By White House | on 25 March 2017
- Improved Access to Care
- Medicaid Expanded Insurance Coverage
- What Marketplace Health Insurance Plans Cover
- CMS: CHIP has provided meaningful health coverage to over eight million children.
- Improving Access to Home- and Community-Based Services
- Strengthening Health Care in Indian Country
- CMS: Early Retiree Reinsurance Program
- President Obama's achievements
- Kaiser Family Health Foundation: Explaining the temporary high-risk pool
- HHS: Maternal, Infant, and Early Childhood Home Visiting
- Updated National HIV/AIDS Strategy:
- HHS Awards More Than $240 Million to Expand the Primary Care Workforce
- Made Health Care and Coverage More Affordable
- CMS Fact Sheet: Medicare Competitive Bidding Program Finds $42 Billion in Savings
- Improved Accountability, Efficiency, and Quality of Care
- CMS: CMS expands quality data on Physician Compare and Hospital Compare to help consumers choose health care providers
- Patients Safer as Hospital-Acquired Conditions Decline
- CMS Fraud Prevention Initiative
- IRS: New Requirements for 501(c)(3) Charitable Hospitals Under the Affordable Care Act
- HHS finalizes streamlined Medicare payment system that rewards clinicians for quality patient care
- Addressed the Prescription Opioid and Heroin Epidemic
- SAMHSA to award nearly $1 billion in new grants to address the nation’s opioid crisis
- Obama Administration Takes Action to Reduce Prescription Drug Shortages in the U.S.
- Administration issues final mental health and substance use disorder parity rule
- White House Drug Policy Office Funds New Projects in High Intensity Drug Trafficking Areas
- Increased Access to Mental Health Services
- Strengthened Nutrition Standards and Promoted Healthy Living
Improving Health for All Americans
President Obama promised that he would make quality, affordable health care not a privilege, but a right. After nearly 100 years of talk, and decades of trying by presidents of both parties, that's exactly what he did. Today, 20 million more adults gained access to health coverage. We've driven the uninsured rate below 10 percent — the lowest level since we started keeping records — and built stronger, healthier communities through advancements in public health, science, and innovation.
Improved Access to Care
Prohibited coverage denials and reduced benefits due to pre-existing conditions
Eliminated lifetime and annual limits on insurance coverage and established annual limits on out-of-pocket spending on essential health benefits
HealthCare.gov: Ending Lifetime & Yearly Limits
"Insurance companies can’t set a dollar limit on what they spend on essential health benefits for your care during the entire time you’re enrolled in that plan."
Required health plans to cover dependent children up to age 26
2.3 million additional young adults (aged 19-25) gained health insurance coverage between the enactment of the Affordable Care Act in 2010 and the start of open enrollment in October 2013 due to the ACA provision allowing young adults to remain on a parent’s plan until age 26.
Prohibited retroactive cancellation of policies, except in the case of fraud, eliminating the practice of people developing costly illnesses and then losing their coverage
"Recission is the retroactive cancellation of a health insurance policy. Insurance companies will sometimes retroactively cancel your entire policy if you made a mistake on your initial application when you buy an individual market insurance policy. Under the Affordable Care Act, rescission is illegal except in cases of fraud or intentional misrepresentation of material fact as prohibited by the terms of the plan or coverage."
Expanded Medicaid to all previously ineligible adults with incomes under 133 percent of the federal poverty level with unprecedented federal support (the Supreme Court directed that this expansion be at the discretion of states)
Medicaid is Expanding Insurance Coverage
The U.S. has seen the sharpest reduction in the uninsured rate since the decade following the creation of Medicare and Medicaid in 1965, and the nation’s uninsured rate is now at its lowest level ever.
Established a system of state and federal health insurance exchanges or marketplaces to make it easier for individuals and small-business employees to purchase health plans at affordable prices
Simplified health choices by requiring individual and small business plans to offer four standard categories at various costs, plus a catastrophic option for people under age 30 and people who cannot otherwise afford coverage
Established individual responsibility by requiring all Americans who can afford insurance coverage to purchase it or pay a fee
IRS: Individual Shared Responsibility Provision
Established employer responsibility under which mid-size and large companies provide health coverage to their workers or contribute to their coverage through a fee
HealthCare.gov: The Employer Shared Responsibility Payment
"Some employers with 50 or more FTE employees who don’t offer insurance, or whose offer of coverage is not affordable or doesn’t meet certain minimum standards, are subject to Employer Shared Responsibility provisions. They may owe a payment if at least one of their full-time employees enrolls in a plan through the Health Insurance Marketplace and receives a premium tax credit."
Ensured individual and small business health plans include essential health benefits, covering emergency services, hospitalization, maternity and newborn care, preventive care such as annual physicals, and more
What Marketplace Health Insurance Plans Cover
Any plan shown in the Marketplace includes these essential health benefits. This is true for all plan categories (all “metal levels,” including Catastrophic plans) and all plan types (like HMO and PPO).
Simplified eligibility and enrollment requirements in Medicaid and the Children’s Health Insurance Program (CHIP)
CMS: CHIP has provided meaningful health coverage to over eight million children.
"This program has helped cut the uninsured rate among children by nearly 60 percent since its start in 1997 – with more than one-quarter of that reduction since the President signed legislation reauthorizing the program in 2009."
Expanded Community Health Centers and incentives for primary care providers to practice in the communities that need them most
Created a new FDA approval pathway to advance biosimilars, which offer the potential to lower treatment costs for patients on high-cost biologics
Provided new home- and community-based options for elderly and disabled Americans who require long-term care services
Improving Access to Home- and Community-Based Services
In recent years, the Administration has expanded efforts to ensure that older adults and individuals with disabilities have access to person-centered services in community settings. For example, the Money Follows the Person Rebalancing demonstration helps states rebalance their Medicaid long-term services and supports systems and provides opportunities for older Americans and people with disabilities to transition back to the community from institutions. The Affordable Care Act extended and expanded this program.
Introduced new coverage options and other improvements for Native Americans through an improved Indian Health Service
Strengthening Health Care in Indian Country
Another critical step forward is implementing the Affordable Care Act, which contains many important benefits for American Indians and Alaska Natives. First and foremost, it includes the permanent reauthorization of the Indian Health Care Improvement Act, ensuring that the IHS is here to stay. It also improves benefits and protections for American Indians and Alaska Natives who have insurance, whether they receive care inside or outside the IHS. And it gives them more choices for health coverage, including Medicaid and the Federal Employees Health Benefits Program.
Created a temporary reinsurance program to sustain group coverage for early retirees prior to 2014 reforms
CMS: Early Retiree Reinsurance Program
"The Early Retiree Reinsurance Program (ERRP) was included in the Affordable Care Act (ACA) to provide financial assistance to employment-based health plan sponsors—including for-profit companies, schools and educational institutions, unions, State and local governments, religious organizations and other nonprofit plan sponsors—that make coverage available to millions of early retirees and their spouses, surviving spouses, and dependents."
Created a temporary high-risk pool program to cover uninsured people with pre-existing conditions prior to 2014 reforms
Kaiser Family Health Foundation: Explaining the temporary high-risk pool
The health reform law created a temporary national high-risk pool to provide health coverage to people with pre-existing medical conditions who had been uninsured for six months. It was a temporary measure designed to bridge the gap until the implementation of other coverage provisions in the law that took effect in January 2014.
Created health plan disclosure requirements and simple, standardized summaries so consumers can evaluate coverage information and compare benefits
Provided funding for a voluntary home-visiting program to support mothers and young children in underserved communities
HHS: Maternal, Infant, and Early Childhood Home Visiting
"HRSA, in close partnership with the Administration for Children and Families (ACF), funds States, territories and tribal entities to develop and implement voluntary, evidence-based home visiting programs using models that are proven to improve child health and to be cost effective. These programs improve maternal and child health, prevent child abuse and neglect, encourage positive parenting, and promote child development and school readiness."
Covered HIV screening for millions without additional cost and prohibited discrimination due to pre-existing conditions like HIV
This Administration updated its comprehensive 2010 National HIV/AIDS Strategy for the United States through 2020, and implemented it alongside requirements to cover HIV screening for millions without additional cost and prohibit discrimination due to pre-existing conditions like HIV.
Read the Updated National HIV/AIDS Strategy:
Created a new funding pool for Community Health Centers to build, expand and operate health-care facilities in underserved communities
Expanded health provider training opportunities, with an emphasis on primary care, including a significant expansion of the National Health Service Corps
HHS Awards More Than $240 Million to Expand the Primary Care Workforce
The Affordable Care Act included funding for health provider training opportunities, with an emphasis on primary care, including a significant expansion of the National Health Service Corps. As of September 30, 2015, there were 9,600 Corps clinicians providing primary care services, compared to 3,600 clinicians in 2008.
Improved policy and extended funding for the Children’s Health Insurance Program, which provides coverage for millions of low-income children, in 2009 and extended those policies in 2015
Since 2008, more than 3 million additional children have gained health insurance.
Children have also seen important gains in insurance coverage in recent years, thanks in large part to improvements to CHIP signed into law by President Obama in 2009 and broader coverage expansions as a result of the ACA.
Made Health Care and Coverage More Affordable
Established financial assistance to help individuals and families who otherwise cannot afford health coverage purchase it through state and federal marketplaces
Created a tax credit for small businesses that provide health coverage to their employees
Businesses with fewer than 25 employees may qualify for a tax credit worth up to 50 percent of their premium costs (up to 35 percent for tax exempt/non-profit employers).
Prohibited charging more for women to receive coverage
Since September of 2013, the uninsured rate for women has dropped nearly 50 percent, meaning that about 9.5 million adult women have gained coverage.
Required health insurers to provide consumers with rebates if the amount they spend on health benefits and quality of care, as opposed to advertising and marketing, is too low
Thanks to a provision in the Affordable Care Act, if your insurance company isn’t spending at least 80 percent of your premium dollars on medical care, they have to send you some money back.
Allowed employer health plans to provide incentives for workers related to wellness programs
The Affordable Care Act creates new incentives to promote workplace wellness programs and encourages employers to take more opportunities to support healthier workplaces. Effective for plan years after January 1, 2014, final rules allow the maximum reward to employers using a health-contingent wellness program to increase from 20 percent to 30 percent of the cost of health coverage, and the maximum reward for programs designed to prevent or reduce tobacco use will be as much as 50 percent.
Phases out the “donut hole” coverage gap for Medicare prescription drug coverage to save Medicare beneficiaries money
Nearly 10.7 million Medicare beneficiaries have received discounts over $20.8 billion on prescription drugs – an average of $1,945 per beneficiary – since the enactment of the Affordable Care Act.
Expanded competitive bidding in Medicare to lower costs for durable medical equipment such as wheelchairs and hospital beds
CMS Fact Sheet: Medicare Competitive Bidding Program Finds $42 Billion in Savings
"The overall savings to Medicare and beneficiaries as a result of the competitive bidding program for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies is expected to total more than $42 billion over the first ten years of the program, according to the CMS Office of the Actuary. The $42 billion savings comes from a combination of savings of more than $25 billion in Medicare expenditures, and savings of over $17 billion for beneficiaries as a result of lower coinsurance payments and the downward effect on monthly premium payments."
Created new Medicare payment and delivery models to pay for the value rather than the volume of services provided, as well as the new Centers for Medicare & Medicaid Innovation to promote improvement in health care quality and costs through the development and testing of innovative health care payment and service delivery models
The economic case for deploying new health care payment models:
Ensured Medicare Advantage plans are paid accurately and required plans to spend at least 85 percent of Medicare revenue on patient care, while enrollment has grown by over 60 percent and average premiums have dropped by 13 percent since passage of the Affordable Care Act.
Reduced drug costs through increased Medicaid rebates, expanded discount programs, and established a new system for approval of more affordable versions of biologic drugs
Some cutting edge drugs are simply too expensive for many seniors. Creating a pathway for the approval of generic biologic drugs will improve affordability of medications for seniors and all Americans.
Improved Accountability, Efficiency, and Quality of Care
Established new transparency requirements and a “star rating” system for hospitals, nursing homes, Medicare Advantage plans, physicians, and other providers to give consumers information related to quality and cost
CMS: CMS expands quality data on Physician Compare and Hospital Compare to help consumers choose health care providers
“Consumers want trustworthy, reliable, and understandable information about the quality of health care delivered by providers,” said CMS Deputy Administrator and Chief Medical Officer Patrick Conway, M.D., MSc. “Both Physician Compare and Hospital Compare show consumers that they have a choice. This large release of quality measures for hospitals and physicians empowers consumers with information to make more informed health care decisions, encourages health care professionals to strive for higher levels of quality, and drives overall health system improvement.”
Provided incentives to hospitals in Medicare to reduce hospital-acquired infections and avoidable readmissions
Patients Safer as Hospital-Acquired Conditions Decline
From 2010–2015, 21 percent of hospital-acquired conditions (HACs) such as adverse drug events, healthcare-associated infections, and pressure ulcers have been prevented in hospital patients. Reducing these HACs has saved an estimated 125,000 lives and nearly $28 billion in health care costs, according to HHS' annual report on patient safety.
Linked Medicare payments to physicians, hospitals, and other providers to quality of care improvements and lower costs
Improved coordination of care between Medicare and Medicaid to better serve individuals who receive care through both programs. Formed the Elder Justice Coordinating Council to identify and prevent elder abuse, neglect and exploitation
Elder Justice Policy Brief
Elder abuse is a serious public health problem affecting millions of older Americans each year, with some studies suggesting that as few as one in 23 cases is reported to authorities. Elder abuse is defined as intentional actions that cause harm or create a serious risk of harm to an older person (whether or not harm is intended). Elder abuse encompasses physical abuse, neglect, financial exploitation, sexual abuse, as well as emotional and psychological abuse.
Included tools to combat fraud, including increased sentencing guidelines for criminal health care fraud with over $1 million in losses and new prevention and detection efforts that identify fraudulent activity and prevent inappropriate payments
CMS Fraud Prevention Initiative
By using innovative predictive modeling technology similar to that used by credit card companies, CMS has stopped, prevented or identified $820 million in fraudulent payments over the past three years. The system identified or prevented $454 million in Calendar Year 2014 alone, a 10 to 1 return on investment.
Increased consumer protection and community service requirements for charitable hospitals
IRS: New Requirements for 501(c)(3) Charitable Hospitals Under the Affordable Care Act
The Affordable Care Act added new requirements that hospitals must adhere to in order to qualify as a 501(c)(3) charitable hospital. The new requirements provide additional benefits to patients and their communities.
Raised the Medicare hospital insurance tax and imposed a new tax on net investment income for high income taxpayers in order to strengthen the Medicare Hospital Insurance Trust Fund
Questions and Answers for the Additional Medicare Tax
Required drug and medical-device manufacturers to publicly disclose payments and other compensation, like gifts and travel, to physicians and teaching hospitals to limit conflicts of interest (also known as the "sunshine" provision)
Why Open Payments is Important to You
Section 6002 of the Affordable Care Act requires the establishment of a transparency program, now known as Open payments. The program increases public awareness of financial relationships between drug and device manufacturers and certain health care providers.
Required the posting of calorie information on menus of chain restaurants with 20 or more locations and vending machines
Promoted the adoption and usage of certified electronic health records by doctors, hospitals, and other providers
Until the President made investments in health information technology by signing the American Recovery and Reinvestment Act, our health care system ran largely on paper. Now, more than 75 percent of doctors now use electronic health records thanks to Administration policies.
Learn more about electronic health records.