Five years later: How ACA is working for Florida—Better Value

Better Value

Providing better value for your premium dollar through the 80/20 Rule: Health insurance companies now have to spend at least 80 cents of your premium dollar on health care or improvements to care, rather than administrative costs like salaries or marketing, or they have to provide you a refund.  This means that 981,273 Floridians with private insurance coverage benefited from $41,679,928 in refunds from insurance companies, for an average refund of $65 per family because of the Affordable Care Act.

Scrutinizing unreasonable premium increases: In every State and for the first time under Federal law, insurance companies are required to publicly justify their actions if they want to raise rates by 10 percent or more. Florida has received $1,000,000 under the new law to help fight unreasonable premium increases. Since implementing the law, the fraction of requests for insurance premium increases of 10 percent or more has dropped dramatically, from 75 percent to 14 percent nationally.  To date, the rate review program has helped save Americans an estimated $1 billion.

Removing lifetime limits on health benefits: The law bans insurance companies from imposing lifetime dollar limits on health benefits – freeing cancer patients and individuals suffering from other chronic diseases from having to worry about going without treatment because of their lifetime limits. Already, 5,587,000 people in Florida, including 2,170,000 women and 1,411,000 children, are free from worrying about lifetime limits on coverage. The law also restricts the use of annual limits and bans them completely starting in 2014.

Ending discrimination for pre-existing conditions: As many as 7,838,642 non-elderly Floridians have some type of pre-existing health condition, including 960,492 children.  Today, health insurers can no longer deny coverage to anyone because of a pre-existing condition, like asthma or diabetes, under the health care law.  And they can no longer charge women more because of their gender.

Expanding mental health and substance use disorder benefits: The Affordable Care Act increases also access to comprehensive coverage by requiring most health plans to cover ten essential health benefit categories, to include hospitalization, prescription drugs, maternity and newborn care, and mental health and substance use disorder services.  The health care law expands mental health and substance use disorder benefits and federal parity protections for 62 million Americans nationwide, including 4,241,690 Floridians.

Submitted by Stephanie A. Owens, Sr. Advisor, U.S. Department of Health and Human Services, Region IV