Although major provisions of the Patient Safety and Affordable Care Act will not be in effect until 2014, health policy analysts said the law has already improved the nation's health care system and the number of people covered by insurance.

Locally, the Family Health Center of Boone County has received two ACA-related grants aimed at increasing health care access for low-income residents.

Some 55,000 young adults in Missouri and an estimated 3.1 million nationally have been able to join or stay on a parent's health plan. And roughly 351,000 families will share $60.7 million in insurance premium rebates in August -- an average of $173 per family -- as a result of the law.

Among such changes already in place:

* Family Health Center received a $2.6 million grant in May for the renovation and construction of a health and dental clinic in Marceline through an emphasis on boosting access to health care in rural areas.

* This week, another round of community health grants awarded a combined $1.9 million to three facilities, including one in Jefferson City.

* Nationally, nearly 50,000 previously uninsured people with pre- existing conditions now have health coverage.

* Last week the Department of Health and Human Services awarded a $13.3 million award to the University of Missouri Health System to fund a program that will use advanced health information technology to improve and decrease the cost of care for Medicare patients.

* The Centers for Medicare and Medicaid Services has announced that the health care reform law helped 307,360 people in Missouri with Medicare receive at least one free preventive service during the first five months of 2012.

But some future benefits and the implementation of other aspects of the law could be halted, depending on a pending Supreme Court decision. The court heard three days of arguments in March on constitutional challenges to the health care reform law President Barack Obama signed in March 2010. The high court could hand down a ruling on the law as early as Monday. Most analysts expect the decision to come before the end of next week.

"There are going to be some pretty immediate consequences based on what happens," said Ryan Barker, health policy director for the Missouri Foundation for Health.

For instance, if the entire law is tossed out, the provisions that phase out the so-called "doughnut hole" in Medicare prescription coverage where people must pay 100 percent of their drug costs -- a threshold that some 8 million seniors hit every year -- would be reversed.

"Seniors on Medicare may all of a sudden see that doughnut hole kick back in," Barker said.

Perhaps the most visible aspect of the law that is connected to people's checkbooks is the ACA's requirement that preventive services and screenings be provided to Medicare patients without charging a co-pay. That requirement, which extends to private insurers in 2014 and excludes paying a deductible for those services, already has been implemented by many private insurers.

"That could come back," Barker said. "All of the sudden we would have co-pays again when we go to the doctor."

Some of the nation's largest insurers have vowed to keep the extended dependent coverage through age 26 and free preventive care, but without the ACA, there wouldn't be a law requiring that action. The law also requires that in 2014, insurance companies can't deny coverage to adults based on pre-existing conditions. That provision already applies to children.

"I don't think we'll see the insurance companies keeping the no pre-existing conditions provisions" without the ACA, Barker said.

Reach Jodie Jackson Jr. at 573-815-1713 or e-mail jjackson@columbiatribune.com.

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This article was published on page A10 of the Friday, June 22, 2012 edition of The Columbia Daily Tribune. Click here to Subscribe.