The Affordable Care Act has already covered one in four uninsured Americans – more than ten million – and improved coverage for virtually everyone with health coverage. Insurers can no longer discriminate against preexisting conditions, charge women more just for being women, or put caps on the care you receive. Hospitals, doctors and other providers are changing the way they operate to deliver better care at lower cost. In the years to come, the ability to buy portable and affordable plans on a competitive marketplace will allow countless Americans to move, start businesses, and dream big American dreams -- without worrying if an illness will bankrupt them. Here is how the Affordable Care Act is working for families in New Mexico:
After Health Reform: Improved Access to Care
· Gallup recently estimated that the uninsured rate in New Mexico in 2014 was 15.3 percent, down from 20.2 percent in 2013.
· Prohibits coverage denials and reduced benefits, protecting as many as 861,621 New Mexicans who have some type of pre-existing health condition, including 122,147 children.
· Eliminates lifetime and annual limits on insurance coverage and establishes annual limits on out-of-pocket spending on essential health benefits, benefiting 555,000 people in New Mexico, including 213,000 women and 148,000 children.
· Expands Medicaid to all non-eligible adults with incomes under 133% of the federal poverty level. 239,747 more people in New Mexico have gained Medicaid or CHIP coverage since the beginning of the Health Insurance Marketplace first open enrollment period.
· Establishes a system of state and federal health insurance exchanges, or marketplaces, to make it easier for individuals and small-business employees to purchase health plans at affordable prices through which 44,085 people in New Mexico were covered in March 2015.
· Created a temporary high-risk pool program to cover uninsured people with pre-existing conditions prior to 2014 reforms which helped more than 1,568 people in New Mexico.
· Creates health plan disclosure requirements and simple, standardized summaries so 913,400 people in New Mexico can better understand coverage information and compare benefits.
After Health Reform: More Affordable Care
· Creates a tax credit to help 33,244 people in New Mexico who otherwise cannot afford it purchase health coverage through health insurance marketplaces.
· Requires health insurers to provide consumers with rebates if the amount they spend on health benefits and quality of care, as opposed to advertising and marketing, is too low. Last year, 628 consumers in New Mexico received $68,528 in rebates.
· Eliminates out-of-pocket costs for preventive services like immunizations, certain cancer screenings, contraception, reproductive counseling, obesity screening, and behavioral assessments for children. This coverage is guaranteed for more than 735,472 people in New Mexico including 305,157 women.
· Eliminates out-of-pocket costs for 226,146 Medicare beneficiaries in New Mexico for preventive services like cancer screenings, bone-mass measurements, annual physicals, and smoking cessation.
· Phases out the “donut hole” coverage gap for 24,074 Medicare prescription drug beneficiaries in New Mexico, who have saved an average of $893 per beneficiary.
· Creates Accountable Care Organizations consisting of doctors and other health-care providers who share in savings from keeping patients well while improving quality, helping 12,388 Medicare beneficiaries in New Mexico.
· Phases out overpayments through the Medicare Advantage system, while requiring Medicare Advantage plans to spend at least 85 percent of Medicare revenue on patient care. Medicare Advantage enrollment has grown by 43,478 to 115,806 in New Mexico since 2009.
After Health Reform: Improved Quality and Accountability to You
· Provides incentives to hospitals in Medicare to reduce hospital-acquired infections and avoidable readmissions. Creates a collaborative health-safety learning network, the Partnership for Patients, that includes 31 hospitals in New Mexico to promote best quality practices.
We're not done. Other legislation and executive actions are continuing to advance the cause of effective, accountable and affordable health care. This includes:
· Incentive payments for doctors, hospitals, and other providers to adopt and use certified electronic health records (EHR). In New Mexico more than 47.8 percent of hospitals and 53.1 percent of providers have electronic health records systems.
· A new funding pool for Community Health Centers to build, expand and operate health-care facilities in underserved communities. Health Center grantees in New Mexico now serve 290,202 patients and received $144,594,719 under the health care law to offer a broader array of primary care services, extend their hours of operations, hire more providers, and renovate or build new clinical spaces.
· Health provider training opportunities, with an emphasis on primary care, including a significant expansion of the National Health Service Corps. As of September 30, 2014, there were 196 Corps clinicians providing primary care services in New Mexico, compared to 97 clinicians in 2008.