Healthcare Reform and You

In March 2010, the President of the United States signed into law the Patient Protection and Affordable Care Act (ACA). This legislation introduced major reforms to the US health care system aimed at expanding coverage and increasing affordability for uninsured and underinsured Americans. Key features of the ACA include:

  • No pre-existing condition denials for children and adults
  • Health Insurance Marketplaces, also known as exchanges, where individuals and small business can shop for health plans that must cover essential health benefits
  • Insurance tax credits for individuals with incomes between 100 and 400 percent of the Federal Poverty Level to help pay for health care premiums
  • Federal funding to encourage states to expand Medicaid coverage to childless adults with incomes up to 133 percent of the Federal Poverty Level
  • Coverage for young adults on their parent's plans up to the age of 26
  • Reduced cost-sharing for prescription drugs in Medicare Part D's "Donut Hole"
  • Penalties for individuals who fail to obtain and maintain health insurance coverage

Getting Started in the Marketplace: Important information when beginning your search for the right plan.

What's New?

Check out the Epilepsy Foundation's new checklist to help you find the plan that will meet your needs.  Make sure to fill out the charts for each plan you are considering!  Click here to view and print the checklist.

Important Resources

Frequently Asked Questions: The Kaiser Family Foundation has put together a list of questions and answers to help you understand how the ACA impacts you

Calculate Your Premium and Subsidy: The Kaiser Family Foundation has created a tool that can help you estimate if you may be eligible for subsidies and how much you could spend on health insurance.

Health Reform and You: A User's Guide to Health Insurance Marketplaces: The National Patient Advocate Foundation has published a guide intended to help individuals understand the new Health Insurance Marketplaces and determine what coverage is right for them and their family

Find your Marketplace In Your State: Healthcare.gov has designed a site that will help navigate you to the right marketplace website for your state

Prescription Drug Coverage: Fact sheets for 19 states and the District of Columbia detailing their prescription drug coverage across the new marketplace plans that will help give you an idea of drug coverage throughout the country courtesy of PhRMA. 

In the States: Find out more about what is going on with health insurance reform in your state

www.healthcare.gov: Federal Web page for resources on health reform and health insurance needs

www.consumerreports.org/health/insurance/health-insurance.htm: Online guide from Consumers Union on major marketplace reforms under the new health reform law

http://healthreform.kff.org/: Kaiser Family Foundation Health Reform Source online publication

Epilepsy Foundation Comments on the ACA

Transparency in the Marketplace: The Epilepsy Foundation joined more than 20 other organizations on comments to the Centers for Medicare & Medicaid Services (CMS) urging them to make the insurance marketplaces more transparent and easier to compare plans.  To read the comments, go to  

Patient Protection and Affordable Care Act: On Friday, December 21, 2012 the Epilepsy Foundation submitted official written comments to Secretary of Health and Human Services Kathleen Sebelius on the Standards Related to Essential Health Benefits, Acutarial Value, and Accreditation.The Foundation also provided comments on the Health Insurance Market Rules; Rate Review. We look forward to the expanded care and benefits that will be provided through the ACA for the millions living with epilepsy, and the Foundation urges HHS to research and clearly address, in policy, the numerous hurdles and restrictions that come with chronic disorders like epilepsy within health care insurance systems.  

Epilepsy Foundation Comments: Epilepsy Foundation comments to the Secretary of Health and Human Services on essential health benefits under the ACA.

Epilepsy Foundation Writes to the Department of Labor and Department of Health and Human Services: Epilepsy Foundation comments to the Secretary of Labor and Secretary of Health and Human Services on clinical trials under the ACA.

Non-discrimination in Workplace Wellness Plans:  On January 25, 2013, the Epilepsy Foundation joined 21 national disability groups on comments to the Department of Labor on proposed rules implementing the Affordable Care Act's (ACA) provision concerning non-discrimination in workplace wellness programs.  While the proposed rules included some protections for consumers, the groups called for clear requirements that wellness programs must comply with the Americans with Disabilities Act. The groups recognize the potential of wellness programs to discriminate against individuals with disabilities, particularly with the use of financial incentives and penalties tied to health status that jeopardize employee's access to affordable, quality health care. Read the letter here.

Essential Prescription Drug Coverage:  On Tuesday, October 2, 2012, the Epilepsy Foundation joined a diverse group of 57 patient advocate organizations to deliver a letter to Secretary of Health and Human Services Kathleen Sebelius, urging the federal government to establish strong prescription drug requirements as part of any regulation that will define essential health benefits unde the Affordable Care Act (ACA). We also ask that the patient protections described in ACA that prevent plans from discriminating against patients, including those with disabilities, be published soon. Read the letter here.

The Epilepsy Foundation, American Academy of Neurology, and the American Epilepsy Society sent a joint disease organization letter to HHS Secretary Sebelius.  The organizations urged the Department in its work on a Notice of Proposed Rulemaking (NPRM) on Essential Health Benefits (EHB) for state-based insurance exchanges under the Affordable Care Act, to at minimum adopt a structure similar to that of the Medicare Part D program in offering access to "all or substantially all" medications in six therapeutic classes affecting conditions such as cancer, HIV/AIDS, kidney disease, mental illness and epilepsy.  Read the letter here

People with epilepsy must have access to and coverage for the care and treatment that works best for them.   Read more about medication substitution issues here. 

ACA in the Judiciary

The Supreme Court and the ACA

The Epilepsy Foundation joined an amicus brief (friend of the court brief) in support of the Medicaid program expansion under the ACA. This brief was important not only as a defense of the ACA's Medicaid expansion, but also to prevent a precedent that could damage or infringe on other important federal spending statues, such as the Individuals with Disabilities Education Act (IDEA); Title I of the Elementary and Secondary Education Act, most recently reauthorized in the No Child left Behind Act; the federal foster care and child support enforcement programs ; Title VI of the Civil Rights Act; Title IX of the Education Amendments of 1972; and Section 504 of the Rehab Act, which prohibit various forms of discrimination (racial, gender, disability) by entities that receive federal funds.

Epilepsy Foundation Advocacy on the ACA & Court Hearings

The Epilepsy Foundation joined 30 CEOs in a supportive statement released by the National Health Council released during the week of oral arguments calling on the U.S. Supreme Court to uphold the constitutionality of the Affordable Care Act.

Epilepsy Foundation Reacts to Supreme Court ACA decision.  Read our statement here: PDF or Blog Epilepsy Impact on the ACA decision? Read more here Patient organizations respond to high court decision here. Consortium for Citizens with Disabilities Statement on the ACA Decision: Read about it here.

Additional References

In the States: Find out more about what is going on with health insurance reform in your state.

www.healthcare.gov – Federal Web page for resources on health reform and health insurance needs

www.consumerreports.org/health/insurance/health-insurance.htm -- Online guide from Consumers Union on major marketplace reforms under the new health reform law

http://healthreform.kff.org/ -- Kaiser Family Foundation Health Reform Source online publication        

The following link offers state specific information on health insurance laws, coverage, programs, and consumer issues: http://healthinsuranceinfo.net/getinsured/ -- Georgetown University Guide on Health Insurance

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