"It's complicated, but there are very many benefits affecting millions of people," said Don Berwick, who served as administrator of the Centers for Medicare and Medicaid Services until the beginning of December. "They will not know it's the Affordable Care Act, but it is."In 2011, the law targeted specific groups of people — mostly the young and senior citizens — while the most argued about pieces won't come until 2014. Then, assuming the Supreme Court doesn't rule against the "individual mandate," the provision that requires most Americans to buy health insurance, millions more people will be affected.
In 2012, Medicare providers will be able to start affordable care organizations to improve quality and cut costs, while the government will implement rules making it easier to use electronic medical records and share data about which treatments work the best and which need improvement. Health and Human Services has designated 32 health care providers as members of the first wave of affordable care organizations that will start Jan. 1 and be eligible for bonus payments from Medicare if they meet savings and care targets.
Here are the five major changes in health care that occurred in 2011 because of the health care law:
A crackdown on fraud
The Justice Department recovered $2.9 billion in health care fraud funds in 2011, according to Vice President Biden. The government was on pace for an 85% increase in health care fraud prosecutions over last year, according to government documents.
In fiscal year 2010, the government prosecuted 731 health fraud cases. In fiscal year 2011, the government prosecuted 1,235 cases, a 69% increase over last year, according to the Transactional Access Records Clearinghouse, a non-profit group that uses government documents to track data. This is the highest number recorded since the group began keeping track 20 years ago.
In September, the government announced it charged 91 people in eight cities with what Attorney General Eric Holder called the biggest takedown in Medicare task force history: Those arrested were accused of trying to steal $295 million from Medicare.
Relief for those 25 and younger
The law allows young adults ages 19 to 25 to stay on their parents' health insurance policies. That means, HHS Secretary Kathleen Sebelius said, that they can take entry-level jobs in fields they like, such as technology start-up firms, rather than take jobs just for the benefits. The law also allows young people with pre-existing conditions, such as heart problems or neurological disorders, to maintain health insurance.
The number of young adults who took advantage of this provision: 2.5 million.
More benefits for senior citizens
Senior citizens have probably benefited the most this year from the law: Prescription drug costs have been reduced by 50% because of drug company discounts. Seniors can receive annual exams and some screenings without paying a co-pay, and they can receive free counseling if they screen positively for obesity to try to decrease heart disease, strokes and diabetes.
By the end of November, more than 24 million seniors had gone in for annual exams or screenings, meaning they went in before something started to bother them.
Seniors benefited from a 50% discount on prescription drugs to help close the "donut hole," the gap between traditional and catastrophic coverage in the Part D drug benefit program. The law required drug companies to offer the discount to participate in the program.
Through the end of October, more than 2.65 million Medicare recipients saved a total of $1.5 billion on their prescriptions. That's an average of $569 per patient.
Preventive care services for the privately insured
Insurance companies sent out notices last fall that their consumers could go in for annual exams, immunizations and screenings without paying a co-pay, deductible or co-insurance. This came as a requirement of the law for anyone who receives insurance through his employer or who is in a personal plan created after March 2010.
This meant they could be screened for diabetes, have their cholesterol levels checked or receive a mammogram without paying a co-pay or deductible. They could also receive counseling on smoking cessation, losing weight or managing depression.
Insurance for those with pre-existing conditions
This year, U.S. citizens denied access to insurance policies because they had pre-existing conditions could join the government's Pre-existing Condition Insurance Plan, found at PCIP.gov. The program is available to people who have not had insurance for at least six months.
This year, HHS worked to make it easier for people to join by cutting premiums in some states by up to 40%. In Florida, the average monthly payment for a person older than 55 was $390. In July, it dropped to $234 a month.
Enrollment has been slow. By the end of October, about 41,500 people had enrolled.
Americans will see several more changes in 2012: Insurance companies must pay rebates to consumers when they spend more than 80% of deductibles on anything besides health care. Providers will form Affordable Care Organizations based around keeping patients healthy, rather than being paid by how many tests or surgeries they perform. And hospitals will be required to publicly release quality data that show how they do with heart attacks, heart failure, pneumonia, surgical care, health-care-associated infections and patient surveys.
Berwick said that people would change their ideas about the law if they understood it better and that it's "frustrating" that people don't understand the good it's doing. "I wish people were realizing now how much this is helping," he said. "If it were to go away, they'll lose this stuff right away."
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