PARKERSBURG - How health care reform affects women and children was the topic of a town hall style meeting Tuesday at West Virginia University at Parkersburg.
Lisa Diehl, North Central coordinator for West Virginians for Affordable Health Care, said the Affordable Care Act, also known as Obamacare, was signed into law in March 2011 and expands health care coverage to most Americans.
"It's a combination of employer-sponsored plans, which a lot of folks get and a lot folks continue to get, expansion of Medicaid if our governor decides if we will expand Medicaid and CHIP and then the affordable individual plans," she said.
Lisa Diehl, left, North Central coordinator for West Virginians for Affordable Health Care, speaks at a town hall meeting at WVU-P on how women and children will be affected by health care reform. Pam Santer, wellness coordinator at West Virginia University at Parkersburg, looks on. (Photo by Jeffrey Saulton)
By 2014, Diehl said, more women will be able to access coverage once it is fully activated. In West Virginia that will mean 63,000 women without health insurance will receive health coverage if the state implements the act's option to expand Medicaid.
"It reforms the insurance industry and there are specific reforms that take place," she said. "No pre-existing condition exclusions will be allowed any longer; currently children can no longer be discriminated against and prevented from getting coverage. They are already feeling the benefit of the Affordable Care Act as well as their parents."
One reform allows young adults to stay on their parents coverage until age 26. It does not matter if they are claimed as a dependent or not. She said the only thing that will keep them from being covered is if they are employed and they have health care benefits through their employer.
Another change is no lifetime or annual limits and an 80 to 85 percent loss ratio.
"We have Sen. Jay Rockefeller to thank for that," she said. "What this new rule says is the large market insurers must use 85 percent of your premium dollar to provide you with health care."
Diehl said about $4 million in rebates made its way to people with private health insurance due to the new rule. She said if the company is spending too much money on administrative costs and other costs, it must use the money for health care.
Diehl said the main part of the Affordable Care Act focuses on prevention care.
"That is the guts of the Affordable Care Act," she said. "It's going to do a lot around prevention and this is one of the most exciting things, I believe, about the new law."
Policies written after September 2010 must cover preventive services with no co-pays and no deductibles. Among the services covered for men and women are cholesterol screening depending on health risk factors, colorectal cancer screening for adults older than 50, depression screening, type two diabetes for adults with high blood pressure, flu vaccination and other immunizations and obesity screening and counseling.
"Any preventive measure your physician deems is appropriate you should be able to get as a preventive measure through your health insurance," she said.
Diehl said the Affordable Care Act will slow the growth of Medicare, not reduce benefits just slow its growth from 6.6 percent a year to 5 percent a year. She said savings will also come from reducing waste and fraud.
Since the Affordable Care Act was passed, she said, $4 billion has been recovered in federal programs, including Medicare.
Diehl said the only provision of the Affordable Care Act overturned by the U.S. Supreme Court was the provision mandating all states to expand their Medicaid program.
"Governors in every state must make the decision if they want to expand Medicaid or not," she said. "Close to 30 states have decided to expand and few have decided not to and we're still trying to make that decision. Basically the money for the expansion has been appropriated. The federal government will fund 100 percent of the expansion for the first three years and over time it will be reduced to 90 percent and will never go below 90 percent."
Diehl said the act is a good deal for West Virginia.
Perry Bryant, executive director of West Virginia for Affordable Health Care, said those whose employers provide health care are excluded from the insurance exchange; however, there are two exceptions.
"One is if it is not comprehensive, if it pays less than 40 percent of the bills," he said. "Or if it is unaffordable which is defined as costing the employee more than 9.5 percent of their pay for single coverage. I suspect there will be very few employees who have employer sponsored health insurance who will be allowed to go to the exchange."