6 Lesser-Known Obamacare Provisions That Could Evaporate

Jan 11, 2017
Originally published on January 18, 2017 7:28 am

The outcome of the repeal-and-replace Obamacare debate could affect more than you might think, depending on just how the GOP congressional majority pursues its goal.

Beyond the Affordable Care Act's marquee achievements like guaranteeing health coverage for people with pre-existing conditions and allowing children to stay on parents' plans until age 26, the roughly 2,000-page law created a host of other provisions that affect the health of nearly every American.

Some of these measures are evident every day. Some enjoy broad support, even though people often don't always realize they spring from the statute.

Here's a sampling of sleeper provisions that could potentially land on the cutting-room floor:

1. Calorie counts at restaurants and fast-food chains

Feeling hungry? The law tries to give you more information about what that burger or muffin will cost you in terms of calories, part of an effort to combat the ongoing obesity epidemic. Under the ACA, most restaurants and fast food chains with at least 20 stores must post calorie counts of their menu items. Several states, including New York, already had similar rules before the law.

Although there was some pushback, the rule had industry support, possibly because posting calories was seen as less onerous than such things as taxes on sugary foods or beverages. The final rule went into effect in December after a one-year delay.

One thing is still not clear: Does simply seeing that a particular muffin has more than 400 calories cause consumers to choose carrot sticks instead? Results are mixed. One large meta-analysis done before the law went into effect didn't show a significant reduction in calorie consumption, although the authors concluded that menu labeling is "a relatively low-cost education strategy that may lead consumers to purchase slightly fewer calories."

2. Private breast-milk pumping space at work

Breast-feeding, but going back to work? The law requires employers to provide women break time to express milk for up to a year after giving birth and provide someplace other than a restroom to do so in private. In addition, most health plans must offer breast-feeding support and equipment, such as pumps, without a patient copayment.

3. Limits on surprise medical bills from ER visits

If you find yourself in an emergency room, short on cash, uninsured or not sure if your insurance covers costs at that hospital, the Affordable Care Act provides some limited assistance. If you are in a hospital that is not part of your insurer's network, the law requires all health plans to charge consumers the same copayments or co-insurance for out-of-network emergency care as they do for hospitals within their networks. Still, the hospital could "balance bill" you for its costs, including ER care, that exceed what your insurer reimburses it.

If it's a nonprofit hospital, and about 78 percent of all hospitals are, the law requires it to post online a written financial assistance policy, spelling out whether it offers free or discounted care and the eligibility requirements for such programs. While not prescribing any particular set of eligibility requirements, the law requires hospitals to charge lower rates to patients who are eligible for their financial assistance programs. That's compared with their gross charges, also known as chargemaster rates.

4. Community health support from nonprofit hospitals

The health law also requires nonprofit hospitals to justify the billions of dollars in tax exemptions they receive by documenting how they go about trying to improve the health of the community around them.

Every three years, these hospitals have to perform a community needs assessment for the area the hospital serves. They also have to develop strategies to meet these needs and update them annually. The hospitals then must provide documentation as part of their annual reporting to the Internal Revenue Service. Failure to comply could leave them liable for a $50,000 penalty.

5. A woman's right to choose her OB-GYN

Most insurance plans must allow women to seek care from an obstetrician-gynecologist without having to get a referral from a primary care physician. While the majority of states already had such protections in place, those laws did not apply to self-insured plans, which are the type often offered by large employers. The health law extended the rules to all new plans. Proponents say direct access makes it easier for women to seek not only reproductive health care, but also screening for such things as high blood pressure or cholesterol.

6. Expanded therapy coverage for children with autism

Advocates for children with autism and people with degenerative diseases argued that many insurance plans did not provide care their families needed. That's because insurers would cover rehabilitation to help people regain functions they had lost, such as walking again after a stroke, but not care needed to either gain functions patients never had, such as speech therapy for a child who never learned how to talk, or to maintain a patient's current level of function. The Affordable Care Act requires plans to offer coverage for such treatments, dubbed habilitative care, as part of the essential health benefits in plans sold to individuals and small groups.

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.

Copyright 2017 Kaiser Health News. To see more, visit Kaiser Health News.

DAVID GREENE, HOST:

To understand what it means that Congress is on its way to repealing the Affordable Care Act, it will help to better understand what the act is. It includes health care provisions that many people do not think of as being part of Obamacare. Julie Appleby wrote a report for Kaiser Health News and spoke with our own Rachel Martin.

RACHEL MARTIN, BYLINE: Thanks for coming in.

JULIE APPLEBY: Thank you.

MARTIN: A lot of Americans don't realize Obamacare isn't just about the insurance marketplaces. What else is in there that might go away if the ACA is dismantled?

APPLEBY: Well, you're right. There's a lot of things people don't realize. So here's three. So on the way in today, you stop at the coffee shop. And you look at that muffin. And you see there's 400 calories in it, right? So...

MARTIN: Yeah.

APPLEBY: The health...

MARTIN: I hate seeing that, by the way.

APPLEBY: ...Law (laughter) requires that restaurants and fast-food chains with at least 20 outlets post calories counts on their menu items.

MARTIN: Oh, that was part of the ACA.

APPLEBY: So that was part of the ACA. At work, employers must provide new moms break time to express milk and a private area, that's not a bathroom stall, in order to do so. At the emergency room, there are some limits in the law on what insurers can charge patients if they're seen in an out-of-network emergency room. Those are just three of the things that a lot of people don't realize are in there that could potentially go away, depending on the repeal process.

MARTIN: In terms of what we know now about how that's unfolding, how likely is it that these things would disappear?

APPLEBY: You know, that's highly uncertain. We don't really know what's going to stay in and what's going to go. The Republicans are obviously eager to repeal the law. But they've not yet coalesced around a replacement plan or even a timetable on when they will do this.

So some of these items could be saved. You know, the Democrats and the Republicans may say, hey, let's keep a certain amount of these aspects. But we just really don't know what will stay and what will go.

MARTIN: Even if the law changes and the legal requirement to comply with these laws goes away, is it likely companies will still provide them? I mean, once you've given women a place to express breast milk, and then you take it away - I imagine there'd be some repercussions.

APPLEBY: Clearly, women and new moms really want that protection. They want that time. They want a private room. Employers sometimes feel burdened with that. They've got to find a place. They've got to set it aside. So there may be some pushback from employers.

The Republicans may feel that that has overstepped the boundaries. You're telling an employer how to operate. But at the same time, they're going to hear from some of their constituents that they really want to keep this provision.

MARTIN: What's the most important yet little-known item in the ACA that might go away, in your opinion?

APPLEBY: You know, there's a lot of things in there. But I was thinking about this. And before the health law, insurers could place annual or lifetime caps on how much they would pay towards your medical care. And these caps were often set at, like, a million or $2 million, which sounds like a lot. But if you have an expensive, serious illness, like cancer, or you have a premature baby that spends a lot of time in the intensive care unit, you can hit that cap.

Insurers said they needed this as one tool to slow premium growth. But it could leave consumers in the middle of an illness or right after an illness without insurance coverage. And that's going to be something that's discussed a lot depending on the repeal package that's chosen.

MARTIN: Julie Appleby is a reporter for Kaiser Health News. Julie, thank you so much.

APPLEBY: You're welcome. Thank you. Transcript provided by NPR, Copyright NPR.