10 lesser known effects of health care reform law

By Madison Park and Elizabeth Landau

(CNN) — On Monday, the U.S. Supreme Court takes on a political, social, economic and medical hot potato: the health care reform law that was signed into law two years ago.

For six hours during each of the next three days, attorneys will argue and justices will consider legal questions about the constitutionality of the Affordable Care Act’s individual mandate and issues surrounding federal versus state powers.

Many of the law’s major aspects have been the topic of much discussion. But are you aware that deep within the sweeping law’s 2,700 pages are many lesser known changes that could affect your life in unexpected ways?

Here are 10 examples:

1. How many goodies your doctors get

Is your doctor prescribing you certain drugs because those are the best for your condition or because of a pharmaceutical company’s influence? Here’s one way you can find out.

The Physician Payment Sunshine Act under health care reform requires drug, device or medical supply companies to report annually certain payments or things of value that they’ve given physicians and teaching hospitals. This could be speaking fees, consulting fees, meals and travel. So, you can find out which and how much companies pay doctors or health care workers. The companies are obligated to report annually about physician ownership and their financial investments.

All this would be available on a public website.

Effective date: Final rule is expected December 2014.

2. More breastfeeding rooms and breaks

Many working mothers now get a more appropriate place for expressing breast milk than they had before. Employers must provide “a place, other than a bathroom, that is shielded from view and free from intrusion from co-workers and the public, which may be used by an employee to express breast milk.”

Nursing mothers also can take “reasonable” breaks during the workday to express milk, as frequently as the mother needs. The exception is companies with fewer than 50 employees, which can claim it’s an undue hardship.

Effective date: March 23, 2010.

3. Caloric reality at every major chain restaurants

Under the law, you would walk into a place like McDonald’s and see calories listed under every menu item — Big Mac (540 calories), McNuggets (10 pieces- 470 calories) and medium fries (380 calories).

The law requires restaurants with 20 or more locations to list calorie content information for standard menu items on menus and drive-through menus. Other fun facts like fat, saturated fat, cholesterol, sodium, total carbohydrates, sugars, fiber and total protein would have to be made available in writing upon request.

So far, there is mixed evidence about whether calorie postings sway nutritional choices.

The rule also extends to vending machine operators who own or operate 20 or more vending machines. The FDA issued a report in April 2011, and left out movie theaters among those establishments required to post calories. So, if implemented, you can tell how many calories your sandwich has at Subway, but you won’t be able to tell how many calories your buckets of popcorn have at the movie theater.

Effective date: The FDA has not yet issued a final rule, so there is no time line on its implementation.

4. Abstinence-only education

The health care legislation renews $50 million per year for five years for abstinence-only education. According to the Department of Health and Human Services, “programs that receive this funding must teach that abstinence from sexual activity is the only certain way to avoid out-of-wedlock pregnancy, sexually transmitted diseases, and other associated health problems.” And they also have to teach that sex before marriage is “likely to have harmful psychological and physical effects.” For every four federal dollars a state receives, it must match $3 (75% of the federal money, in other words).

5. Flexible spending accounts stiffen

Flexible spending accounts previously could be used to buy over-the-counter drugs and vitamins. As of 2011, the accounts became restricted to prescription drugs, although in some cases a doctor can “prescribe” over-the-counter medicines to make them count. Health care related purchases that still qualify include condoms, contact lens solution, home diagnostic tests and bandages.

But note that in 2013, your contribution amount to these accounts will have an annual limit of $2,500; previously there was no limit.

Effective date: January 1, 2011, for the medication provision; January 1, 2013, for the contribution limit.

6. Tanning will cost you

You’ve been paying a 10% tax every time you’ve visited the tanning booth, thanks to health care reform.

The UV-emitting tanning devices have been classified as “carcinogenic to humans” by the International Agency for Research on Cancer, which is part of the World Health Organization. Indoor tanning has also been banned for minors in California because of the potential for skin cancer.

Effective date: July 1, 2010.

7. Support for wellness programs at work

Face it, staying healthy in a stressful workplace with the tempting soda machine in the break room can be tough. But the health care reform law gives companies incentives to start wellness initiatives.

Small business got incentives in 2011, when companies with fewer than 100 employees working at least 25 hours per week became eligible for wellness program grants. The law sets up a $200 million grant program from 2011 to 2015.

As of 2014, participants in wellness programs generally can get discounts or rewards from their employers of up to 30% of the cost of their health care premiums (currently, the maximum discount is 20%). That reward can go up to 50% if the secretaries of Labor, Health and Human Services and the Treasury deem it appropriate.

Effective date: January 1, 2011, for the small business and January 1, 2014, for the potential discount raise.

8. Free preventive care

Mammograms, physical exams, colonoscopies, vaccinations — these are among the preventive care services that will be fully covered by insurance companies.

This requirement kicked in for new health insurance plans that began on or after September 2010. Examples of preventive care include screenings for cholesterol, diabetes, HIV and sexually transmitted diseases, which are covered without a co-pay.

For women, this would also cover genetic counseling for the BRCA gene for women at higher risk of breast cancer, mammograms every one or two years for women over age 40 and HPV DNA testing every three years for women. For kids, the services include autism, vision, developmental and lead screenings. The complete list is available here.

Effective date: All health insurance plans must comply by 2018.

9. Home visits to expecting families

The law also includes funding support for early childhood home visitation for people expecting children and families who have young children. Professionals come to the home to provide information and support. The aim is to reduce child abuse and neglect, promote the health of mothers and their children and prioritize high-risk populations. Research supports such positive outcomes. The health care law provides $1.5 billion for related state-based initiatives over five years.

Effective date: Began in 2010 with $100 million for fiscal year.

10. Health plans you can read

Have you ever been confused by the language in health insurance plans?

The health reform law requires health insurers and health plans to provide concise and understandable information about the plan and its benefits. According to the Health and Human Services press release, “The new rules will also make it easier for people and employers to directly compare one plan to another.”

Patients have a right to two key documents to understand and compare their health insurance choices: a comprehensible summary of benefits (which is standardized similar to nutrition facts on packaged foods) and a glossary of terms of health insurance coverage.

Effective date: September 23, 2012.

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