About Health Care Reform
President Barack Obama signed the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act in March 2010. These health care reforms aim to expand coverage to millions of Americans and will require many changes to health insurance products and the regulations that govern them. This site provides explanations of the different parts of this legislation and additional resources.
For more information on health care reform, click on http://www.healthcare.gov, which is the official federal government site and managed by the U.S. Department of Health and Human Services (HHS). Other information is available from the Center of Consumer Information and Insurance Oversight at http://cciio.cms.gov.
- SMALL BUSINESS TAX CREDITS - Offers tax credits to small businesses to make employee coverage more affordable. Tax credits of up to 35 percent of premiums will be available to firms that choose to offer coverage. Effective beginning calendar year 2010. (Beginning in 2014, the small business tax credits will cover 50 percent of premiums.)
- DISCRIMINATION AGAINST CHILDREN WITH PRE-EXISTING CONDITIONS - Prohibits new health plans in all markets plus grandfathered group health plans from denying coverage to children with pre-existing conditions. Effective 6 months after enactment. (Beginning in 2014, this prohibition would apply to all persons.)
- HELP FOR UNINSURED AMERICANS WITH PRE-EXISTING CONDITIONS UNTIL EXCHANGE IS AVAILABLE (INTERIM HIGH-RISK POOL) - Provides access to affordable insurance for Americans who are uninsured because of a pre-existing condition through a temporary subsidized high-risk pool. Effective in 2010.
- ENDS RESCISSIONS - Bans insurance companies from dropping people from coverage when they get sick. Effective 6 months after enactment.
- BEGINS TO CLOSE THE MEDICARE PART D DONUT HOLE - Provides a $250 rebate to Medicare beneficiaries who hit the donut hole in 2010. Effective for calendar year 2010. (Beginning in 2011, institutes a 50% discount on prescription drugs in the donut hole; also completely closes the donut hole by 2020.)
- FREE PREVENTIVE CARE UNDER MEDICARE - Eliminates co-payments for preventive services and exempts preventive services from deductibles under the Medicare program. Effective beginning January 1, 2011.
- EXTENDS COVERAGE FOR YOUNG PEOPLE UP TO 26TH BIRTHDAY THROUGH PARENTS' INSURANCE - Requires new health plans and certain grandfathered plans to allow young people up to their 26th birthday to remain on their parents' insurance policy, at the parents' choice. Effective 6 months after enactment
- HELP FOR EARLY RETIREES - Creates a temporary re-insurance program (until the Exchanges are available) to help offset the costs of expensive premiums for employers and retirees for health benefits for retirees age 55-64. Effective in 2010.
- BANS LIFETIME LIMITS ON COVERAGE - Prohibits health insurance companies from placing lifetime caps on coverage. Effective 6 months after enactment.
- BANS RESTRICTIVE ANNUAL LIMITS ON COVERAGE - Tightly restricts the use of annual limits to ensure access to needed care in all new plans and grandfathered group health plans. These tight restrictions will be defined by HHS. Effective 6 months after enactment. (Beginning in 2014, the use of any annual limits would be prohibited for all new plans and grandfathered group health plans.)
- FREE PREVENTIVE CARE UNDER NEW PRIVATE PLANS - Requires new private plans to cover preventive services with no co-payments and with preventive services being exempt from deductibles. Effective 6 months after enactment.
- NEW, INDEPENDENT APPEALS PROCESS - Ensures consumers in new plans have access to an effective internal and external appeals process to appeal decisions by their health insurance plan. Effective 6 months after enactment.
- ENSURES VALUE FOR PREMIUM PAYMENTS - Requires plans in the individual and small group market to spend 80 percent of premium dollars on medical services, and plans in the large group market to spend 85 percent. Insurers that do not meet these thresholds must provide rebates to policyholders. Effective on January 1, 2011.
- COMMUNITY HEALTH CENTERS - Increases funding for Community Health Centers to allow for nearly a doubling of the number of patients seen by the centers over the next 5 years. Effective beginning in fiscal year 2011.
- INCREASES THE NUMBER OF PRIMARY CARE PRACTITIONERS - Provides new investments to increase the number of primary care practitioners, including doctors, nurses, nurse practitioners, and physician assistants. Effective beginning in fiscal year 2011.
- PROHIBITS DISCRIMINATION BASED ON SALARY - Prohibits new group health plans from establishing any eligibility rules for health care coverage that have the effect of discriminating in favor of higher wage employees. Effective 6 months after enactment.
- HEALTH INSURANCE CONSUMER INFORMATION - Provides aid to states in establishing offices of health insurance consumer assistance in order to help individuals with the filing of complaints and appeals. Effective beginning in fiscal year 2010.
- HOLDS INSURANCE COMPANIES ACCOUNTABLE FOR UNREASONABLE RATE HIKES - Creates a grant program to support States in requiring health insurance companies to submit justification for all requested premium increases, and insurance companies with excessive or unjustified premium exchanges may not be able to participate in the new Health Insurance Exchanges. Starting in plan year 2011.
Back to Top
The Pre-Existing Condition Insurance Plan makes health insurance available to people who have had a problem getting insurance due to a pre-existing condition.
The Pre-Existing Condition Insurance Plan:
- Covers a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs.
- Does not charge you a higher premium just because of your medical condition.
- Does not base eligibility on income.
To be eligible for the Pre-Existing Condition Insurance Plan
- You must be a citizen or national of the United States or reside in the U.S. legally.
- You must have been without health coverage for at least the last six months. Please note that if you currently have insurance coverage that doesn't cover your medical condition or are enrolled in a state high risk pool, you are not eligible for the Pre-Existing Condition Insurance Plan.
- You must have a pre-existing condition or have been denied coverage because of your health condition.
Pre-Existing Condition Insurance Plan Fact Sheet en Español
Back to Top
Starting in 2014, states are called to establish health insurance exchanges - new, competitive, state-run and consumer-centered health insurance marketplaces. The Exchanges will provide eligible consumers and businesses with "one-stop-shopping" where they can compare and purchase health insurance coverage.
Subsidies for individuals whose income is between 133-400 percent of FPL can only be used for insurance purchased in the exchange. Exchanges can be operated as a non-profit entity or as a quasi-governmental unit, and states have the option to establish regional exchanges both within and between states. States will also be responsible for making eligibility determinations across all levels of coverage, including Medicaid. The establishment of an exchange will involve a critical level of coordination across several state agencies and with the federal government.
Back to Top
If you have fewer than 25 employees and provide health insurance you may qualify for a small business tax credit of up to 35% (up to 25% for non-profits) to offset the cost of your insurance. This will make the cost of providing insurance much lower.
Millions of small employers received postcards from the IRS beginning in April that alerted them to the new Small Business Health Care Tax Credit and encouraged them to check their eligibility. Even if you didn't receive a postcard, your business still may be eligible.
Eligible small employers use Form 8941 to figure the credit for small employer health insurance premiums for tax years beginning after 2009.
- Providing health care coverage. A qualifying employer must cover at least 50 percent of the cost of health care coverage for some of its workers based on the single rate.
- Firm size. A qualifying employer must have less than the equivalent of 25 full-time workers (for example, an employer with fewer than 50 half-time workers may be eligible).
- Average annual wage. A qualifying employer must pay average annual wages below $50,000.
- Both taxable (for profit) and tax-exempt firms qualify.
Amount of Credit
- Maximum Amount. The credit is worth up to 35 percent of a small business premium costs in 2010. On Jan. 1, 2014, this rate increases to 50 percent (35 percent for tax-exempt employers).
- Phase-out. The credit phases out gradually for firms with average wages between $25,000 and $50,000 and for firms with the equivalent of between 10 and 25 full-time workers.
Back to Top
Brochures and Literature
Back to Top
Back to Top
The South Carolina Department of Insurance has submitted and received the following grant applications for federal assistance implementing the mandates of the Affordable Care Act.
Premium Review Grant
The Affordable Care Act provides States with $250 million Health Insurance Premium Review Grants over five years to help create a more level playing field by empowering how States review proposed health insurance premium increases and holding insurance companies accountable for unjustified premium increases.
Program Manager: Keith Rodgers
Keith Rodgers' Bio
Back to Top
State Planning and Establishment Grant
The Affordable Care Act authorized State Planning and Establishment Grants to help States establish health insurance Exchanges. States could apply for the first round of funding - up to $1 million for each State and the District of Columbia. These grants will give states the resources to conduct the research and planning needed to build a better health insurance marketplace and determine how their Exchanges will be operated and governed. Future funding will support development and implementation activities that States will undertake through 2014.
Visit www.healthplanning.sc.gov for detailed information.
Back to Top
Consumer Assistance Program Grant
The Affordable Care Act provides consumers with significant new protections including the ability to choose a health plan that best suits their needs, to appeal decisions by plans to deny coverage of needed services, and to select an available primary care provider of their choosing.
The new Consumer Assistance Grants program will provide nearly $30 million in new resources to help States and Territories educate consumers about their health coverage options, empower consumers, and ensure access to accurate information. Grants were made available to support States' efforts to establish or strengthen consumer assistance programs that provide direct services to consumers with questions or concerns regarding their health insurance.
(Toll-free accessible only in SC)
Back to Top