How the Health Care Law is Making a Difference for the People of Puerto Rico
For too long, too many hardworking Americans paid the price for policies that handed free rein to insurance companies and put barriers between patients and their doctors. The Affordable Care Act gives hardworking families in Puerto Rico the security they deserve. The new health care law forces insurance companies to play by the rules, prohibiting them from dropping your coverage if you get sick, billing you into bankruptcy because of an annual or lifetime limit, or, soon, discriminating against anyone with a pre-existing condition.
All Americans will have the security of knowing that they don’t have to worry about losing coverage if they’re laid off or change jobs. And insurance companies now have to cover your preventive care like mammograms and other cancer screenings. The new law also makes a significant investment in State and community-based efforts that promote public health, prevent disease and protect against public health emergencies.
Health reform is already making a difference for the people of Puerto Rico by:
Expanding health insurance coverage in every state
Establishing the Health Insurance Marketplace. When key parts of the health care law take effect in 2014, there’ll be a new way for individuals, families and small businesses to get health insurance. Beginning Oct. 1, 2013, individuals in every state will be able to shop for health insurance and compare plans through the Marketplace.
Increasing Access to Medicaid. The Affordable Care Act also fills in gaps in coverage for the poorest Americans by giving states the option to expand Medicaid to individuals under 65 years of age with income below 133 percent of the federal poverty level (FPL) (approximately $14,000 for an individual and $29,000 for a family of four) beginning in January 2014. States will receive 100% federal funding for the first three years to support this expanded coverage, phasing to 90% federal funding in subsequent years. In addition, Medicaid and Children's Health Insurance Program (CHIP) eligibility and enrollment will be much simpler and will be coordinated with the Marketplace.
Health plans are now required to allow parents to keep their children under age 26 without job-based coverage on their family coverage, and, thanks to this provision, 3.1 million young people have gained coverage nationwide.
The Affordable Care Act makes prescription drug coverage (Part D) for people with Medicare more affordable. It does this by gradually closing the gap in drug coverage known as the "donut hole." Since the enactment of the law, 6.1 million Americans with Medicare who reached the donut hole have saved over $5.7 billion on prescription drugs. Nationwide, drug savings of $2.5 billion in 2012 were higher than the $2.3 billion in savings for 2011. In Puerto Rico, people with Medicare saved over $138.9 million on prescription drugs since the law’s enactment. In 2012 alone, 85,781 individuals in Puerto Rico saved over $56.1 million, or an average of $655 per beneficiary. In 2012, people with Medicare in the “donut hole” received a 50 percent discount on covered brand name drugs and 14 percent discount on generic drugs. And thanks to the Affordable Care Act, coverage for both brand name and generic drugs will continue to increase over time until the coverage gap is closed.
The health care law requires many insurance plans to provide coverage without cost sharing to enrollees for a variety of preventive health services, such as colonoscopy screening for colon cancer, Pap smears and mammograms for women, well-child visits, and flu shots for all children and adults. The law also makes proven preventive services free for most people on Medicare.
In 2011 and 2012, 71 million Americans with private health insurance gained preventive service coverage with no cost-sharing. And for policies renewing on or after August 1, 2012, women can now get coverage without cost-sharing of even more preventive services they need. Approximately 47 million women will now have guaranteed access to additional preventive services without cost-sharing.
The Affordable Care Act is also removing barriers for people with Medicare. With no deductibles or co-pays, cost is no longer a barrier for seniors and people with disabilities who want to stay healthy by detecting and treating health problems early. In 2012 alone, an estimated 34.1 million people with Medicare benefited from Medicare’s coverage of preventive services with no cost-sharing. In Puerto Rico, 58,993 individuals with traditional Medicare used one or more free preventive service in 2012.
Under the new health care law, insurance companies must provide consumers greater value by spending generally at least 80 percent of premium dollars on health care and quality improvements instead of overhead, executive salaries or marketing. If they don’t, they must provide consumers a rebate or reduce premiums. This means that 58,648 Puerto Rico residents with private insurance coverage will benefit from $5,508,831 in rebates from insurance companies this year, for an average rebate of $225 per family covered by a policy.
In every State and for the first time under Federal law, insurance companies are required to publicly justify their actions if they want to raise rates by 10 percent or more. Puerto Rico has received $3,000,000 under the new law to help fight unreasonable premium increases.
The law bans insurance companies from imposing lifetime dollar limits on health benefits – freeing cancer patients and individuals suffering from other chronic diseases from having to worry about going without treatment because of their lifetime limits.
Supporting Puerto Rico’s work on Affordable Insurance Exchanges
Puerto Rico has received $917,205 in grants for research, planning, information technology development, and implementation of Affordable Insurance Exchanges.
- $917,205 in Planning Grants: This grant provides Puerto Rico the resources needed to conduct the research and planning necessary to build a better health insurance marketplace and determine how its exchange will be operated and governed. Learn how the funds are being used in Puerto Rico here.
Preventing illness and promoting health (Last Updated: March 15, 2012)
Since 2010, Puerto Rico has received $3,200,000 in grants from the Prevention and Public Health Fund created by the Affordable Care Act. This new fund was created to support effective policies in Puerto Rico, its communities, and nationwide so that all Americans can lead longer, more productive lives.
The Affordable Care Act increases the funding available to community health centers nationwide. In Puerto Rico, 20 health centers operate 73 sites, providing preventive and primary health care services to 362,271 people. Health Center grantees in Puerto Rico have received $72,481,344 under the Affordable Care Act to support ongoing health center operations and to establish new health center sites, expand services, and/or support major capital improvement projects.
As a result of historic investments through the Affordable Care Act and the Recovery Act, the numbers of clinicians in the National Health Service Corps are at all-time highs with nearly 10,000 Corps clinicians providing care to more than 10.4 million people who live in rural, urban, and frontier communities. The National Health Service Corps repays educational loans and provides scholarships to primary care physicians, dentists, nurse practitioners, physician assistants, behavioral health providers, and other primary care providers who practice in areas of the country that have too few health care professionals to serve the people who live there. As of September 30, 2012, there were 17 Corps clinicians providing primary care services in Puerto Rico compared to one in 2008.
Strengthening partnerships with Puerto Rico
The law gives states support for their work to build the health care workforce, crack down on fraud, and support public health. These partnerships help ensure that health care providers are working where they are needed most - in both urban and rural areas. They ensure that half a million people annually get access to HIV/AIDS treatment and access to high quality primary care services.
Examples of Affordable Care Act grants to Puerto Rico not outlined above include:
- $1,095,081 for school-based health centers to help clinics expand their capacity to provide more health care services and modernize their facilities.
- $2,500,000 for Maternal, Infant, and Early Childhood Home Visiting Programs. These programs bring health professionals, social workers, or paraprofessionals to meet with at-risk families in their homes and connect families to the kinds of help that can make a real difference in a child’s health, development, and ability to learn - such as health care, early education, parenting skills, child abuse prevention, and nutrition.
Last updated: March 18, 2013