On June 28, 2012, the US Supreme Court ruled that the Affordable Care Act’s (ACA) individual mandate is a constitutional exercise of Congress’s power to impose taxes. Due to the Court’s decision, compliance efforts likely will continue with major provisions of the ACA becoming effective in 2013 and 2014. According to Chief Justice Roberts, “The Affordable Care Act’s requirement that certain individuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax. Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness.”

An estimated 10.7 million American women use oral contraceptives, the leading method of contraceptive in the United States. The Patient Protection and Affordable Care Act now requires coverage of FDA-approved contraceptive methods for women at 100 percent, without charging a copayment, coinsurance or deductible, when filled at a network pharmacy. HHS commissioned an Institute of Medicine study to review what preventive services are necessary for women’s health and well being and should be considered in the development of comprehensive guidelines for preventive services for women.

The essential benefits report, created by the Institute of Medicine (IOM), has been released. The Affordable Care Act requires the package to reflect benefits covered by a typical employer plan and include 10 categories. According to the report, HHS officials will compare potential services and products against a set of critera, created by the IOM, including medial effectiveness, safety and relative value compared with alternative options, and evaluate whether the package as a whole protects the most vulnerable individuals, promotes services that have proved effective and addresses the medical concerns of greatest important to the public. In keeping with their assigned task, the IOM did not address and specific types of benefits in their recommendations. It instead tells the Secretary of HHS how to define the minimum benefits. Click here to view additional recourses by the IOM including the IOM’s press release, criteria, report brief and report release presentation.

HHS issued two rules on August 1st addressing the preventive care requirements in the Patient Protection and Affordable Care Act (PPACA). The first is a proposed rule, which would require new health insurance plans to cover women’s preventive services without charging a co-payment, co-insurance or deductibles for plan years starting on or after August 1, 2012. The requirement will not apply to grandfathered plans that were in effect before the law was enacted on March 23, 2010.

The first “unintended consequence” of the Patient Protection and Affordable Care Act (PPACA) addressed in Part 1 of the blog described how routine physical exams were not specifically listed as a preventive service under health reform so insurance companies do not have to cover this service. The second “unintended consequence” of health reform addressed in Part 2 of the blog revealed how most insurance companies are not offering individual insurance policies to children under 19 since they are prohibited from applying pre-existing conditions exclusions. The third and final “unintended consequence” of health reform that I will discuss relates to dependent children under the age of 26 staying on their parents’ plans.

The first “unintended consequence” of the Patient Protection and Affordable Care Act (PPACA) addressed in Part 1 of our blog described how routine physical exams were not specifically listed as a preventive service under health reform so insurance companies do not have to cover this service. Today, we will discuss the second “unintended consequence” of health reform, which addresses how new individual insurance policies are prohibited from applying pre-existing conditions exclusions for children under 19.

Wikipedia states that the law of unintended consequences is a warning that an intervention in a complex system always creates unanticipated and often undesirable outcomes. Unfortunately, health reform has “unintended consequences” written all over it. Three specific examples include: preventive care, no pre-existing conditions for children under 19, and dependent children under the age of 26 staying on parents’ plans. I’ll focus on the first topic today: preventive care.

The DOL, HHS, and IRS jointly issued another set of FAQs (Part V) regarding implementation of the market reform provision Affordable Care Act, with topics including auto-enrollment in group health plans, summary of benefit disclosure requirements to group health plan participants, grandfathered plans, dependents to age 26 requirements, preexisting condition requirements for children in individual health policies, and value-based insurance design in connection with preventive care benefits.

The DOL, HHS, and IRS jointly issued another set of FAQs (Part IV) regarding implementation of the market reform provisions of the Affordable Care Act. For simplicity, only the questions are included below. You may view the government’s response here or access FAQs Part I, Part II and Part III.

The Obama administration predicted that hundreds of thousands of people would enroll in the Pre-existing Conditions Insurance Plan (PCIP), but the actual enrollment only totaled 8,011 as reported November 5, 2010. As a result, the Department of Health and Human Services (HHS) announced the federally-administered PCIP program will expand the one option offered in 2010 to three options in 2011: the Standard Plan, the Extended Plan and the Health Savings Account eligible plan. In addition, families will be able to enroll their eligible children age 0-18 in PCIP at child-only rates.