Health-care reform brings home many benefits

Since it was enacted by Congress a year ago, the Patient Protection and Affordable Care Act, popularly known as "health care reform," has been the subject of both celebration and condemnation. While not perfect, the act offers sound and comprehensive approaches that will improve access to health care for millions of Americans.

At the advent of the new law, Virginia's health care picture showed:

•The state had nearly 1 million residents uninsured, including 150,000 children, in 2010, despite being ranked seventh nationally in per capita income.

•The percentage of residents under 65 who get health insurance at work declined from 71.6 percent in 1999 to 65.7 percent in 2009, while the cost of that insurance skyrocketed.

•In 2009, only 37 percent of small businesses (those with fewer than 50 workers) offered health coverage to their staff, below the national average and down from 44 percent the year before.

•Virginia ranked 47th in per capita Medicaid expenditures in 2008, largely attributable to restrictive eligibility rules and low payments to providers.

•In 2009, Virginia hospitals provided $491 million in charity care services and experienced $376 million in bad debt expenses. For 29 Virginia hospitals, charity care and bad debt constituted more than 15 percent of their overall expenses.

The health care reform act addresses these problems and more.

Several important insurance reforms are already in effect and provide significant protections to consumers, including a provision that allows young adults to stay on their parents' health insurance plans until they reach age 26. Some 54,000 young adults in Virginia will benefit.

Under the law, insurance companies can no longer deny coverage to children with pre-existing health conditions. It is estimated that 123,000 Virginia children will benefit. In 2014, pre-existing condition restrictions will be prohibited for adults as well.

The act prohibits lifetime limits on all new insurance plans, with annual limits totally eliminated by 2014. These are essential protections for very sick people, including cancer patients and premature infants, who could quickly hit caps in their policies, losing coverage just when they needed it the most.

For Medicare beneficiaries in Virginia, cost sharing for preventive health services — such as mammograms for breast cancer, colonoscopies for colon cancer and PSA testing for prostate cancer — has been eliminated. The act also will phase out Medicare's prescription drug "doughnut hole," which now imposes high costs on beneficiaries who need a large amount of medications.

Another direct benefit is the tax credit for small businesses that provide health insurance to their employees. Overall, Virginia has received more than $50 million in federal grants and projects designed to help it plan for future changes.

A major reform to take effect in 2014 is the required increase in income eligibility limits for Medicaid. With Virginia's Medicaid eligibility limits for adults currently among the lowest in the country, anywhere from 270,000 to 425,000 individuals may newly qualify for Medicaid coverage, including very poor adults who have never had insurance. The federal government will cover 100 percent of the Medicaid cost of this newly eligible population for three years, then eventually 90 percent.

At the same time that Virginia and other states are implementing the new law and benefitting from it, they have filed various court challenges to it. While these cases work through the courts, a Virginia Health Reform Initiative Advisory Council, appointed by Gov. Robert F. McDonnell, has studied ways to implement health care reform in Virginia.

Last December the advisory council adopted 28 recommendations focusing on improving Virginia's health system, with or without national health reform and reflecting many of the federal act's aims.

Tens of thousands of Virginians already have gained coverage or better health care because of the new federal law. By focusing on research and planning, Virginia is well-positioned to move forward so that many thousands more will have access to affordable, quality care.