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Behind the Scenes: Other Parts of the ACA

The Affordable Care Act (ACA), the massive — 2,700 pages! — healthcare reform law, must sometimes feel like a bit like Cinderella: an unwanted, misunderstood stepchild, blamed for everything bad, credited with nothing good.  Then again, others treat the legislation as worthy of Midas, pure gold, perfection, the solution to all our ills.

Now we know the real story is somewhere in between.  So let’s dust off  the cinders, readjust our sights and have a look at some of the lesser known provisions and effects of the law.  Keep in mind that some of its regulations went into effect in 2010, while dozens of others are being implemented through 2018.

Domestic violence help

Of all things strange and unlikely, until this legislation was passed, an insurance company could deny health coverage to a victim of domestic violence because it considered the domestic violence to be a pre-existing condition.  Really!  As of 1 August 2012, all insurance plans are required to cover screening and counseling for domestic abuse.  This is from a provision for preventive services for women’s health, the one also including routine breast and pelvic exams, pap tests, prenatal care and so forth.  As HHS Secretary Kathleen Sebelius observed,

It’s an unfortunate equal opportunity [issue] for victims — all races, ages, ethnic backgrounds and income levels are at one point or another victims of domestic violence.  And often people feel ashamed or feel they’ve done something to cause the violence to occur.  But this is a situation in the health insurance market.  Prior to the Affordable Care Act being law, it was legal for an insurance company to deny health coverage to a domestic violence victim because she was a domestic violence victim.  Because that’s considered a pre-existing condition.  That will no longer be legal by 2014.

Lynn Rosenthal, White House adviser on violence against women, reports that domestic violence causes 2 million injuries and more than 1,200 deaths every year.  As she wrote in a blog posting:

They need treatment for immediate injuries and ongoing care for related health problems.  They need to be able to talk to their health care provider about the cause of their injuries without fear of losing their health insurance….Most importantly, they need our compassion and support.

What to do about smokers?

Smoking takes a terrible, hugely expensive toll on our health.  There is no upside.  Beginning in 2014, then, smokers can be charged up to 50% more than nonsmokers for their health insurance.   Right now, current regulations permit employees who fail to meet certain specified standards to pay up to 20% of their insurance costs.

This surcharge approach is an effective way to discourage smoking.  George Washington law professor John Banzhaf worked with HHS and Congress, encouraging them to include surcharges for smokers in the law.  Smoking is a choice, not an accident.  As Baznhaf said,

The largest totally unnecessary expense that most corporations and employers bear – which unfortunately are largely passed along to their employees – are the unnecessary medical and other costs [of] smoking.

Banzhaf is also hopeful that the surcharges may inspire the development and use of more wellness programs aimed at quit-smoking programs and support.

And there’s another approach – to simply not hire any smokers.  There are some states with laws in place prohibiting this, of course, but they are rarely enforced. And it is obvious that hiring exclusively nonsmokers means the time and funds spent on wellness programs to counsel smokers could then be spent elsewhere.

And then we have the faux tanners…

This was a surprise to us, given we are non-users of the technology.  Since 1 July 2010, tanning bed fanatics (tan-actics?) have to pay a 10% tax whenever they indulge in an indoor tanning session.  The tax is in place for two reasons:

  1. It contributes towards paying the enormous price of reform, and
  2. The Centers for Disease Control and Prevention reports that indoor tanning has been linked to skin cancers including melanoma, squamous cell carcinoma and cancers of the eye.

Now this is a famously, continuously,  controversial issue.  Tanners are mad.  Tanning salon owners are even madder.  In fact, once the Supreme Court upheld the PPACA last June, the Indoor Tanning Association went on record as saying

As the thousands of business owners in this industry can attest, taxes have serious consequences for small businesses and their employees.

Further, they complained

These businesses have paid this unfair tax for the past two years, and the results are in: Over 3,100 tanning businesses closed; over 35,000 jobs were destroyed.  Since the tax went into effect, we estimate $145,000,000 has been taken out of the pockets of consumers and main street businesses and remitted to the federal government.

Facing the music: calories front and center!

This is a tough one.  We can no longer plead ignorance about the caloric toll our french fry habit might be exacting.  Denial is out, full disclosure is in.  The law requires that every major restaurant chain – in fact, all restaurants with 20 or more locations – list calorie counts on menu boards, menus, and even (oh, no!) drive-through signs.  And the rest of the nutritional information, details about sodium carbs, sugars, cholesterol and so on – is to be available in writing upon request.

This, naturally, hasn’t been much more popular with business owners than the tanning bed thing.  The Food Marketing Institute and some politicians claim that the law could prove very costly and hard to navigate.  What happens, for example, to places like grocery markets that also serve ready-to-eat items?  How do they comply?  And caloric information itself varies from store to store and region to region.  What are vendors to do about that?

The Food Marketing Institute endorsed new legislation last June that supports Congress’s original intent on menu labeling, that it was aimed at restaurants and not mainstream grocery stores.  This should save food retailers from an estimated $1 billion-worth of unjustifiable regulatory expenses.  It won’t protect us from having to face the fact that one large order of fries, without the ketchup,  costs 500 calories!  

Tomorrow: the rest of some interesting little-known provisions of the ACA.

Special thanks to BenefitsPro, September 11, 2012.  

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