ACA Implementation

Section: 

Prior to passage of the Affordable Care Act (ACA), an estimated 36 percent of Americans who tried to purchase health insurance directly from an insurance company were denied coverage, charged higher premiums, or received limited benefits because they had a pre-existing condition. (Commonwealth Fund) ACA outlaws such discriminatory practices, but people with chronic conditions still face barriers to health care because of unfair plan design.

Working with member organizations represented on the NHC Government Relations Affinity Group (GRAG) and the Health Care Reform Action Team, the NHC has been active on major policy areas during the implementation of ACA. The main areas of emphasis are ensuring health insurance plans meet the needs of people with chronic conditions and reforming the health care delivery system to improve access to quality care.

The NHC is focused on five core issues to make sure that insurance plans meet the needs of patients: nondiscrimination, transparency, uniformity of plan materials, continuity of care, and enforcement of patient protections.

  • At the urging of the NHC, the 2017 Notice of Benefit and Payment Parameters (NBPP) included many patient-centered proposals. However, ground-breaking opportunities to enhance the delivery of care did not make it into the final rule.
  • The 2016 Notice of Benefit and Payment Parameters for insurance exchanges includes many of the NHC’s recommended patient protections.  
  • In 2015, the NHC created state-specific progress reports to assess the patient-centeredness of health insurance markets, conducted a national study of the patient experience enrolling in the exchanges,  and relaunched a website dedicated to helping people pick the right insurance plan that meets their health and budget needs, including an out-of-pocket cost calculator. The successful implementation of ACA relies on states as regulators of the health insurance market. State support is critical to guaranteeing the ACA's goals of high-quality and affordable health care for all.
  • In 2011, the NHC developed in 2011 a diagram that addresses the elements for getting the Right Care, at the Right Time, for the Right Patient, at the Right Price.To provide true value in health care, there must be a confluence of health research and personal circumstances, which include the patient's genetic, ethnic, religious, and social-economic status at the point of care. The marriage of health research with real-world application leads to improved health outcomes and helps us to curb costs responsibly.