Healthcare Reform

ADVERTISEMENT

 


CHADD Supports These Thirteen Principles for Healthcare Reform

  1. A healthcare initiative that provides healthcare coverage for all Americans.
  2. Healthcare plans that require “parity” for mental health assessment and treatment. This includes non-discrimination between health conditions.
  3. Healthcare plans must not discriminate on the basis of pre-existing conditions or health status.
  4. Healthcare plans must not terminate coverage when people become seriously ill or are being treated for long-term chronic conditions and must not have lifetime caps.
  5. Health plans must not be allowed to charge exorbitant out-of-pocket deductibles and co-pays.
  6. A healthcare initiative that allows young adults to stay covered on their parents’ plan until the age of 26.
  7. A healthcare initiative that specifically covers young adults, with a particular focus on young adults with special healthcare needs.
  8. A healthcare initiative that specifically covers the assessment and treatment of children, particularly those children with special healthcare needs.
  9. A healthcare initiative that requires continued affordable coverage when one loses or changes jobs.
  10. A healthcare initiative that includes wellness and prevention services.
  11. A healthcare initiative that emphasizes integrated primary healthcare with specialty services, including promotion of the medical home concept. This also includes consumer-oriented and “meaningful” use of electronic medical records and personal health records.
  12. A healthcare initiative that allows all citizens a choice of health plans.
  13. A healthcare initiative that requires health plans to include culturally and linguistically appropriate programs and affirmative provisions dealing with racial and ethnic disparities. This includes recognition of disability-based health disparities.

Does the Patient Protection and Affordable Care Act of 2010 cover people with ADHD?

The Patient Protection and Affordable Care Act of 2010 (ACA) (which may also be called the "Affordable Care Act, ACA," or even "Obamacare") does not specifically mention ADHD, but its protections should benefit people with ADHD.

Health Insurance in General:

In general, under the ACA, health insurance cannot now exclude, limit, or deny coverage to a child, based solely on a pre-existing condition. Insurers cannot limit lifetime coverage to a fixed dollar amount or remove coverage due to a mistake on an application.

In general, starting in 2014, insurance cannot discriminate against individuals of any age due to a pre-existing condition, nor impose annual dollar limits on coverage. Each State will have competitive marketplaces called Health Insurance Marketplaces1 where small businesses and individuals can purchase private insurance plans and ask questions. For example, marketplaces can tell consumers whether they are eligible for tax credits for private insurance or for programs like the Children's Health Insurance Program (CHIP). Note that health insurance obtained before March 23, 2010, may be a "grandfathered" plan that is exempt from providing some protections under the ACA.

Specific Coverage for Diagnosis and Treatment of ADHD:

Health plans offered in the Marketplaces and Medicaid state plans, will be required to offer essential health benefits in 10 categories including: (1) "prescription drugs" and (2) "mental health and substance use disorder services, including behavioral health treatment." Plans in each Marketplace will also offer differing levels of coverage. Each state will have the opportunity to set standards for plans offered in its Exchange. States that choose not to set their own standards will have those standards set by the federal government. Thus, prescription drug coverage will vary among states; and which conditions qualify for coverage under "mental health and substance use disorder services, including behavioral health treatment" will vary among states. Plans within each state can differ in the amount of coverage, if any, offered for ADHD. Thus, when shopping for insurance in a Marketplace, compare plans to determine whether, and what kind of, coverage is available for the diagnosis and treatment of ADHD.

See Key Features of the Law via the following links:

_______________

1. These marketplaces were first referred to as "Affordable Insurance Exchanges," but the federal government changed the name to "Health Insurance Marketplace" in Summer 2013. Posted January 13, 2014

New Insurance Finder Web Tool Released

On August 24, 2010, the U.S. Department of Health and Human Services announced the release of a new web tool, available for download at HealthCare.gov, that will make it easier to search for insurance coverage options. “By putting the power of information at your fingertips, HealthCare.gov is helping American families everywhere to take control over their health care and make the choices that are right for them,” said HHS Secretary Kathleen Sebelius. For anyone seeking to understand the new benefits under the Affordable Care Act, the website is an extremely valuable resource.

The Insurance Finder widget enables anyone with a website or blog to embed a tool on their site that allows users to begin the process of searching for insurance coverage options. After users answer two questions (“select a state” and “which best describes you”), they click on "next steps" and are redirected to a page on HealthCare.gov that continues the process. Based on their answers to specific questions, the coverage finder provides a personalized list of coverage choices.
Posted 8/25/10

New Insurance Appeals Regulations

On July 22, 2010, the White House announced new federal regulations to strengthen patients’ rights to appeal health insurance denials. That same day, the National Health Council released the following statement from its president, Myrl Weinberg:

People with chronic conditions make up the largest segment of users of health care in this country. They require care and treatment that will allow them to live the healthiest, most productive lives possible. It is essential that they be able to obtain and retain coverage and care that meet their individual health care needs.

The steps taken today by the Obama Administration will provide patients with an understandable, predictable internal and external appeals process. It’s the right thing to do. It's a fair solution for patients—particularly those living with chronic diseases and disabilities.

We are also pleased that $30 million has been allocated for strengthening state-based consumer assistance offices. This is a critical step to improving patient awareness of their rights.

Posted August 16, 2010

 

HHS Secretary Sebelius Announces Pre-Existing Condition Insurance Plan

On July 1, 2010, U.S. Department of Health and Human Services Secretary Kathleen Sebelius announced the establishment of a new Pre-Existing Condition Insurance Plan (PCIP). The plan will make temporary coverage available to Americans who have been uninsured for at least six months and who are unable to obtain health coverage because of a pre-existing health condition. The PCIP will be in effect now through 2014, when the new health insurance exchanges are established. Twenty-nine states plus the District of Columbia have decided to administer the plan themselves, and twenty-one states elected to have HHS administer their plans.

Posted July 5, 2010

The New Healthcare Reform Law

Read blogs by former CHADD CEO E. Clarke Ross that review the law:

Added June 22, 2010
Page updated 7/12/12