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Scorecard: What The Health Law Has Delivered, Or Not

Met expectations
Hasn’t met expectations
Too soon to tell

While many of the most significant provisions of the 2010 health law don’t take effect until 2014, some key changes have kicked in since Congress approved it two years ago. Kaiser Health News consulted the agencies implementing the law to track how some of these new programs are going, and compared that data to the original projections of the nonpartisan Congressional Budget Office and the Obama administration. Much of the available data covers a limited period — usually through the end of 2011 or the fiscal year ending Sept. 2011.

Provision 2010 Projected Impact and Cost What’s Been Done Score
Expanding Coverage
Pre-Existing Condition Insurance Program provides health coverage from 2010 to 2014 for adults who have been uninsured for at least six months and who have a pre-existing medical condition. Between 200,000 and 400,000 enrollees. [HHS]

$5 billion authorized through 2013

48,879 people covered through 2011. [HHS]

Cost: $618 million through 2011. [HHS]

Insuring young adults provision requires private insurers to extend coverage of children until age 26, effective Sept. 23, 2010, regardless of their tax status or whether they are students, unless he or she has another offer of employer-based coverage. 1.2 million young adults. [HHS]

Cost: Average 0.7 percent premium increase in 2011 in the group market. [HHS]

Estimated 2.5 million young adults enrolled through June 2011. [HHS]

Cost: Estimated 0.9 percent increase in 2011 premiums for those who buy coverage in the group market. [Commonwealth Fund]

Children with pre-existing conditions younger than 19 cannot be denied coverage. The provision applies to all job-related health plans as well as to individual health insurance policies issued on or after March 23, 2010. As many as 72,000 children with pre-existing conditions. [HHS]

Premium increase of 1 percent or less. [HHS]

Number of children affected: not available.

Cost: No significant change in premiums for employer-sponsored policies. [Commonwealth Fund]

Owners of small businesses may qualify for tax credits up to 35% of their contribution to employees’ health insurance. The credits were made available beginning in tax year 2010. More than 4 million small businesses would qualify. [HHS]

Cost: $6 billion by the end of Sept. 2011, and $37 billion through 2019. [CBO]

An estimated 309,000 firms received $435 million worth of tax credits as of last November. [IRS]
Early Retiree Reinsurance Program encourages employers and unions to continue coverage of early retirees and their families by providing a temporary reimbursement for some of their insurance costs. Cost: $3.8 billion through 2011 ($5 billion total through 2013). [CBO] More than 2,800 employers received $4.7 billion toward coverage of 19.1 million people. The program ended Dec. 31, because it used up all its money. [HHS]
Sales tax on indoor tanning services, effective July 1, 2010, to help fund coverage expansions. 25,000 businesses expected to pay the 10 percent tax, generating $2.7 billion over 10 years, or $270 million a year. [CBO] An average of 10,300 businesses paid the tax for the first three quarters of fiscal 2011.

The businesses paid $54.4 million, or an estimated $72.5 million through September 2011. [Treasury]

Many preventive benefits must be provided without cost-sharing to people with private health insurance, if they are enrolled in plans issued after March 23, 2010. At least 41 million beneficiaries in 2011. [HHS]

Cost: An average 1.5 percent premium increase for those covered in a group plan in 2011. [HHS]

An estimated 54 million people received at least one free preventive health benefit in 2011. [HHS]

Cost: Estimated 0.4 percent increase in 2011 premiums for those covered in a group plan. [Commonwealth Fund]

Seniors’ Benefits
Rebates for prescription drugs, in the form of a one-time, tax-free payment of $250, were sent to Medicare Part D beneficiaries for drugs purchased in 2010 when they reached the coverage gap, or “doughnut hole.” 4 million eligible beneficiaries.

Cost: $200 million. [CBO]

3.8 million beneficiaries received a $250 rebate check. [HHS]

Cost: $946 million. [KHN interview]

Prescription drug discounts are to be provided to Medicare Part D beneficiaries beginning in 2011 on covered brand-name and generic drugs when they reach the coverage gap, or “doughnut hole.” 4 million beneficiaries.

Cost: $1.5 billion. [CBO]

In 2011, 3.8 million beneficiaries saved $2.3 billion. [HHS]

Cost: Not available.

Many preventive benefits must be provided without cost-sharing to Medicare beneficiaries, effective Jan. 1, 2011. About 36 million beneficiaries in traditional Medicare.

Cost: $200 million in the year ending September, 2011. [HHS]

An estimated 32.5 million seniors received at least one free preventive benefit in 2011. [HHS]

Cost: Not Available

Consumer Protections
Proposed premium rate increases of 10 percent or higher for individual or small group plans must be justified to state or federal reviewers beginning in September, 2011 for plans issued after March 23, 2010. Regulators in 37 states can reject a requested increase. If a state has no review authority, federal regulators can step in. However, federal officials can ask, but not require an insurer to reduce a proposed hike. Law provides $250 million to states to strengthen their rate review processes. [HHS] 42 states and the District of Columbia have received grants of $157 million to develop or improve premium review [KHN interview]. At least five states have forced insurers to reduce proposed premium increases, and federal officials say fewer insurers have proposed double-digit rate increases since the provision went into effect. [HHS]
Insurers must spend at least 80 percent of beneficiaries’ premiums on medical care or health quality improvements. “Mini-med” plans that offer limited benefits have a one-year exemption. Self-insured employers, which pay claims directly instead of through an insurance company, are not covered. Approximately 74.8 million privately insured Americans affected. As many as 9 million people who buy individual policies are projected to receive rebates worth up to $1.4 billion by Aug. 1. [HHS] Insurers will report data for the first time in June showing whether they’ve met the new standard, called a medical loss ratio. Those plans that fail to do so must pay rebates to individual policyholders by Aug. 1, unless they operate in the eight states that received temporary exemptions. Plans selling group insurance must deliver rebates to the policyholder — in most cases, the employer – and can do so in the form of lower premiums.
Grants for consumer assistance to help states strengthen consumer assistance programs. All states, territories and the District of Columbia eligible.

Projected cost: $31 million through September 2011. [CBO]

38 states, territories and the District of Columbia have received grants. [HHS]

Cost: $23.5 million.

Insurers can no longer impose lifetime dollar limits on essential health services for plans issued or renewed after Sept. 23, 2010. Projected to extend coverage to as many as 20,400 people a year who would be expected to exceed lifetime limits. Cost: No more than 0.75% increase in premiums in the group market. [HHS] 105 million people no longer face such limits. [HHS]

Cost: Estimated 0.5% increase in 2011 premiums in the group market. [Commonwealth Fund]

— Compiled by Susan Jaffe

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