Big changes for insurers.

• Author: Cauchi, Richard
• Position: HEALTH REFORM: SPECIAL REPORT

A casual observer might be excused for thinking the Affordable Care Act has more to do with reforming insurance than with health care. Indeed, during its first two years, the act's most visible features have been aimed at the commercial insurance market.

Many states are currently implementing more than a dozen major new requirements. Most of these provisions are based on long-standing practices in the states, which for decades have led efforts to regulate health insurance, affecting who and what is covered, how much it costs, and how consumers will navigate the often complicated systems.

The new pace of change has been daunting, and the effects far-reaching. One of the first changes noticed by the public occurred in July 2010 with the launch of the Pre-Existing Condition Insurance Plan for people denied insurance because of their serious health condition or chronic disease. Twenty-seven states chose to run these high-risk pools, while the others and the District of Columbia opted to have the federal government handle it.

Another high-profile provision requires insurers to offer the option for young adults through age 25 to stay on their parents' plans. Since September 2010, 2.5 million young adults have done so.

The most frequently used new benefit is Medicare preventive screenings with no co-pay, including an annual wellness exam, which about 24.2 million people took advantage of in 2011.

Other key provisions affecting insurance providers include:

* Drug coverage. After Medicare patients spend more than $2,810 a year on medications, they now receive a 50 percent discount on most of their drugs. In 2011, this saved 3.6 million people at least $2.1 billion. This shrinks the Medicare Part...