What You Might Not Know About PPACA

Here are some of the lesser known effects of the law.

Domestic violence help

Health care reform brings attention to a subject that usually doesn't get much.

As of Aug. 1, 2012, the law requires that all insurance plans cover screening and counseling for domestic abuse, a provision found under preventive services for women's health. (The other women's health benefits are more widely known and include contraceptives and routine breast and pelvic exams, pap tests and prenatal care.)

The law also will also prevent domestic violence from being considered a "pre-existing condition."

During a WedMD seminar in July, Health and Human Services Secretary Kathleen Sebelius praised the PPACA for bringing attention to "an issue that's off the radar."

"It's an unfortunate equal opportunity [issue] for victims—all races, ages, ethnic backgrounds and income levels are at one point or another victims of domestic violence. And often people feel ashamed or feel they've done something to cause the violence to occur," Sebelius said. "But this is a situation in the health insurance market. Prior to the Affordable Care Act being law, it was legal for an insurance company to deny health coverage to a domestic violence victim because she was a domestic violence victim. Because that's considered a pre-existing condition. That will no longer be legal by 2014."

For victims of domestic violence, access to health care is critical, Lynn Rosenthal, White House adviser on violence against women, wrote in a blog post.

"They need treatment for immediate injuries and ongoing care for related health problems. They need to be able to talk to their health care provider about the cause of their injuries without fear of losing their health insurance," she said. "Most importantly, they need our compassion and support."

Domestic violence causes 2 million injuries and more than 1,200 deaths every year, Rosenthal says.

Photo credit: Nutdanai Apikhomboonwaroot

Fake tanners will pay

This has really been a hot-button issue, so to speak: Since July 1, 2010, Jersey Shore-looking wannabes have to pay a 10 percent tax every time they visit an indoor tanning service.

The reason for the tax is twofold: It makes a dent in the huge price tag of reform, while discouraging indoor tanning for health reasons. Indoor tanning has been linked with skin cancers including melanoma, squamous cell carcinoma, and cancers of the eye, says the Centers for Disease Control and Prevention.

But the tax has left tanning salon goers and owners outraged. And controversy hasn't cooled down, either.

After the Supreme Court upheld PPACA back in June, the Indoor Tanning Association said, "As the thousands of business owners in this industry can attest, taxes have serious consequences for small businesses and their employees."

"These businesses have paid this unfair tax for the past two years," the association said, "and the results are in: Over 3,100 tanning businesses closed; over 35,000 jobs were destroyed. Since the tax went into effect, we estimate $145,000,000 has been taken out of the pockets of consumers and main street businesses and remitted to the federal government. "

Photo: "Tan Your Buns" owner caleb Hoag shows North Dakota State University student Miranda Fahey one of the tanning beds at his salon in Fargo, ND. (AP Photo/Dave Samson)

Smokers need not apply?

Under a provision of the law, smokers can be charged up to 50 percent more than nonsmokers for health insurance beginning in 2014. Current regulations allow companies to require workers who fail to meet specific standards to pay up to 20 percent of their insurance costs.

George Washington University law professor John Banzhaf helped persuade HHS and Congress to include the surcharges for smokers in the law. "The largest totally unnecessary expense that most corporations and employers bear—which unfortunately are largely passed along to their employees—are the unnecessary medical and other costs [of] smoking," he says.

The surcharge is an effective method of discouraging smokers. It also may result in more wellness programs aimed at reducing the number of workers who light up, Banzhaf says.

But as an alternative, some employers have decided that the best way to avoid such costs is to not hire smokers at all. Though there are laws in place in some states prohibiting that, he argues they're rarely enforced. Hiring only nonsmokers eliminates the time and money to establish a wellness program to help smokers.

Photo: Bill Longshaw

Workplace breastfeeding support

Breastfeeding advocacy groups are praising a provision in PPACA that supports women who chose to breastfeed.

The provision states that employers shall provide reasonable, unpaid break time and a private, non-bathroom location for an employee to express breast milk for her nursing child for up to one year after the child's birth. Employers with less than 50 employees are not subject to the requirement if it would cause "undue hardship."

"Mothers, babies and employers all win with breastfeeding support," says Joan Younger Meek, a doctor and chair of the United States Breastfeeding Committee.

"Research clearly demonstrates the value of breastfeeding for the health of women and children, and medical experts agree with the U.S. Department of Health and Human Services in recommending exclusive breastfeeding for six months and continued breastfeeding for the first year of life and beyond," Meek says. "But returning to work can be a major hurdle for new mothers struggling to balance working and breastfeeding without the simple support measures this law ensures."

The group argues that in addition to recognizing the health benefits of breastfeeding, the new rule also financially benefits employers.