Wednesday, September 1, 2010

Understanding the Patient Protection and Affordable Care Act (PL111-148)

Understanding the Patient Protection and Affordable Care Act (PL111-148)

People with mental illness are expected to benefit from expanded insurance access and treatment coverage under the landmark $938 billion health care overhaul signed into law by President Obama in March, 2010.

The primary insurance overhaul measure includes benefits for people with mental illness who have lacked insurance coverage or whose insurance omitted or sharply limited coverage for mental illness treatment.

The legislation requires new state health insurance exchanges that will serve as a marketplace to assist uninsured individuals and small employers in purchasing private health plans. All plans in the exchanges must offer the same minimum benefits package, which must include mental health services and substance use treatment. The bill did not define that any specific mental illness be required to be covered as that language was not included in the bill. The EDC has been working with key Members of Congress in both the House and Senate to ensure that eating disorders will be part of the minimum benefits package - meaning that insurance companies as part of the exchange will have to cover eating disorder treatment.

Other provisions require insurers to offer and renew insurance coverage for all who apply; prohibit health insurers from cancelling coverage; specify that premium rates in the individual and small-group market can vary on only the basis of tobacco use, age, family composition, and state-defined geographic rating areas; and allow adult children to remain on their parents' health policies until they turn 27 if they do not have access to a policy on their own.

Because the legislation phases in various insurance provisions over the next decade, the legislation includes a more immediate benefit that may assist people with serious mental illness: new high-risk pools. The legislation requires the Department of Health and Human Services to identify such risk pools by July and to provide temporary coverage for such people until the ban on insurance denials for preexisting conditions begins in four years.

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