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Patient
Protection and Affordable Care Act
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The Patient Protection and Affordable
Act, as amended by the Health Care and Education Reconciliation Act of 2010 (the “Affordable Care Act”) creates the largest restructuring of the U.S. healthcare system since the enactment of Medicaid or Medicare nearly a half-century ago.
- Extends healthcare coverage to nearly 32 million currently uninsured individuals.
- Expands Medicaid.
- Authorizes State-run insurance exchanges.
- Provides tax credits and subsidies for small businesses and uninsured individuals not eligible for Medicaid to purchase insurance through new insurance exchanges.
The Affordable Care Act will create new consumer protections and impose new standards for the insurance industry, including:
- Prohibiting insurance companies from refusing to insure individuals with “pre-existing conditions.”
- Prohibiting insurance companies from dropping from coverage individuals who get sick.
- Prohibit individual and group plans from placing annual or lifetime dollar limits on coverage.
- Establishing new federal authority to prevent unreasonable premium increases.
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What Health
Reform Means to the Virgin Islands
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The Affordable Care Act also creates an historic opportunity for the Virgin Islands to restructure, expand and improve the Virgin Islands healthcare system.
The Affordable Care Act provides $1 billion for option of the Territories to establish limited insurance exchanges;
V.I. allocation will be approximately $30 million.
- Option must be elected by October 1, 2013 for exchange to commence operations by January 1, 2014.
- Election contingent upon agreement between Territory and Secretary of
HHS.
- Secretary of HHS may establish and operate exchange if determined that the State (or Territory) has not taken sufficient actions to meet the requirements of the Act.
The Affordable Care Act provides an additional $255 million($285 million if
V.I. chooses not to elect to establish an insurance exchange) over 9-year reform for the Virgin Islands to expand its Medicaid Program.
- Eligible for 55 percent FMAP (increase from current 50 percent level).
- Eligible for 91.5 percent FMAP for Children’s Health Insurance Program (“CHIP”).
- Additional funding will allow expansion of Medicaid program from current level of 8500 enrollees to over 20,000.
- Expansion will set stage for jump to parity with States at the end of the reform period (2019).
- More categories of Medicaid costs, however, will be subject to (increasing) Medicaid cap.
- Expansion may include (but not require) “newly
eligibles,” i.e., childless, non-pregnant adults not currently eligible.
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SEARCH the
SITE
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The Affordable Care Act
provides for the establishment of “Exchanges,” which
will be entities where uninsured individuals (who are
not eligible for Medicaid) and small businesses can
purchase qualified private health insurance plans.
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