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More Secrets of the ACA

As promised, here are some more lesser known effects of the comprehensive Patient Protection and Affordable Care Act (PPACA, but most often, simply ACA):

Workplace breastfeeding support!

Joan Younger Meek is a physician and the head of the United States Breastfeeding Committee.  Breastfeeding advocacy groups across the country are very happy about a provision in the ACA that supports women who chose to breastfeed their babies.   As Dr. Meek observes,

Mothers, babies and employers all win with breastfeeding support…Research clearly demonstrates the value of breastfeeding for the health of women and children, and medical experts agree with the US Department of Health and Human Services in recommending exclusive breastfeeding for six months and continued breastfeeding for the first year of life and beyond.  But returning to work can be a major hurdle for new mothers struggling to balance working and breastfeeding without the simple support measures this law ensures.

The basic provision goes as follows: employers are to provide reasonable, unpaid break time and a private, non-bathroom setting for employees to express breast milk for her nursing child for up to a year following the child’s birth.  Those employers with fewer than 50 employees are not subject to this requirement if it would cause ‘undue hardship’ to comply.

And Dr. Meek sees yet another upside to recognizing and supporting the health benefits of breastfeeding.  The new rule actually benefits employers financially.  In her view, the small effort required on the part of employers to set aside ‘a clean place in privacy’ and unpaid break times will bring them, ultimately, lower employee healthcare costs, lower absenteeism and lower turnover rates – all good things for the bottom line.

Pizza Economics

The National Restaurant Association was quick to assert that the ACA could well adversely affect a restaurant’s ability to make a profit.  It’s sort of the same argument the tanning people used over the tanner’s tax.  The law requires companies with more than 50 employees to provide its workers with access to affordable health insurance.

Papa John’s CEO John Schnatter declared last summer that healthcare reform in the US would raise the price of pizza, an apparently unforgivable outcome.  He reasoned that his own company, with some 16,500 employees that would have to be offered health care coverage, will need to charge 11 to 14 cents more per pizza (or 15 to 20 cents per order) to pay for that coverage – or pay a penalty to the government.  Profit margins are too thin for that, or so the thinking goes.

Schnatter also explained that

We’re not supportive of Obamacare, like most businesses in our industry….But our business model and unit economics are about as ideal as you can get for a food company to absorb Obamacare.

Other restaurant chains are similarly concerned about their profit margins, including White Castle, McDonald’s, Dunkin’ Donuts, Burger King and Quiznos.

More mental health emphasis

Whether or not legislation changes our actual perception of things is an idea good for a lively debate, but the ACA is most ambitious in certain areas.  It mandates coverage parity.  Mental health treatment is put on a par with medical care.  The copayments, deductibles and doctor visits cannot be more restrictive for mental illnesses than physical medical and surgical coverage.

Mental health advocate Bill Emmet, a consultant and senior policy adviser based in Los Angeles, sees this as a significant step forward, saying

I would say not single piece of legislation has had as much of a potential impact on the lives of people with mental illness as the Patient Protection and Affordable Care Act….The end of restrictions on coverage of people with pre-existing conditions will have a disproportionate benefit for people with mental illnesses, resulting not only in greater access to care for their mental health disorders, but – more important – in better overall health, as many will have access to health insurance for the first time.

The CDC reports that about 25 percent of Americans have a mental illness.  They also note that those with mental illness are more likely to have other high-cost health problems resulting from smoking and obesity, among other challenges.

In Emmet’s experience, the provision allowing young adults to stay on a  parent’s health insurance plan through age 26 will really show the impact of the better mental health coverage, as

…mental illnesses often reveal themselves just as young people are making their way in the world, and this provision will ensure they have coverage at a critical time for early intervention and treatment.

Flexible spending account adjustments.

This is not an especially exciting change, but flexible spending accounts are popular and have been readjusted.

As of 1 January 2011, the accounts can no longer be used to buy over-the-counter medicines or drugs.  And there’s a cap now, which is new.  Beginning in 2013, the law stipulates that $2,500 is the cap on health care FSA contributions.

Advocacy groups are not giving up on the system, however.  According to Jody Dietel, chief compliance officer at WageWorks and executive director of Save Flexible Spending Plans,

While the new cap may require an adjustment from FSA participants, the accounts are still a can’t-miss savings opportunity.

Special thanks to BenefitsPro, September, 2012.

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