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ACA Repeal? For Massachusetts, So What?

Posted by John McDonough  January 18, 2012 09:20 PM

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Someone asked me recently: if the Affordable Care Act (ACA) is based on Massachusetts health reform, why should Massachusetts residents care if the law were repealed? What do we have to lose?

Good question. I went through major sections of the law, and came up with this list of three dozen substantive policies that would adversely affect Massachusetts residents if the ACA were repealed. Here is my list (ACA section in parentheses):

  • The prohibition on insurers imposing lifetime and/or annual benefit limits. (1001/2711)
  • The prohibition on health insurance "rescissions," or cancelling policies when an enrollee files a claim because of an application error. (1001/2712)
  • The requirement that all effective clinical preventive services are covered by insurance policies, and without cost sharing, already in effect. (1001/2713)
  • The requirement that insurers must provide all enrollees with a clear and annual summary of benefits and coverage not to exceed four pages. (1001/2715)
  • The requirement that health insurers must spend at least 80 or 85 cents of every premium dollar on medical expenses, including a rebate to consumers when the target is not met. (1001/2718)
  • Grants to states to provide support for consumer heath information. (1002)
  • Requirements for health insurers and medical providers to simplify and reduce the paperwork and clerical burden on patients, providers, and insurers (1003)
  • Premium tax credits and cost sharing support for individuals and families with incomes between 300-400% of the federal poverty level (FPL), or up to $88,000 for a family of four -- Massachusetts health reform only provides subsidies for families up to 300% FPL (1401/1402)
  • A new health insurance tax credit for eligible small businesses. (1421)
  • Establishment of new quality standards for adults in Medicaid. (2701)
  • Extension of the Children's Health Insurance Program through 2019. (2101)
  • Creation of the Innovation Center within the Center for Medicare and Medicaid Services. (3021)
  • A program to reward medical providers who take responsibility for the cost and quality of care provided to their patients. (3022)
  • Financial penalties on hospitals with excessive rates of preventable hospital readmissions (3025) and hospital acquired infections. (3008)
  • A requirement for the federal government to devise a national strategy to improve quality, to be updated annually. (3011)
  • Limits on cost sharing for Medicare Advantage (Part C) enrollees. (3202)
  • Closing of the Medicare Prescription Drug "doughnut hole." (3301)
  • Establishment of the Prevention & Public Health Investment Fund to make national investments in prevention and public health, including Community Transformation Grants already in place in Massachusetts. (4002)
  • Creation of an interagency federal council to set national prevention and health promotion strategies. (4001)
  • Requirement for Medicare to cover, with no cost sharing, an annual wellness visit plus personalized prevention services. (4103)
  • Investments in school based health clinics for medically underserved children and families. (4101)
  • Requirement that chain restaurants with at least 20 outlets must post the calories of each item on menus and menu boards. (4205)
  • Establishment of standards for the accessibility of medical diagnostic equipment for individuals with disabilities. (4203)
  • Requirement that all employers with 50 or more employees must provide break time and a place for breast-feeding mothers to express milk. (4203)
  • A requirement for all federal health programs to collect and report data by race, ethnicity, primary language, and other disparity indicators. (4302)
  • Creation of a national childhood obesity demonstration program. (4306)
  • Establishment of a National Health Care Workforce Commission. (5101)
  • Increase in Medicare payments for primary care physicians and surgeons who practice in underserved regions. (5501)
  • Increased funding for a major expansion in Community Health Centers and in the National Health Service Corps which pays the debt of medical students who practice in underserved areas. (10503)
  • The Physician Payment Sunshine Act will require drug, medical device, and medical supply manufacturers to report all payments, gifts, and transfers of value to physicians and teaching hospitals. (6002)
  •  Establishment of new transparency requirements on nursing homes to protect residents and their families. (Title VI, subtitle B)
  • Establishment of Patient Centered Outcomes Research Institute (PCORI) to generate comparative clinical research to compare the effectiveness of medical treatments (6301)
  • Development of new provisions to combat fraud, waste, and abuse in Medicare, Medicaid and private health insurance. (Title VI, subtitle E)
  • Establishment of the Elder Justice Act to undertake a national effort to prevent and eliminate elder abuse, neglect and financial exploitation
  • Authorization for FDA to enable the manufacture and sale of biosimilar biological products. (Title VII)
  • Requirement that health insurers provide coverage of costs for individuals participating in approved clinical trials. (10103)

Many of these are already in effect today, and others are moving quickly toward implementation. Listed here are 36 provisions of the ACA which will provide positive benefits for Massachusetts residents and which will be lost if the ACA is repealed.

This blog is not written or edited by Boston.com or the Boston Globe.
The author is solely responsible for the content.

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About the author

John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »

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