A primer on the new health care environment
Sunday evening I switched the TV to CNN and watched a few minutes of procedural discussions from the U.S. House of Representatives on the most recent health care reform bill. It was obvious this would take some time.
Monday morning I fired up the computer and noted that the bill had passed along with a companion measure amending it. The Senate has promised modifications from its previous measure to meet House concerns.
The House bill, previously passed through the Senate, now known as the Patient Protection and Affordable Care Act, HR 3590, goes today to President Obama’s desk for signature along with HR 4872, the Reconciliation Act of 2010. The president has promised to issue an Executive Order to address right-to-life concerns regarding federal funding for abortion.
With this series of events, the most sweeping changes in health care since Medicare are slated to become law.
It is almost certain that if Scott Brown, the new Senator from Massachusetts elected to Ted Kennedy’s seat, had not been elected, the bill would not have taken such a circuitous path.
Still it passed.
For the past several months we have been inundated through the mail, television commercials, e-mails, recorded telephone messages and virtually every print media with arguments contrary to and favoring health care reform. Now that the dust has settled, we can preliminarily note winners, losers, the provisions that passed and those that line the cutting-room floor.
Immediate measures — pre-existing conditions, adding adult children to parents’ health coverage. For those who expect immediate change, there will be time to adjust and the early changes are likely to be well received. Within six months of passage, health plans will be prohibited from excluding children with pre-existing conditions. This prohibition will be extended to adults. Also within six months, parents will be able to add non-dependent children up to age 26 to their existing insurance plans. This covers the situation of college students and young adults who are unable to obtain health insurance on their own or through employers.
Elimination of the “doughnut hole.” Seniors affected by the “doughnut hole” in prescription drug coverage under Medicare “D” who pay for drug spending between $2,830 and $6,440 will first receive a $250 rebate for 2010. In 2011, the doughnut hole will begin to be reduced through discounts on brand-name drugs. By 2020 the doughnut hole would be eliminated although seniors would still pay 25 percent of their prescription drug costs.
Employer provided health care coverage. Those employees who are already covered under employer-based health insurance will have no change in their coverage under the law.
The uninsured. By 2014, almost every citizen would be required to get health insurance or pay a fine. The fine would be phased in gradually to a maximum of $695 for an individual and would likely be less than the cost of buying insurance so there is still concern that young healthy individuals might not buy in.
Cost of insurance. To deal with the concern that individuals and families will have difficulty in paying for insurance, states will create purchasing pools known as “exchanges” to provide a marketplace for private insurers to offer a wider range of plans for small businesses and individuals who do not have insurance. This is consistent with the idea that if there were greater competition, the costs would be kept lower.
For families that need assistance in buying insurance, there would be subsidies and tax credits. For the poorest uninsured, Medicaid would be expanded to cover people with incomes up to 133 percent of the poverty level ($29,327 for a family of four). For the first time, working childless adults who do not meet the extreme disability and low income requirements of SSI could receive Medicaid.
High-cost “Cadillac” insurance plans. A tax on high-cost group plans that cost $10,200 or more for an individual and $25,500 for a family is slated to begin in 2018 and is not anticipated to be a big revenue producer.
Primary care physicians. People can keep their primary care physicians and health care providers of their choice under the act. Medicaid reimbursements for primary care physicians would be increased to the Medicare rates beginning in 2013.
What did not pass. The “government option” discussed early on did not pass. A proposal to allow adults age 55 and over to “buy in” to Medicare also was defeated. The concern with the loss of the government option is that there will be inadequate cost controls.
The Senate still needs to act on the measures added by the House and there will be much further discussion, for certain. The shape of health care reform for the future is going to take some time to determine.
About the Author Janet Colliton
Esquire, Colliton Law Associates, P.C. Janet Colliton has practiced law for over 38 years, 37 of them in Chester County, Pennsylvania, a suburb of Philadelphia. Her practice, Colliton Law Associates, PC, is limited to elder law, Medicaid, including advice, applications and appeals, and other benefits planning including Veterans benefits, life care and special needs planning, guardianships, retirement, and estate planning and administration.