T h e A f f o r d a b l e C a r e A ct www.wvahc.org This publication was funded through a generous grant from the Claude Worthington Benedum Foundation Goals of the Affordable Care Act The Affordable Care Act (ACA) aims to ensure quality health care for all Americans at a price they can afford. The new law is being phased in over several years. The earliest provisions are already benefitting millions of Americans, especially children, young adults, people with expensive illnesses, and seniors. By early 2014, the major features of the ACA will be in place, with four overarching goals: EmployerSponsored Plans Affordable Individual Plans Medicare Medicaid and CHIP 1. Expand coverage. The ACA extends health coverage to virtually all Americans. People who participate in health plans through their employers will continue to do so. Medicare will be enhanced, and Medicaid will be expanded to more adults in states that take advantage of new federal options and decide to fully implement the law. New “health insurance exchanges” will offer competitively-priced plans to individuals not covered by employer or government-sponsored plans and to small businesses. Significant tax credits will be available to individuals and small businesses that qualify to help make health coverage more affordable. Ten essential benefits must be covered by all plans offered through the health insurance exchanges including: patient office visits; inpatient and outpatient hospital services; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; laboratory services; preventive and wellness services; chronic disease management; and pediatric services, including oral and vision care. 2 West Virginians for Affordable Health Care 2. Reform insurance industry rules. New ACA rules now require insurance companies to sell policies that fully cover children with pre-existing conditions, and this protection will be extended to adults in 2014. Other major changes include allowing young adults to stay on their parents’ insurance policy until age 26; prohibiting lifetime limits on benefits; and limiting the percentage of money that an insurance company can spend on administrative costs. Starting September 23, 2012, insurance policies must be written in plain language. And starting in 2014, the ACA will prohibit new insurance plans from charging women higher premiums than men for the exact same policy. 3. Strengthen prevention. The ACA increases the emphasis on keeping people well. Medicare and new insurance policies must now cover more preventive measures, and states have the option to extend these preventive measures to their Medicaid programs with additional federal funding to do so. These preventive services are provided with no deductible, copayment or coinsurance, and are based on what is clinically appropriate for the patient. 4. Contain costs. Our current approach to health care is fragmented and inefficient, and reimburses medical providers for the quantity, versus quality, of services they provide. The ACA begins to address these problems by paying providers based on quality and ensuring that patient care is coordinated. West Virginians for Affordable Health Care 1544 Lee Street Charleston, WV 25311 (304) 344-1673 www.wvahc.org The Affordable Care Act: What Health Reform Means for Women and Families The Affordable Care Act (ACA) takes historic steps to elevate the importance of women’s health and health care. The new law improves coverage of essential services for women, eliminates gender discrimination in the insurance industry, and ensures access to affordable health plans, regardless of employment. This report describes the provisions of the ACA in three areas of particular concern to women: I. Preventive health care, including the expansion of coverage for both general and gender-specific services for adults, as well as preventive services for children with no deductibles or co-payments. II. Reproductive health care, including the expansion of maternity coverage, improved access to gynecologists and family planning, and information on how the law applies to abortion. III. Expanded coverage and equity improvements, including expansion of Medicaid eligibility, enhancements in Medicare coverage of preventive services and prescription drugs, the end to gender discrimination and pre-existing condition limitations in health plans, and coverage of young adults on their parents’ health plans. In addition, the ACA strengthens offices that focus on women’s health within the US Department of Health and Human Services and other federal agencies. The Affordable Care Act: What Health Reform Means for Women and Families 3 I. Preventive Health Care The adage “an ounce of prevention is worth a pound of cure” is a centerpiece of the ACA. The new law shifts the emphasis from a health system that responds primarily to illness and injury to one that also focuses on keeping people healthy. Women in particular will benefit from the preventive services that health plans are required to cover under the ACA with no cost-sharing. These include evidencebased screenings, counseling, and procedures that over the course of a lifetime may have a profound impact on the health of individuals and the nation as a whole. 2010 Preventive Measures All new insurance policies issued after September 2010 must cover clinically appropriate preventive measures, with no deductible, copayment or coinsurance. Appendix A provides a complete list of the 2010 preventive measures that must be covered for women, men and children at no additional cost. Examples include: • Women are covered for mammography every one to two years after age 40; pap smears; and osteoporosis screenings for women over 60, depending on risk factors. • Pregnant women are covered for expanded counseling for tobacco and alcohol use; folic acid supplements; and screenings for iron deficiency and anemia. • Both women and men are covered for cholesterol screening, depending on health risk factors; colorectal cancer screening for adults over 50; 1 This also applies to enrollees who have individual (non-employment based) policies. 4 West Virginians for Affordable Health Care depression screening; type two diabetes for adults with high blood pressure; diet counseling for adults at risk for chronic disease; flu vaccination and other immunizations; and obesity screening and counseling. Patients should use an in-network provider to avoid additional charges, and may have to pay for an office visit if the preventive measure is not the primary purpose of the health care visit. Not all insurance plans are required to cover these preventive measures. “Grandfathered” plans are exempt. Grandfathered plans are plans that were in existence on March 23, 2010, when the ACA was signed into law, and have not made significant changes to the costs paid by employees1 or the services covered. The Public Employees Insurance Agency (PEIA), for example, has increased costs to employees over the last several years, and has lost its grandfathered status. See Appendix B for a detailed explanation on changes that insurance plans can make and what impact these changes will have on their grandfathered status. Estimates vary on how many policies will retain their grandfathered status. Some reports project that 66 percent of small employers and 45 percent of large employers would lose their grandfathered status by 2014. Others are projecting that 80 percent of employers will have at least one insurance plan option that will no longer be grandfathered by 2014. Over time, fewer insurance plans will be grandfathered, and once they lose their grandfathered status, they will be required to cover preventive services with no cost sharing. Some insurance companies have voluntarily added these preventive measures as a covered benefit. Highmark Blue Cross Blue Shield of West Virginia has added these preventive measures with no deductible or copayment to the covered services that they provide to their fully insured customers. So, regardless of whether a plan is grandfathered or not, these preventive measures will be covered by those companies that are fully insured by Blue Cross Blue Shield. Other insurance companies may have added these preventive measures. You should consultant your plan manager administrator to see if these are covered services. Under the ACA, more than 250,000 West Virginia women will gain access to all FDA approved contraceptive measures with no deductible or copayments. Removing the financial barrier to contraceptives will allow more women to space their pregnancies and avoid unwanted pregnancies. 2012 Preventive Measures In August 2011, the US Department of Health and Human Services (HSS) adopted eight additional preventive measures for women that were recommended by the Institute of Medicine. These services must be provided with no deductible, copayment or coinsurance when a new plan year begins after August 1, 2012.2 Appendix A provides a complete list of these 2012 additional preventive services for women. Examples include: • Well-woman visits to obtain recommended preventive services for women under age 65; • Comprehensive breastfeeding support and counseling from trained providers, as well as breastfeeding supplies for pregnant and nursing women; • Domestic violence screening and counseling for all women; and • All Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling. 2 For most women a new plan year will begin January 1, 2013. For women covered by PEIA, it will begin July 1, 2013. The Affordable Care Act: What Health Reform Means for Women and Families 5 As with the 2010 preventive measures, grandfathered insurance plans are exempt from providing these additional preventive measures. Preventive Health Care for Children Women with children also will be interested in the numerous preventive measures for infants, children and adolescents that now must be covered by new insurance policies without any deductible or copayment. Under the ACA, Bright Future Guidelines will provide children with the gold standard for preventive care. Abortifacient (abortion-inducing) drugs are not contraceptives, and therefore are excluded from coverage. HHS exempted churches and other houses of worship that objected on religious grounds from paying for or providing contraceptives. HHS did not exempt affiliated church organizations such as Catholic hospitals or religious social service agencies. However, HHS is considering alternative methods of financing of contraceptives for these organizations. Alternatives being considered include having contraceptives be provided directly by the organization’s insurance company, through a rebate from a pharmaceutical company, or through an arrangement with a drug company doing business with the Federal Employee Health Benefits program. A decade of work by government agencies, professional organizations and experts in infant, child and adolescent health has created the Bright Futures Guidelines as the “gold standard” for preventive services for children and youth. The ACA incorporates the guidelines of Bright Futures in its preventive services for children and youth. Appendix A provides a complete list of preventive measures that must be covered for children at no additional cost. Examples include periodic well baby and well child visits; vision and hearing screening; assessment of developmental and behavioral progress; physical examination; and oral health screening. Additionally, childhood immunizations must be covered by all new insurance policies without a deductible or copayment. These immunizations include hepatitis B, diphtheria, tetanus and pertussis, measles, mumps and rubella, and annual flu shots for children over six months of age.3 3 As note above, patients should use an in-network provider to avoid additional charges; may be charged for an office visit if the preventive measure is not the primary purpose of the health care visit; and grandfathered plans are exempt from the requirement that they provide these preventive measures without a deductible or copayment. 6 West Virginians for Affordable Health Care With the adoption of the ACA virtually all insurance policies will cover maternity care in the future II. Reproductive Health Care Maternity Coverage The ACA requires ten “essential health benefits” be covered by all health insurance plans sold through the health insurance exchanges and all new individual and small group policies sold outside the health insurance exchanges beginning on January 1, 2014. One of the required essential health benefits is maternity and newborn services. Additional provisions in the ACA that will benefit women during and after pregnancy include: • Pregnancy-tailored counseling from a doctor that will help pregnant women quit smoking and avoid alcohol use; • Requiring Medicare to pay nurse midwives the same reimbursement that physicians receive. Although Medicare pays for very few deliveries, its payment structure is often adopted by Medicaid and private insurance companies; • Requiring large employers (50 or more employees) to provide new mothers a private place and break time to express breast milk for one year after the birth of a child; • Increased education and support to women with postpartum depression and increased funding to research the cause and treatment for postpartum depression; and The ACA has provided more than $4 million to support maternal, infant and early childhood home visitation programs in West Virginia • Grants for maternal, infant and early childhood home visiting programs for at risk families. West Virginia already has received $4.2 million in grant monies for these programs. Grandfathered plans are not required to provide essential health benefits, including maternity and newborn care. However, the Pregnancy Discrimination Act requires all employers with 15 or more employees to cover pregnancy-related conditions on par with other medical conditions. This means that after January 2014, virtually all health insurance policies will cover maternity and newborn care. The Affordable Care Act: What Health Reform Means for Women and Families 7 Abortion The ACA reinforces current federal laws on coverage of abortion services, including limiting the use of federal funds to cases of rape, incest or to protect the life of the pregnant woman (known as the Hyde limitations). The ACA does not pre-empt state law regarding abortion. States may include policies in their state health insurance exchanges that cover abortions beyond the Hyde limitations, and must include at least one policy that does not. Under the ACA, West Virginia has received more than $1 million in grants to reduce teen pregnancies and sexually transmitted diseases. Access to Gynecologists The ACA prohibits new insurance plans from requiring a woman to obtain approval from her primary care provider in order to see a gynecologist. Additionally, the ACA allows a woman to select her own gynecologist. In the past, some HMOs automatically assigned women to gynecologists and primary care providers, and their children to pediatricians. Women will now be able to select their gynecologists, primary care providers and their children’s pediatricians. The health providers must be in the insurance company’s network and accepting new patients. Grandfathered plans are exempt from this requirement. Family Planning New insurance plans that renew after August 2012 must cover all FDA-approved contraceptives with no cost sharing. The ACA also includes two grants for programs to reduce teen pregnancies. The State Personal Responsibility Education Program (PREP) funds evidence-based sex education to reduce the rate of teen pregnancies and sexually transmitted infections. The Abstinence Education Grant program funds “abstinence only until marriage” programs. During 2010 and 2011, West Virginia organizations received $550,000 in PREP grants and $600,000 in Abstinence Education Grants. 8 West Virginians for Affordable Health Care Plans sold through health insurance exchanges that offer abortion coverage above the Hyde limitations (medically necessary abortions, for example) cannot use federal tax credits for these abortion services. Insurance companies that provide access to abortion beyond the Hyde limitations will have to separate funds received from federal tax credits from private premium payments to comply with this requirement. Insurance companies may not discriminate against any provider or health care facility based on their willingness or unwillingness to perform or provide referrals for abortions. Also, the Pre-Existing Conditions Insurance Plans, which guarantee access to a high riskpool for people with pre-existing conditions, cannot cover abortion services beyond the Hyde limitations. Abortion Coverage in the Health Insurance Exchanges Guaranteed Optional Restricted At least one plan does not include coverage of abortion beyond the Hyde limitations. A plan(s) that includes abortion coverage beyond the Hyde limitations. Use of federal funds (i.e. subsidies) for abortion coverage beyond the Hyde limitations. An estimated 63,000 uninsured West Virginia women will receive health coverage if the state fully implements the ACA’s option to expand Medicaid. III.Expanded Coverage and Equity Improvements Medicaid Expansion Since women earn less than men on average, the expansion of Medicaid eligibility in 2014 will principally benefit women. Currently, the state’s Medicaid program only covers parents who earn less than 35 percent of the federal poverty level, about $6,700 for a family of three. Childless adults in West Virginia do not qualify regardless of income. In 2014, the ACA will cover all individuals and families who earn less than 138 percent of the federal poverty level or about $26,300 for a family of three if West Virginia takes advantage of new federal options and decides to fully implement the new law. Of the estimated 115,000 uninsured women in West Virginia, 55 percent – about 63,000 women – will become eligible for Medicaid, according to the Kaiser Family Foundation. More than 236,000 West Virginia Medicare members received free preventive services under the ACA in 2011. mammograms, pap smears and colorectal cancer screens due to the ACA. Changes in Medicare More than half (56 percent) of all Medicare members are women. There are two important improvements in Medicare as a result of the ACA. • In addition to having access to all clinically appropriate preventive measures, Medicare members are also eligible for an annual wellness benefit. The additional preventive measures and wellness visit are being provided without a deductible or copayment. In 2011, more than 236,000 West Virginians with Medicare coverage received free preventive services such as • Medicare members have an improved prescription drug benefit to reduce the gap in prescription drug coverage referred to as the “doughnut hole.” In 2012, Medicare members in the doughnut hole are receiving a 50 percent discount on brand name drugs and a 14 percent discount on generic drugs. During the first two years of the ACA, West Virginia Medicare members have received more than $45 million in assistance when they were in the doughnut hole. The ACA closes the doughnut hole entirely by 2020. The Affordable Care Act: What Health Reform Means for Women and Families 9 End to Discrimination Based on Pre-existing Conditions New health insurance policies cannot deny a child a policy because the child has a pre-existing condition or issue a policy that excludes coverage of the pre-existing condition. This provision currently applies to children up to their 19th birthday. Beginning on January 1, 2014, this provision is extended to adults. Until 2014, young adults who have employer-sponsored health insurance available to them are not eligible for their parent’s policy. After 2014, they can choose between the employer-sponsored insurance and their parents’ policy. Young adults who are married and/or have dependent children are eligible for their parent’s policy, but their dependent children are not. End of Gender Discrimination In the individual market, insurance companies can continue to charge children a higher premium for a pre-existing condition. However, in group plans, which is where most West Virginians receive health insurance coverage, individuals with pre-existing conditions cannot be charged a higher premium, although employers with higher than average claims can be charged higher premiums. This additional cost cannot be passed on to individuals who have a pre-existing condition or higher than average claims. All plans sold in the health insurance exchanges will be new plans and will be prohibited from discriminating against both people with pre-existing conditions and small businesses based on the health status of their employees. This means that insurance companies can no longer charge higher premiums to people with preexisting conditions or to small businesses with higherthan-average claims. “Gender rating” is the insurance company’s practice of charging women a higher premium than men for the exact same policy. Currently, women often pay a higher premium than men in the individual market. However, in the group market, most employers (those covered by Title VII of the Civil Rights Act of 1964) cannot discriminate against women by charging them a higher premium than similarly situated men. This does not prevent insurance companies from charging a higher premium to companies with a high percentage of women such as child care centers, nonprofit organizations, dentist offices, etc. Gender rating is prohibited by the ACA in both the individual market and the small group market for all new plans effective January 1, 2014. All plans sold in the health insurance exchanges beginning on January 1, 2014 will be new plans, and therefore, prohibited from charging women higher premiums than men. Grandfathered plans are exempt from the prohibition on gender rating. Additionally, the ACA prohibits discrimination in health programs that receive federal dollars. For example, insurance companies that participate in the health insurance exchanges, where they will receive federal subsidies for insuring moderate- and middleincome families, will be prohibited from discriminating based on gender. Federal Offices Will Focus on Women’s Health 16,000 young adults in West Virginia were able to stay on their parents’ policy in 2011, and that number is projected to increase. Young Adult Coverage Young adults can now stay on their parents’ health insurance policy until their 26th birthday. The young adult can be in school or out of school; married or unmarried; living with his or her parents or living separately; listed as a dependent on his or her parent’s IRS filing or filing a separate tax return; and still qualify for coverage under his or her parent’s health insurance policy. 10 West Virginians for Affordable Health Care The new law strengthens offices that will focus on women’s health within US Department of Health and Human Services, Food and Drug Administration, Centers for Disease Control and Prevention, Health Resources and Services Administration, and other agencies. The purposes of these Offices of Women’s Health are to provide information on women’s unique health care needs and establish goals and priorities for improvements in women’s health. Although these Offices of Women’s Health are in the executive branch of government, they cannot be eliminated or reorganized without the approval of Congress. APPENDIX A Preventive Measures for Women, Pregnant Women, Adults and Children Women-Specific Preventive Measures Effective Date for Most Women4 Preventive Measure January 2011 Mammography every one to two years for women over 40 January 2011 Cervical cancer screening for sexually active women January 2011 Osteoporosis screening for women over 60, depending on risk factors January 2011 Chlamydia infection screening for younger women and others at higher risk January 2011 Breast cancer (BRCA) counseling about genetic testing for women at higher risk January 2011 Breast cancer chemoprevention counseling for women at higher risk January 2011 Gonorrhea screening for all women at higher risk January 2011 Syphilis screening for all pregnant women or other women at increased risk January 2013 Well-woman visit to obtain recommended preventive services for women under 65 January 2013 Domestic violence screening and counseling for all women January 2013 Human immunodeficiency virus (HIV) screening and counseling for sexually active women January 2013 Human papillomavirus (HPV) DNA test: high risk HPV DNA testing every three years for women with normal cytology results who are 30 or older January 2013 Sexually transmitted infections (STI) counseling for sexually active women January 2013 All Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling. 4 The benefits listed as having an effective date for most women of January 2011 technically went into effect when a new plan year began after September 23, 2010. For most women that was January 1, 2011. The benefits listed as having an effective date of January 2013 will actually have an effective date when a new plan year begins after August 1, 2012. For most women that will be January 1, 2013. The Affordable Care Act: What Health Reform Means for Women and Families 11 Preventive Measures for Pregnant Women Effective Date for Most Women Preventive Measure January 2011 Anemia screening on a routine basis for pregnant women January 2011 Hepatitis B screening for pregnant women at their first prenatal visit January 2011 Folic Acid supplements for women who may become pregnant January 2011 Bacteriuria urinary tract or other infection screening for pregnant women January 2011 Rh (Rhesus) incompatibility screening for all pregnant women and follow-up testing for women at higher risk January 2011 Special, pregnancy-tailored counseling from a health care provider that will help pregnant women quit smoking and avoid alcohol use January 2013 Breastfeeding: comprehensive support and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women January 2013 Diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes Preventive Measures for Women and Men 12 Effective Date for Most Adults Preventive Measure January 2011 Alcohol misuse screening and counseling January 2011 Aspirin use for men and women of certain ages January 2011 Blood pressure screening for all adults January 2011 Cholesterol screening for adults of certain ages or at higher risk January 2011 Colorectal cancer screening for adults over 50 January 2011 Depression screening for adults January 2011 Type 2 Diabetes screening for adults with high blood pressure January 2011 Diet counseling for adults at higher risk for chronic disease January 2011 HIV screenings for all adults at higher risk January 2011 Immunization vaccines for adults — doses, recommended ages, and recommended populations vary • Hepatitis A • Hepatitis B • Influenza • Measles, Mumps, Rubella • Tetanus, Diphtheria, Pertussis January 2011 Obesity screening and counseling for all adults January 2011 Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk January 2011 Tobacco Use screening for all adults and cessation interventions for tobacco users January 2011 Syphilis screening for all adults at higher risk West Virginians for Affordable Health Care • Herpes Zoster • Meningococcal • Varicella • Human Papillomavirus (HPV) • Pneumococcal Preventive Measures for Children and Adolescents5 Effective Date for Most Children Preventive Measure January 2011 Alcohol and drug use assessments for adolescents January 2011 Autism screening for children at 18 and 24 months January 2011 Behavioral assessments for children of all ages January 2011 Blood pressure screening for children of all ages January 2011 Cervical Dysplasia screening for sexually active females January 2011 Congenital Hypothyroidism screening for newborns January 2011 Depression screening for adolescents January 2011 Developmental screening for children under age 3, and surveillance throughout childhood January 2011 Dyslipidemia screening for children at higher risk of lipid disorders January 2011 Fluoride Chemoprevention supplements for children without fluoride in their water source January 2011 Gonorrhea preventive medication for the eyes of all newborns January 2011 Hearing screening for all newborns January 2011 Height, weight and body mass index measurements January 2011 Hematocrit or Hemoglobin screening January 2011 Hemoglobinopathies or sickle cell screening for newborns January 2011 HIV screening for adolescents at higher risk January 2011 Immunization vaccines for children from birth to age 18 -- doses, recommended ages, and recommended populations vary • Diphtheria, Tetanus, Pertussis • Hepatitis A • Hepatitis B • Inactivated Poliovirus • Influenza • Meningococcal • Pneumococcal January 2011 Iron supplements for children ages 6 to 12 months at risk for anemia January 2011 Lead screening for children at risk of exposure January 2011 Medical history for all children throughout development January 2011 Obesity screening and counseling January 2011 Oral health risk assessment for young children January 2011 Phenylketonuria (PKU) screening for this genetic disorder in newborns January 2011 Sexually transmitted infection (STI) prevention counseling for adolescents at higher risk January 2011 Tuberculin testing for children at higher risk of tuberculosis January 2011 Vision screening for all children • Haemophilus influenzae type b • Human Papillomavirus (HPV) • Measles, Mumps, Rubella • Rotavirus • Varicella 5 A complete list of children’s preventive measures and when they should occur can be found at: http://brightfutures.aap.org/pdfs/AAP%20Bright%20Futures%20Periodicity%20Sched%20101107.pdf The Affordable Care Act: What Health Reform Means for Women and Families 13 APPENDIX B Explanation of “Grandfathered Plans” Under the ACA “New” insurance policies include all new policies and policies that are not “grandfathered.” Grandfathered plans are plans that were in existence on March 23, 2010, when the ACA was signed into law, and have not made significant changes in the costs paid by employees or the services covered. For example, the West Virginia Public Employees Insurance Agency (PEIA) was in existence when the ACA became law, but because it has changed the costs employees must pay by so much, it has lost its grandfathered status. In order to maintain grandfathered status, plans may only make limited changes in their health insurance policies that were in effect on March 23, 2010. Examples of changes that will cause a health plan to lose its grandfathered status include: • Significant Cut or Reduction in Benefits: For example, if a plan decides to no longer cover care for people with diabetes or HIV/AIDS. • Increase in Co-Insurance Charges: Typically, co-insurance requires a patient to pay a fixed percentage of a charge (for example, 20% of a hospital bill). In order to maintain its grandfathered status, a plan cannot increase this percentage. • Significant Increases in Copayments: In order to maintain its grandfathered status, a plan cannot increase copayments by more than the greater of $5 (adjusted annually for medical inflation) or a percentage equal to the medical rate of inflation plus 15 percentage points. For example, if a plan raises its copayment from $30 to $50 over the next two years, it will lose its grandfathered status. • Significant Increases in Deductibles: In order to maintain its grandfathered status, a plan can increase deductibles by no more than a percentage equal to the medical rate of inflation plus 15 percentage points. 14 West Virginians for Affordable Health Care • Significant Reduction in Employer Contributions: Grandfathered group plans (job-based coverage), cannot decrease the percent of premiums the employer pays by more than 5 percentage points. For example, if a group plan decreases the employer’s share of premium costs from 80% to 70%, it would lose its grandfathered status. • Significant Increases in Annual Limits on Benefits: Some insurers cap the amount that they will pay for covered services each year. To maintain its grandfathered status, a health plan cannot decrease any annual dollar limits that were in place as of March 23, 2010. Grandfathered plans that do not have an annual dollar limit cannot add a new one except in very limited situations. • May Change Insurance Companies: An employer with a group health plan can switch plan administrators as well as buy insurance from a different insurance company without losing grandfathered status, provided the plan does not make any of the above six changes to its cost or benefits structure. The Affordable Care Act: What Health Reform Means for Women and Families Written by Perry Bryant Executive Director West Virginians for Affordable Health Care Edited by Julie Pratt Ridgeline: Ideas in Action Layout Design by Renate Pore Lydia Mitts West Virginians for Affordable Health Care Families USA Dave Love The Phillips Group This publication was funded through a grant from the Claude Worthington Benedum Foundation This and other publications on the Affordable Care Act are available are on WVAHC’s web site: www.wvahc.org WVAHC Board of Directors Dan Foster, MD, President Barbara Fleischauer Margaret Chapman Pomponio CAMC and West Virginia Senate West Virginia House of Delegates WV FREE Sam Hickman, Vice President Reverend Todd Garland Craig Robinson NASW West Virginia Chapter Catholic Diocese of Wheeling-Charleston Cabin Creek Clinic David Forinash, Secretary Brandon Merritt Tom Sims Retired health care administrator Kanawha-Charleston Health Department AARP West Virginia Reverend James Patterson Northeastern University School of Law Sally K. Richardson, Treasurer WVU Institute for Health Policy Research Beth Baldwin West Virginia Nurses Association Rachel Dash Temple Israel Partnership of African American Churches Kenny Perdue West Virginia AFL-CIO George Pickett, MD Emily Spieler Kathleen Stoll Families USA Gary Zuckett West Virginia Citizen Action Group Retired state public health director WVAHC Board Advisors WVAHC Staff About WVAHC Sue Coyle Ashley Adams WVU School of Nursing Eastern Panhandle Regional Coordinator West Virginians for Affordable Health Care is a tax-exempt, nonprofit organization under IRS 501(c)(3) regulations. WVAHC was organized in 2005 by a diverse group of individuals concerned about the rising cost of health care and insurance coverage. We are funded by membership dues, public donations, and grants. No member is paid for serving on our Board of Directors. Dolly Ford Licensed Clinical Social Worker Danny Scalise Capital Resource Agency Nancy Tyler Nancy Tyler Healthcare Chris Zinn Lisa Diehl North Central Regional Coordinator Renate Pore Director of Health Care Policy Doris Selko Southern Regional Coordinator Hospice Nurse West Virginians for Affordable Health Care 1544 Lee Street, Charleston, WV 25311 (304) 344-1673 • www.wvahc.org The Affordable Care Act: What Health Reform Means for Women and Families 15 West Virginians for Affordable Health Care 1544 Lee Street Charleston, WV 25311 (304) 344-1673 www.wvahc.org