Series Part 4: Affordable Care Act Facts

Kenneth Munson, regional director of the U.S. Department of Health and Human Services, laid out what he described as the facts about the Affordable Care Act, which Republicans often refer to as Obamacare.

  • Editors note: This is the fourth of a four-part series on health care, following a Monday, Aug. 20, forum at Pheasant Run in St. Charles.


According to Kenneth Munson, regional director of the U.S. Department of Health and Human Services, the Affordable Care Act requires:

  • Insurers to cover children up to age 26 on parents’ health care coverage.
  • The 80/20 rule, effective Aug. 1: For every premium dollar paid, 80 cents must be spent on care. While many companies already meet this threshold, Munson said about $1.1 billion will go back to consumers, either via direct rebate or discounts on future rates.
  • Companies cannot deny coverage for children with pre-existing conditions. This would expand to adults in 2014. He said 75 percent of health care costs go toward paying for chronic conditions, which is especially important for women. The pre-existing condition list has been expanded for women.
  • Bars lifetime limits on health care coverage. An end to annual limits would be phased in over the coming years.
  • The Affordable Care Act bans recissions, which occur when an insurer cancels the coverage of someone diagnosed with a serious illness due to an honest mistake in the original health coverage application.
  • Co-payments would be eliminated for certain diagnostic costs for preventative services. Munson said the reason is that the costs of co-payments has become an obstacle for those who should be receiving mammograms, colonoscopies and similar tests that can detect a problem early, before treatment becomes more expensive.
  • Phases out by 2020 the so-called doughnut hole for Medicare beneficiaries.
  • Fraud prevention is among the goals of the Affordable Care Act.
  • Exchanges: Give people buying insurance the ability to compare apples with apples — in other words, compare plans where the coverage does not vary. Munson said this is a contentious issue at the state level now, because if the states do not establish exchanges, the federal government will do so..
  • MedicAid expansion: Eligibility increases to 133 percent of the federal poverty level.


I like the efforts to increase preventative screening like Colonoscopies.But I don't like NO Co-payments. Reason: Co payments of 25$ help us pay our utility bills,rents and staff on time. Insurers ususally pay in 2- 3 months.So a doctor is always tight on money. Have you tried a dentist or eye care shop?They demand money right away?
Arthur Dietrich August 26, 2012 at 07:13 PM
I like the fact that in 2014 I won't have to be denied coverage due to pre-existing conditions.
Dwight Swartwood August 26, 2012 at 11:14 PM
What is the estimated increased cost for these planned improvements. They all seem very good, my children and grandchildren may benefit, but they all come with increased costs.


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