Menendez: The Affordable Care Act is Working for New Jersey

Press Release

In an event marking the 2nd anniversary of Affordable Care Act, U.S. Senator Robert Menendez today joined health care leaders and local residents who are seeing its real benefits in their own lives. The event was held at the Joseph M. Sanzari Children's Hospital at HackensackUMC.

"I fought hard for the Affordable Care Act because of parents like Nicole, young adults like Robert and seniors like Helene who are experiencing its benefits today," said Menendez. "Their stories -- representing millions of Americans just like them --illustrate why we needed to level the playing field when it comes to dealing with insurance companies and give families a fighting chance at affordable health care. Those who call for repeal are ignoring the reality that it is already working for New Jersey families."

At the event, three New Jerseyans shared their personal stories about how the Affordable Care Act is working for them and their families:

Nicole Pratt of Jersey City is the mother of two children with special health care needs. Like so many parents caring for children with special needs, she worried about insurance companies denying coverage for her kids because of pre-existing conditions. Thanks to the Affordable Care Act, insurers can't deny coverage to children because of pre-existing conditions and Nicole will no longer have to worry about exhausting her lifetime benefits which could be financially devastating. Already more than 3 million New Jerseyans, including more than 870,000 children, are free from worrying about lifetime limits on coverage.

Robert Brown of Lawrenceville is 25 and after attending Mercer County College, is looking for work. Like so many young adults, Robert found the cost for insurance was just too expensive, even for a basic plan with high co-pays and no prescription drug coverage. Rather than being uninsured, thanks to the Affordable Care Act, Robert is now covered on his father's insurance plan until he's 26. In 2011, 68,816 young adults in New Jersey gained insurance coverage as a result of the new health care law allowing them to stay on their parents' plan until their 26th birthday.

Like a lot of seniors, Helene Dreskin of Livingston has health conditions that require expensive medications. Helene represents those seniors enrolled in Medicare Part D who have fallen into the "donut hole" forcing her to pay full price for her prescription medications out of pocket. Because of health reforms, Helene was able to receive a one-time $250 rebate check in 2010 to cover some of her costs and last year, when she hit the donut hole, she received a 50% discount on the costs of her name-brand drugs. The donut hole is closing more and more ever year, saving Helene and seniors like her money on their prescriptions and by 2020, it will be closed entirely. In 2011, seniors in New Jersey saved an average of $756 on their prescriptions.

Menendez was also joined by Dennis Gonzalez, Executive Officer of the U.S. Department of Health and Human Services, Mercedes Rosa, Director of the Family to Family Health Information Center at Statewide Parenting Advocacy Network (SPAN).

THE FACTS: THE AFFORDABLE CARE ACT IS WORKING FOR NEW JERSEY

Two years ago, the Affordable Care Act was signed into law and brought with it the Patient's Bill of Rights to protect consumers from insurance industry abuses and other reforms to ensure all Americans get the health care they need. Senator Menendez supported common sense health care reforms because too many New Jerseyans struggle with insurance companies that decide who gets care, too many families find themselves one diagnosis away from bankruptcy and too many individuals put off preventive screening because they just couldn't afford it.

Today, thanks to the Affordable Care Act, insurance companies are prohibited from imposing lifetime limits on coverage, are required to cover preventive care like immunizations, mammograms, and other cancer screenings for free, and can't deny children coverage because of a preexisting condition. Seniors are receiving a 50 percent discount on their medications in the "donut hole," which will continue to close. And starting in 2014, insurance companies must guarantee health insurance for all Americans, including anyone with a pre-existing condition, and will be prohibited from imposing annual limitation on benefits.

Because of a provision Senator Menendez wrote, insurance companies can no longer demand pre-approval for emergency care or charge you more for emergency services in an out-of-network hospital. Plus, insurance plans can no longer drop coverage because of an honest mistake when filling out a form. And, insurance companies must ensure that 80 cents of every dollar are spent on delivering or improving health care, not on executive bonuses and advertising.

How the Affordable Care Act is Helping Individuals

* Children1
o In New Jersey, 49 percent of children, nearly one million, in both private plans and Medicaid/CHIP plans, are now benefiting from increased access to preventive services.
o 342,360 children in New Jersey with private insurance are now able to access to recommended preventive services at no cost. New Jersey has one of the highest proportions of children in the nation receiving these new benefits.
* Seniors2
o In 2011, 125,968 seniors in New Jersey saved an average of $756 dollars on their prescription medication. These savings total more than $95 million.
o In 2011, 985,987 seniors in New Jersey with Medicare were able to receive free preventive services -- such as mammograms and colonoscopies -- or a free annual wellness visit with their doctor.
* Young Adults
o In 2011, 68,816 young adults in New Jersey gained insurance coverage as a result of the new health care law allowing them to stay on their parents' plan until their 26th birthday.
* Families
o 1,694,000 individuals in New Jersey with private health insurance were able to receive free preventive services, such as autism screenings, behavioral assessments, developmental screenings, fluoride supplements, hearing screenings, obesity screenings, iron supplements and immunizations for children; screenings for blood pressure, cholesterol, colorectal cancer, diabetes for all adults. Additionally, for women, starting in August, 2012, services such as neonatal care, gestational diabetes screenings, breastfeeding support and contraception will be available without cost sharing.

How the Affordable Care Act is Improving Health Insurance

* Ending Arbitrary Limits on Coverage
o Insurance companies are no longer allowed to impose limits on lifetime coverage, meaning that people with a serious diagnosis like cancer will no longer have to worry about maxing out their benefits and being left to either forgo treatment or be saddled with outrageous medical bills. Already 3,274,000 residents of New Jersey, including 1,214,000 women and 877,000 children, are free from worrying about lifetime limits on coverage.
o Starting in 2014, insurance companies will also be prohibited from placing limits on annual benefits.
* Requiring Insurance Premiums go towards Health Care
o Insurance companies are now required to pay at least 80 cents of every dollar paid in premiums on health care services or improving health care quality, not unrelated expenses like advertising and executive compensation. If insurers fail to meet that requirement, they will have to provide a rebate or reduce premiums, ensuring that people get quality coverage for their money.
* Establishing Health Insurance Exchanges
o New Jersey has received $8.6 million in federal support grants to help establish a Health Insurance Exchange. Starting in 2014, these Exchanges will allow people without access to large group insurance plans, such as the self-employees and others in the individual market, to shop in a regulated and efficient marketplace for their coverage. Plans in the Exchanges will be required to provide clear and easily understandable benefits and costs, so families will be able to purchase the coverage that is best for their needs.

How the Affordable Care Act is Improving Health Care Delivery

* Supporting Community Health Centers
o There are 127 health centers in New Jersey, providing care to nearly half-a-million residents. They have received $31.4 million in grants to build, expand and improve health center sites in medically underserved areas, improve capacity and expand the services available to better meet the needs of the community.
* Supporting Prevention and Public Health
o New Jersey has received $20.6 million in grants from the law's Prevention and Public Health Fund. This funding is going towards supporting effective programs throughout the state that support public health, reduce illnesses and improve our ability to stay healthy and happy.
* Building our Health Care Workforce
o New Jersey received $9.3 million in funding to help support low income individuals receive the training they need to get high-skill jobs as health care professionals.
o The National Health Service Corps has provided $240,000 to help repay education loans for students studying to become health care professionals, in return for their work in underserved areas.

* Supporting School Based Health Clinics
o New Jersey received $1.7 million to help students gain access to care by expanding school clinics and health services.
* Supporting Children and Families with Special Health Needs
o New Jersey's Family-to-Family Health Information Center has received $191,000 to provide referral and support services to families dealing with children with special health care needs.
* Supporting Mothers and their Babies
o New Jersey has received $4.6 million in support for Maternal, Infant, and early Childhood Home Visiting Programs. These services bring health professionals to at-risk families to help educate them about health care, early education, parenting skills, nutrition and abuse prevention.

Source