That's because insurers would cover rehabilitation to help people regain functions they had lost, such as walking again after a stroke, but not care needed to either gain functions patients never had, such as speech therapy for a child who never learned how to talk, or to maintain a patient's current level of function. The Affordable Care Act requires plans to offer coverage for such treatments, dubbed habilitative care, as part of the essential health benefits in plans sold to individuals and small groups.
Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.
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