U.S. lags behind in healthcare innovation, Sebelius says

By Jessica Zigmond 

Posted: February 27, 2014 – 3:45 pm ET

Tags: Advisory Board Co.American Recovery and Reinvestment ActCommunityHospitalsKathleen SebeliusMedicarePublic Health

http://www.modernhealthcare.com/article/20140227/NEWS/301019759/u-s-lags-behind-in-healthcare-innovation-sebelius-says?AllowView=VXQ0UnpwZTVDUGFaL1IzSkUvSHRlRU9vajAwZERlTlU=&utm_campaign=am

The federal government’s top health official Thursday gave U.S. healthcare innovation a grade of Incomplete.

“That’s really the great dichotomy of the time we’re living in,” HHS Secretary Kathleen Sebelius said. “We live in a 21st century world with a 20th century delivery system. We live in a world in which the National Cancer Institute is texting teens to convince them to quit smoking, but ask any parent how easy it is to get their kid’s immunization report from the doctor’s office.”

Although new health innovations, discoveries and technologies are allowing Americans to live longer, healthier lives, the processes of patient experience—such as how patients manage their health, how they choose a physician and how doctors work together to create a treatment plan—have not always kept pace with new medicines, vaccines and procedures, Sebelius said in addressing attendees at the Care Innovation Summit put on by the Aspen Institute and Advisory Board Co.

The answer, Sebelius suggested, is twofold: Unlock and release the information that drives innovation; and align payment for care in a way that pays for better outcomes and innovations, rather than for more operations and hospital readmissions.

And the federal government can help by unlocking some of this information. HHS has been doing that in part through the Hospital Compare website, which allows patients to compare categories such as patient experience, average wait times and whether a hospital has medical imaging capabilities, Sebelius said.

HHS for years has collected data in a wide variety of areas, such as public healthMedicare, clinical trials and spending. But often that information was either difficult or even impossible to access, either because it was hidden behind walls that would require huge sums of money to access, or because the data were published in formats that were indecipherable, she acknowledged. In other words, Sebelius said, it was “lazy” data that had potentially valuable information.

Now, HHS is working to make that “active” data. Just recently, the department had its 1,000th data set released on HealthData.gov. In the past, Sebelius said, that information would have been available only to scientists and researchers who were willing to pay for it.

“What we’re finding is if we make data open and accessible, the private and nonprofit sectors use it to start innovating,” she said.

Sebelius shared a few success stories of healthcare providers who have seen significant changes through the use of electronic health records, including one physician in the small town of Plainville, Kan., who transferred her patient records to EHRs. After she did, she was surprised to learn that only 43% of patients in her practice over the age of 50 for whom colon cancer screenings were recommended were actually getting tested. The physician created a system in which she was notified if a patient didn’t follow through. In a year and a half, that number rose to 89%, and she is working toward 100%.

“Nationally there has been tremendous progress in the last five years from quills and clipboards to computers and keyboards,” Sebelius said. “When President Obama took office in 2009, 1 in 8 hospitals were using any kind of basic electronic record. By 2012, that number had tripled,” she said, adding that the number of doctors using EHRs is now more than 50% and on the rise.

These changes are due in large part to incentives included in the American Recovery and Reinvestment Act, she said, and emphasized that with those incentives also came the national protocols to become a meaningful user.

Looking ahead, Sebelius challenged members of the health reform community to agree that from now on, “We’ll look at innovation that is something that is happening for us and with us and by us,” she said, “rather than something happening to us.”

Follow Jessica Zigmond on Twitter: @MHjzigmond

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Obesity rates for some children nearly halved since 2003, CDC study shows

By Steven Ross Johnson 

http://www.modernhealthcare.com/article/20140225/blog/302259992?AllowView=VXQ0UnpwZTVDUGFiL1RIZ0s4WHRlRU9yalVrZEErOWY=

A glimmer of hope in the fight against childhood obesityemerged Tuesday with the release of a new government study.

The obesity rate for children between ages 2 and 5 fell to 8% in 2012 from 14% in 2003, according to the study from theCenters for Disease Control and Prevention.

Despite the improvement within that specific age group, the study, published online Tuesday in the Journal of the American Medical Association, found no significant change in the rate of obesity among American adults and youth overall. Approximately 35% of adults ages 20 and over were obese in 2012 with a body mass index at or above 30, which represented a 3 percentage point increase from the obesity rate in 2003 when it was at 32%, but a 1 percentage point decrease from the rate in 2009. A similar trend was found among young people between the ages of 2 and 19 years old, where 16.9% were found to be obese in 2012; a figure that has remained relatively unchanged compared with the rate in 2003.

“Although overall we didn’t see any signs of significant change of obesity in youth and adults, there was some good news in that we saw a decrease within young children,” said study author Cynthia Ogden, an epidemiologist at the CDC’s National Center for Health Statistics. “This is the first time since we’ve been tracking obesity that we’ve seen a decrease in any (age) group, so I think there’s a small glimmer of hope there, but we still have a long way to go.”

The study did not provide a reason for the decline. The cause was most likely the result of a comprehensive set of efforts geared toward reducing the obesity rate among young children, according to Dr. Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation.

“I think these comprehensive approaches that provide healthier environments where kids live and learn are the ones that seem to be most promising,” Lavizzo-Mourey said.

Increases in the promotion of healthier eating and more physical activity also have played a role, Lavizzo-Mourey noted.

“We continue to see signs that, for some children in this country, the scales are tipping,” said CDC Director Dr. Tom Frieden in a written statement. “This confirms that, at least for kids, we can turn the tide and begin to reverse the obesity epidemic.”

Today’s figures come on the heels of a CDC study released last year that found that from 2008 to 2011, the obesity rate decreased slightly among low-income children between the ages of 2 and 4 years old in 19 states.

The findings drew praise from first lady Michelle Obama, who on Tuesday announced the Obama administration would propose new guidelines for school wellness policies that include prohibiting promotion of unhealthy food and beverages at public schools, and require parents and community member to get involved in those policies. Childhood obesity has been Mrs. Obama’s signature issue for the past several years. She began developing her “Let’s Move!” campaign in 2010.

“I am thrilled at the progress we’ve made over the last few years in obesity rates among our youngest Americans,” Mrs. Obama said in a written statement. “With the participation of kids, parents and communities in ‘Let’s Move!’ these last four years, healthier habits are beginning to become the new norm.”

Follow Steven Ross Johnson on Twitter: @MHSjohnson

 

How The Affordable Care Act Pays For Insurance Subsidies

November 07, 2013 2:57 AM

The new health care law will provide around $1 trillion in subsidies to low- and middle-income Americans over the next decade to help them pay for health insurance.

Johanna Humbert of Galien, Mich., was pleasantly surprised to discover that she qualifies for an insurance subsidy, since her current plan is being canceled. Humbert makes about $30,000 a year, so she’ll get a subsidy of about $300 a month. The new plan is similar to her current one, but it will cost $250 — about half of what she pays now.

But where will the money come from to pay for subsidies like these?

On his show last Friday, liberal comedian Bill Maher called the Affordable Care Act a “Robin Hood” plan. “It does take from the rich to make better the poor,” he said.

You can certainly make a case for that, says economist Joseph Antos of the American Enterprise Institute. “In a general sense, the rich, of course, subsidize the poor. The rich pay more income taxes,” he says. “So, yes, absolutely, that’s how subsidies are supposed to work.”

So if you’re a low-income person getting a tax credit from the U.S. Treasury to subsidize your health care, a big chunk of that credit is coming from taxes paid by the well-off.

The Cost Of Subsidies

But the authors of the Affordable Care Act didn’t want the subsidies to become a drain on the Treasury and add to the deficits. So they included provisions designed to offset the cost of the subsidies.

MIT economist Jonathan Gruber, who helped develop the law, says about half the costs are offset by projected savings in Medicare payments to insurers and hospitals. Another quarter is offset by added taxes on medical-device makers and drug companies.

“The other source of revenue is a tax increase on the wealthiest Americans,” he says. “Those families with incomes above $250,000 a year will now have to pay more in Medicare payroll taxes.”

Those provisions actually make the bill a net positive for the federal budget, according to the nonpartisan Congressional Budget Office. By the CBO’s accounting, Obamacare will produce a surplus. Gruber says the law will “actually lower the deficit by about $100 billion over the next decade and by $1 trillion in the decade after.”

However, many Republicans have expressed skepticism about those findings.

New Policy, New Marketplace

The subsidies do mean some low-income people will pay almost nothing for insurance, while higher-income people will pay the full market price.

Dentist Aaron McLemore of Louisville, Ky., makes more than $100,000 a year, and doesn’t qualify for any subsidy on the Obamacare exchange. The 31-year-old’s current policy is being canceled. A new policy from the exchange will more than double his monthly premium and boost his annual deductible to $7,000.

His higher costs aren’t subsidizing lower-income policy holders, whose subsidy has already been paid by the government. But he is providing a subsidy in another way: The Affordable Care Act requires him to buy a policy with features he doesn’t need.

“Seeing as I’m a single male with no kids or dependents, and I’m paying for pediatric dental care and maternity care, it doesn’t make a whole lot of sense to me,” McLemore says.

What Obamacare is doing is moving McLemore out of the individual market — where people are sorted by age and health history and scope of coverage — to a market more like the traditional, employer-based group policy, in which young and old workers get the same coverage and pay the same premium.

Gruber, the MIT economist, says that model reflects the basic idea of insurance.

“The notion of insurance is we’re protected against risk,” he says. “What that means is that [during] a period of time when we’re healthy, we pay more in premiums than we collect in benefits. In those periods of time we’re sick — and we all go through them — we collect more in benefits than we pay in premiums.”

Young, healthy people subsidize older people, who are more likely to be sick. Of course, most of those younger folks will eventually become old folks and experience the same benefit.

UPDATE 1-Two U.S. hospital chains dismiss Obamacare technical woes

Source Link:  http://www.reuters.com/article/2013/11/05/hospitals-reform-idUSL2N0IQ1JN20131105

Tue Nov 5, 2013 2:49pm EST

By Susan Kelly

Nov 5 (Reuters) – Two U.S. hospital operators said on Tuesday technology problems bedeviling the federal government’s online health insurance marketplace were gradually diminishing and will not stop them from pushing ahead with plans to provide care to those who sign up.

“If any company had three years’ notice about having a website functioning for a major product launch on October 1, it would have worked. It’s frustrating that it did not work,” hospital operator Tenet Healthcare Corp’s Chief Executive Trevor Fetter said in an interview with Reuters following the company’s third-quarter earnings conference call.

While the glitches that have prevented many potential health plan enrollees from signing up are disappointing, “we’re not terribly concerned about it,” Fetter said.

That is because those uninsured patients will not be able to access the new plans until January anyway, so there is still plenty of time to sign up, he said.

Fetter said problems with online access to the federal insurance exchange have been lessening, and patients can also enroll through call centers, where waiting times have been coming down. State exchanges such as the one set up in California are working much better and are offering a selection of affordable plans, he added.

“This is a really important innovation,” Fetter said. “I wouldn’t judge it by the initial performance of the federal website.”

HCA Holdings Inc Chief Executive Richard Bracken said issues with the federal website have not deterred the company from its own plans to contract with insurers to provide care to new patients.

Ninety-seven percent of HCA’s U.S. hospitals have an exchange contract with access to a bronze level insurance plan, he said. Such plans have the lowest premiums.

“We are well-positioned to participate and provide healthcare services,” Bracken said on the company’s earnings conference call.

Tenet said it has contracts with about three-quarters of all the exchange plans that are offered in its markets.

EAGER FOR PATIENTS

Hospital companies have a lot riding on the success of the insurance exchanges. Hospitals are struggling with declining admissions as many Americans have stayed away from the doctor due to lack of insurance or high deductible on their plans.

The companies expect patient admissions to grow and bad debts to decline as more patients gain insurance to pay for their care.

Tenet shares fell about 9 percent on Tuesday, to $43.96, after it provided a disappointing outlook for the fourth quarter when it released its third-quarter results on Monday.

HCA, the largest publicly owned U.S. hospital operator, was one of the only hospital chains to report a modest increase of less than 1 percent in admissions to its facilities in the third quarter. Its shares fell 2.5 percent Tuesday to $46.53.

Jefferies & Co analyst Brian Tanquilut said he believes hospitals in 2014 will benefit primarily from more people being eligible for the Medicaid health insurance program that serves the poor.

“The health reform story is intact, but near term, the volume headwinds, which have been hampering hospitals for five years, continue to persist,” he said.

 

IRS website offers information about Affordable Care Act

Posted: Monday, August 19, 2013 7:07 pm

Richard Craver/Winston-Salem Journal

The Internal Revenue Service has create a website – www.irs.gov/aca — aimed at providing information about how the implementation of the federal Affordable Care Act will affect individuals, families and businesses from a tax provision perspective.

The home page has three sections, which explain the tax benefits and responsibilities for individuals and families, employers and other organizations, with links and information for each group. The site provides information about tax provisions that are in effect now and those that will go into effect in 2014 and beyond.

Topics include premium tax credits for individuals, new benefits and responsibilities for employers, and tax provisions for insurers, tax-exempt organizations and certain other business types.

AFLAC Incorporated : Aflac Launches Enhanced Health Care Reform Website for Employers

08/16/2013 | 10:25am US/Eastern

COLUMBUS, Ga., Aug. 16, 2013 /PRNewswire/ — Health care reform is a puzzle to many U.S. employers and their employees. To help them better understand how to assemble the pieces, Aflac, the No. 1 provider of voluntary and guaranteed renewable insurance in the U.S.(1), has enhanced its health care reform website with materials that explain the legislation in clear, easy-to-understand language.

“Business leaders are confused about health care reform and for good reason – it is complex and as the law is implemented, it can be increasingly difficult for them to understand their options and the specific actions they need to take,” said Michael Zuna, Aflac executive vice president and chief marketing officer. “By using the tools on our site and speaking to our nationwide network of agents, employers can not only stay up to date and understand key decision points, but also obtain information that will help them make the best benefits decisions for their organizations and employees.”

Site visitors will find a variety of tools and resources designed to help employers understand health care reform and how the law affects both businesses and workers. Materials include:

    --  Health Care Reform Communications Toolkit: Provides employers with the
        resources they need to meet the October 1 deadline for informing
        employees about the Health Insurance Marketplace.The kit features:
        --  A PowerPoint presentation with a high-level reform overview of the
            ACA.
        --  Two sets of email and letter templates - one for employers who will
            offer health insurance and one for those who won't.
        --  FAQs that address changes to employee benefits plans.
        --  Videos highlighting Health Insurance Marketplace basics and levels
            of coverage.
    --  Employer's Guide: Explains health care reform and its effect on U.S.
        businesses.
    --  HCR Essentials: A quick guide to HCR information for employers.
    --  Consumer-Driven Health Care Insights: Features tips for helping
        employees understand reform.

Answering Questions, Outlining Solutions

Aflac put additional efforts into developing even more robust health care reform materials after the 2013 Aflac WorkForces Report revealed that employers and workers are having continued trouble understanding the legislation.(2)

Fully 55 percent of employees who took part in the Aflac WorkForces Report said they’d done nothing to prepare for reform-driven changes to their benefits plans, and 76 percent agreed health care reform is too complicated to understand. Employers find reform puzzling too: Just 27 percent said they understand the legislation very or extremely well.

“Aflac is dedicated to helping employers and employees comprehend the changing benefits and health insurance landscape by providing regular updates and new tools throughout the implementation of the ACA,” Zuna said. “Employers can look to Aflac as a partner in demystifying the law, helping educate employees on the resulting changes and providing much-needed voluntary benefits that can help offset rising health care costs.”

Employers who want straight forward and easy-to-understand advice about health care reform should visit aflac.com/healthcare_reform.

About Aflac
When a policyholder gets sick or hurt, Aflac pays cash benefits fast. For nearly six decades, Aflac insurance policies have given policyholders the opportunity to focus on recovery, not financial stress. In the United States, Aflac is the number one provider of guaranteed-renewable insurance. In Japan, Aflac is the number one life insurance company in terms of individual policies in force. Aflac individual and group insurance products provide protection to more than 50 million people worldwide. For seven consecutive years, Aflac has been recognized by Ethisphere magazine as one of the World’s Most Ethical Companies. In 2013, FORTUNE magazine recognized Aflac as one of the 100 Best Companies to Work for in America for the 15th consecutive year. Also, in 2013, FORTUNE magazine included Aflac on its list of Most Admired Companies for the 12th time, ranking the company number one in the life and health insurance category. Aflac Incorporated is a Fortune 500 company listed on the New York Stock Exchange under the symbol AFL. To find out more about Aflac, visit aflac.com or espanol.aflac.com.

This material is intended to provide general information about an evolving topic and does not constitute legal, tax or accounting advice regarding any specific situation. Aflac cannot anticipate all the facts that a particular employer or individual will have to consider in their benefits decision-making process. We strongly encourage readers to discuss their HCR situations with their advisors to determine the actions they need to take or to visit healthcare.gov (which may also be contacted at 1-800-318-2596) for additional information.

(1 )The NU 200 Industry Leaders,” National Underwriter, September 19, 2011
(2) The 2013 Aflac WorkForces Report was conducted by Research Now on behalf of Aflac,http://www.aflac.com/aflac_workforces_report/2013/executive_summmary.aspx – accessed July 19, 2013

Source Link:  http://www.4-traders.com/AFLAC-INCORPORATED-11556/news/AFLAC-Incorporated-Aflac-Launches-Enhanced-Health-Care-Reform-Website-for-Employers-17196067/

 

How the health reform law will affect senior care

By KATRINA CAMERON-Staff Writer

POSTED:   08/17/2013 12:19:05 AM PDT

The Affordable Care Act won’t hurt health care for the baby boomer population, and it will strengthen Medicare, the national insurance program for people age 65 and older.Every day across the nation, 10,000 people are turning 65, said Myron Machula, vice president and CFO of Enloe Medical Center. The total number of people age 65 or older in Butte, Glenn and Tehama counties is 55,000.

“That’s a fair amount of the population,” Machula said. “They count on this Medicare program for the health care that they receive.”

“There has been a misconception that the Affordable Care Act is going to take away benefits from people with Medicare, and it isn’t going to,” said Tatiana Fassieux, program manager at Passages.

Instead of cutting basic Medicare benefits, it improves them, she said.

According to the National Council on Aging, prescription drug costs will lessen because the coverage gap — better known as the “donut hole” — for those with Part D plans will be slowly phased out by 2020.

“Ideally, what’s going to happen is on a general basis nationally people won’t have to spend more than 25 percent for their prescriptions, so that was one aspect of the Affordable Care Act,” Fassieux said.

Medicare beneficiaries will also benefit from more preventative care, such as cancer and diabetes screening, according to the National Council on Aging. A free annual wellness visit allows the beneficiary and doctor to develop a prevention plan to keep the patient healthy. Patients can also get free vaccines.

“Preventative care is what saves money,” Fassieux said.

The law also helps ensure Medicare patients return home successfully from hospital stays, according to the National Council on Aging.

Eighty percent of older American have a least one chronic medical condition such as high blood pressure, heart disease or diabetes.

About 65 percent of Enloe Medical Center’s in-patient care is Medicare beneficiaries, Machula said. About 40 percent of outpatients are on Medicare.

The law also makes it easier to receive and pay for long-term care at home, according to the National Council on Aging. Medicare doesn’t currently cover long-term care, but starting in 2014 the law will increase protection for spouses of individuals who receive Medicaid home care services.

Another benefit is the law allows the Department of Justice to go after individuals or hospitals that have committed Medicare fraud, Fassieux said.

Medicare began paying bonuses of 10 percent to primary care doctors to improve access, according to the National Council on Aging.

The difficulty of getting into a primary physician’s office has already been an issue, but the rising number of people who will soon have insurance through the Affordable Care Act may make it more problematic.

“Why is that occurring?” Machula said. “Well, because again the volume of physicians is shy of what the need is, so the idea is to take the mid-level practitioners to help with what will be this increase for those who need care because they have the card.”

A question still unanswered is what an individual is to do if he or she bought an exchange insurance plan and then becomes eligible for Medicare. Fassieux said it’s unknown if someone can have both Medicare and the exchange plan.

Although there are still many unanswered questions regarding the Affordable Care Act, it appears that it will benefit older Americans.

Source Link: http://www.chicoer.com/health/ci_23882967/how-health-reform-law-will-affect-senior-care

Expert: Exchanges Could Boost Quality Reporting, Delivery Reform

Tuesday, August 13, 2013

Health insurance exchanges under the Affordable Care Act could be a mechanism for delivery reform and quality reporting, an insurance exchange expert said at an Alliance for Health Reform briefing on Friday, MedPage Today reports (Pittman, MedPage Today, 8/12).

Background

Under the ACA, states by January 2014 must create online health insurance exchanges to provide coverage options for individuals and small businesses.

Most insurance exchanges will rely on a solid IT foundation to connect with advanced eligibility systems for Medicaid and other state-administered health programs (iHealthBeat, 6/27).

Details of Comments

Sarah Dash of Georgetown University’s Center on Health Insurance Reform said that insurance exchanges will be required to report quality measures on participating plans beginning in 2016 but that some marketplaces could ask insurers to record more data on specific items.

After the briefing, Dash said that states “might want to come up with new quality metrics that they think are important.”

According to Dash, several states will require plans sold through the exchange to report quality measures in the first year to provide consumers with more information when selecting coverage.

Dash said, “Whether consumers are going to be actively following that … I think that remains to be seen” (MedPage Today, 8/12).

Source Link: http://www.ihealthbeat.org/articles/2013/8/13/expert-exchanges-could-boost-quality-reporting-delivery-reform

Language barriers could deter minorities from benefiting from healthcare reform

  • JESSICA KWONG/THE S.F. EXAMINER
  • At a panel discussion, state Assemblyman Phil Ting, D-San Francisco, promoted Assembly Bill 1263.

With California at the forefront of the most comprehensive nationwide health care reform effort in half a century, it isn’t affordability but language barriers that providers and legislators fear will prevent minorities from taking advantage of greater access to coverage.

The Affordable Care Act, which begins open enrollment in October and becomes effective Jan. 1, will make health insurance more accessible and affordable to millions of Americans who now lack insurance. But in California, where nearly 16 million people, or 43 percent, speak a language other than English — it’s 45 percent in San Francisco — implementing the act presents a challenge.

At a panel discussion about this topic Wednesday, state Assemblyman Phil Ting, D-San Francisco, promoted Assembly Bill 1263, under which California would invest $200,000 to gain $270 million in federal funds authorized by the act to fund interpreter services for state Medicaid enrollees.

Interpreters are very often “our lifeline,” Ting said, noting that many immigrant families are accustomed to having their children translate when they receive medical treatment.

The U.S. Department of Health and Human Services does not recommend using children as interpreters, especially because they often lack medical vocabulary, said panelist Annis Arthur, deputy regional manager for the department’s Office for Civil Rights.

Legislation like AB 1263 would help break down language as the barrier to health care access, Ting said.

“We can’t expect our children to be there,” Ting said. “What kind of system will they be able to access? I don’t want to hyperbolize, but in these situations it’s a case of life or death.”

Members of the Asian and Latino community helped put a human face on this issue at Wednesday’s panel.

San Francisco resident Juan Situ shared how she waited hours for an interpreter to help her fill out forms for her sister’s hospitalization, only for the situation to get no better after her procedure.

“After the surgery, the interpreter was gone and we wanted to ask the doctor why my sister was in so much pain,” Situ said in Cantonese. “Finally, the doctor came to us but there was no interpreter, so we could not communicate.”

Although California and the U.S. have great language access laws, lapses exist, said forum panelist Cary Sanders, director of policy analysis at the California Pan-Ethnic Health Network.

“Part of it is they are not aware they have the right to request language access,” she said. “That is a huge issue. We heard a couple stories today but think of all the stories we are not hearing. The system fails and we don’t know about it.”

Obamacare Presents Complex Choices For People With Disabilities

Source Link:  http://www.webmd.com/health-insurance/20130809/obamacare-presents-complex-choices-for-people-with-disabilities?src=RSS_PUBLIC

WebMD News from Kaiser Health News

By Eric Whitney, CPR
The Affordable Care Act has set new standards — called essential health benefits — outlining what health insurance companies must now cover. But there’s a catch: Insurance firms can still pick and choose to some degree which specific therapies they’ll cover within some categories of benefit. And the way insurers interpret the rules could turn out to be a big deal for people with disabilities who need ongoing therapy to improve their day-to-day lives.

Bryce Vernon is a 20-year-old film student who lives in Los Angeles and has cerebral palsy. He speaks only with the aid of a special computer mounted to his wheelchair that tracks his eye movements. Using his eyes, Vernon can indicate on a screen what letters and words he wants the computer’s voice to say.

It’s amazing technology, and Vernon gets a lot more out of it with help from speech-language pathologist Jill Tullman.

“Now Bryce, I’m want to show you this super cool random button I think you’re going to love,” Tullman tells him during a therapy session at a special camp for young people who use the technology. Vernon’s parents paid out-of-pocket for him to attend the camp.

Tullman helps him pre-load several different ways of saying goodbye.

“Bye, later dude, later, bye, I’m out of here, see ya later,” Vernon says, testing it out.

In the parlance of health policy, the work Tullman is doing with Vernon is called “habilitative services.” It’s different from the more familiar sort of rehab people often get after an injury or surgery. Habilitative services are for people who can benefit from one-on-one time with a therapist to improve daily living skills. But such services can be expensive, and not all insurance plans have covered them.

The Affordable Care Act is changing that, says health economist Lisa Clemans-Cope with the Urban Institute.

“You’re much more likely to find these benefits in a plan in the individual market [starting in 2014] than you would be today. Far more likely,” says Clemans-Cope.

This is because “habilitative services” are included within the 10 categories of essential health benefits the ACA will require in those new plans. Still, while some categories are straightforward — such as maternity care and preventive care — the category including habilitative services leaves more room for interpretation.

For instance, insurers could choose to cover physical therapy for someone with a broken bone, but not cover long-term support services for chronic conditions, such as speech therapy for kids with developmental delays.

Clemans-Cope says some insurers may arrange their benefits in a way that discourages people with expensive chronic conditions from signing up with them. And, she says, people who want to have specific therapies covered are going have to slog through some fine print to figure out if they’ll actually benefit from a particular policy. (The new policies will start to go on sale this fall and go into effect beginning Jan. 1, 2014.)

“This is a big improvement, but we should emphasize that it’s not totally fixed,” Clemans-Cope says. “And people are really going to have to get help to decide which plans cover the benefits they need. ”

Whether a person will be able to get the new therapy benefits also depends on where they live. The level of benefits insurers have to provide in each category is based on a model policy in each state, and some of those model policies are a lot more generous than others.

Jill Tappert, an activist in Colorado for people with disabilities, says a lot of details still need to be sorted out before she’ll be able to say whether the health care law has improved things much.

“I certainly hope the way the Affordable Care Act is implemented is a game changer for people in the disabilities community. It can be,” says Tappert, who spent years fighting for habilitative service coverage for her daughter who has autism. “The opportunity is there for policy makers to vastly improve lives.”

Barbara Vernon, Bryce’s mother, says Bryce is now covered by Medi-Cal, California’s Medicaid program. His primary insurance had been her employer-sponsored plan until she was laid off in 2009. She searched for private coverage for Bryce, but says, “Private was so unbelievably expensive, it was unaffordable.”

Barbara says her family’s insurance is “a patchwork,” with Bryce likely to stay on Medi-Cal even after his 21st birthday. She and her other son have an individual plan they have purchased, and her husband has an employer-sponsored plan — but it covers only the employee, not the family.

For his part, Bryce Vernon says his life is a lot better since getting the kind of help that many others may be able to get from the health law, starting in 2014. He works hard to get the most out of the technology and the therapy that lets him speak. His advice to others: “Never, ever give up.”

The new rules for what health insurance companies have to cover may still change. Federal regulators plan to review them as the health law rolls out and could make changes in 2016.

This piece is part of a reporting partnership among NPR, Colorado Public Radio and Kaiser Health News.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communications organization not affiliated with Kaiser Permanente.