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Spectrum: Autism Research News

Key provisions could disappear with Affordable Care Act repeal

Mayra Del Real, 28, holds her newborn baby at the Eisner’s Women’s Health Center on Thursday, 21 January 2016.

Heidi de Marco / KHN
THIS ARTICLE IS MORE THAN FIVE YEARS OLD

This article is more than five years old. Autism research — and science in general — is constantly evolving, so older articles may contain information or theories that have been reevaluated since their original publication date.

The Affordable Care Act (ACA) of course affected premiums and insurance purchasing in the United States. It guaranteed people with pre-existing conditions could buy health coverage and allowed children to stay on parents’ plans until age 26. But the roughly 2,000-page bill also included a host of other provisions that affect the health-related choices of nearly every American. Some of these measures are evident every day. Some enjoy broad support, even though people often don’t always realize they spring from the statute.khn-logo1-100

In other words, the outcome of the repeal-and-replace debate could affect more than you might think, depending on exactly how the Republican congressional majority pursues its goal to do away with ‘Obamacare.’

No one knows how far the effort will reach, but here’s a sampling of sleeper provisions that could land on the cutting-room floor:

Calorie counts at restaurants and fast food chains

Feeling hungry? The law tries to give you more information about what that burger or muffin will cost you in terms of calories, part of an effort to combat the ongoing obesity epidemic. Under the ACA, most restaurants and fast food chains with at least 20 stores must post calorie counts of their menu items. Several states, including New York, already had similar rules before the law. Although there was some pushback, the rule had industry support, possibly because posting calories was seen as less onerous than such things as taxes on sugary foods or beverages. The final rule went into effect in December after a one-year delay. One thing that is still unclear: Does simply seeing that a particular muffin has more than 400 calories cause consumers to choose carrot sticks instead? Results are mixed. One large meta-analysis done before the law went into effect didn’t show a significant reduction in calorie consumption, although the authors concluded that menu labeling is “a relatively low-cost education strategy that may lead consumers to purchase slightly fewer calories.”

Privacy please: workplace requirements for breast-feeding rooms

Breast-feeding, but going back to work? The law requires employers to provide women with break time to express milk for up to a year after giving birth and to provide someplace — other than a bathroom — to do so in private. In addition, most health plans must offer breast-feeding support and equipment, such as pumps, without a co-payment.

Limits on surprise medical costs from hospitals and emergency room visits

If you find yourself in an emergency room, short on cash, uninsured or not sure if your insurance covers costs at that hospital, the law provides some limited assistance. If you are in a hospital that is not part of your insurer’s network, the ACA requires all health plans to charge consumers the same co-payments or co-insurance for out-of-network emergency care as they do for hospitals within their networks. Still, the hospital could “balance bill” you for its costs — including emergency-room care — that exceed what your insurer reimburses it.

If it’s a nonprofit hospital — and about 78 percent of all hospitals are — the law requires it to post online a written financial assistance policy, spelling out whether it offers free or discounted care and the eligibility requirements for such programs. Although it doesn’t prescribe any particular set of eligibility requirements, the law requires hospitals to charge lower rates to individuals who are eligible for their financial assistance programs. That’s compared with their gross charges, also known as chargemaster rates.

Nonprofit hospitals community health assessments

The health law also requires nonprofit hospitals to justify the billions of dollars in tax exemptions they receive by demonstrating how they go about trying to improve the health of the community around them.

Every three years, these hospitals have to perform a community needs assessment for the area the hospital serves. They also have to develop — and update annually — strategies to meet these needs. The hospitals then must provide documentation as part of their annual reporting to the Internal Revenue Service. Failure to comply could leave them liable for a $50,000 penalty.

A woman’s right to choose … her OB-GYN

Most insurance plans must allow women to seek care from an OB-GYN without having to get a referral from a primary care physician. Although the majority of states already had such protections in place, those laws did not apply to self-insured plans, which are often offered by large employers. The health law extended the rules to all new plans. Proponents say direct access makes it easier for women to seek not only reproductive health care, but also related screenings for such things as high blood pressure or cholesterol.

And what about those therapy coverage assurances for families who have children with autism?

Advocates for children with autism and people with degenerative diseases argued that many insurance plans did not provide care their families needed. That’s because insurers would cover rehabilitation to help people regain functions they had lost, such as walking again after a stroke, but not care needed to either gain functions the individual never had, such speech therapy for a child who never learned how to talk, or to maintain a person’s current level of function. The law requires plans to offer coverage for such treatments, dubbed habilitative care, as part of the essential health benefits in plans sold to individuals and small groups.

This story originally appeared on Kaiser Health News. It has been slightly modified to reflect Spectrum’s style.


TAGS:   autism, funding, policy