This writer has read both the main bill, Patient Protection and Affordable Care Act (H.R. 3590), and the Reconciliation Act (H.R. 4872). Below are the Key Provisions of H.R. 3590 and H.R. 4872 (Health Reform Act (s) signed in March by President Obama.)
2010
HEALTH INSURANCE CONSUMER INFORMATION—Provides aid to states in establishing offices of health insurance consumer assistance in order to help individuals with the filing of complaints and appeals. Effective beginning in fiscal year
SMALL BUSINESS TAX CREDITS—Offers 35% tax credits to small businesses (25 or fewer full time employees).
NO DISCRIMINATION AGAINST CHILDREN WITH PRE‐EXISTING CONDITIONS—Prohibits new health plans in all markets plus grandfathered group health plans from denying coverage to children with pre‐existing conditions. Takes effect on September 23.
HELP FOR UNINSURED AMERICANS WITH PRE-EXISTING CONDITIONS UNTIL EXCHANGE IS AVAILABLE (INTERIM HIGH‐RISK POOL)—Provides access to affordable insurance for Americans who are uninsured because of a pre‐existing condition through a temporary subsidized high‐risk pool.
ENDS RESCISSIONS—Bans insurance companies from dropping people from coverage when they get sick.. Takes effect on September 23.
BEGINS TO CLOSE THE MEDICARE PART D DONUT HOLE—Provides a $250 rebate to Medicare beneficiaries who hit the donut hole in 2010.* (Closes donut hole by 50% in 2011.)
EXTENDS COVERAGE FOR YOUNG PEOPLE UP TO 26TH BIRTHDAY THROUGH PARENTS’ INSURANCE—Requires new health plans and certain grandfathered plans to allow young people up to their 26th birthday to remain on their parents’ insurance policy. Takes effect September 23.
HELP FOR EARLY RETIREES—Creates a temporary re‐insurance program (until Exchanges in 2014) to offset premiums for employers & retirees age 55‐64.
BANS LIFETIME CAPS ON COVERAGE—Prohibits health insurance companies from placing lifetime caps on coverage. Takes effect September 23.
BANS RESTRICTIVE ANNUAL CAPS ON COVERAGE—Tightly restricts the use of annual limits to ensure access to needed care in all new plans and grandfathered group health plans. Takes effect September 23. (Beginning in 2014, the use of any annual caps would be prohibited for all new plans and grandfathered group health plans.)
FREE PREVENTIVE CARE UNDER NEW PRIVATE PLANS—Requires new private plans to cover preventive services; no co‐payments and preventive services exempt from deductibles.
NEW, INDEPENDENT APPEALS PROCESS—Ensures consumers in new plans have access to an effective internal and external appeals process to appeal decisions by their health insurance plan. Takes effect September 23.
PROHIBITS DISCRIMINATION BASED ON SALARY/WAGES—Prohibits new group plans from making rules for coverage that discriminate in favor of higher wage employees. Takes effect September 23.
APPEAL PROCESS—New plans must implement an appeals process on claims and determinations.
TANNING TAX—10% tax on amounts paid for indoor tanning services starting July 1.
ADOPTION TAX CREDIT INCREASE—The tax credit for adopting a child is increased by $1000 to $13,170. The increase is good through 2011.
2011
*INSTITUTES 50% CLOSURE OF DONUT HOLE —50 % Discount on prescription drugs in the Medicare donut hole (completely closes the donut hole by 2020). See +
HOLDS INSURANCE COMPANIES ACCOUNTABLE FOR UNREASONABLE RATE HIKES—Creates a grant program to support states in requiring health insurance companies to submit justification for all requested premium increases, and insurance companies with excessive or unjustified premium exchanges may not be able to participate in the new Health Insurance Exchanges.
FREE PREVENTIVE CARE UNDER MEDICARE—Eliminates co‐payments for preventive services, including wellness visits, and exempts preventive services from deductibles under the Medicare program. Effective beginning January 1, 2011.
ENSURES VALUE FOR PREMIUM PAYMENTS—Individual and small group plans must spend 80%of premium dollars on medical services. Plans in the large-group market must spend 85%. Insurers that do not meet these thresholds must provide rebates to policyholders. Effective on January 1, 2011.
COMMUNITY HEALTH CENTERS—Increases funding for Community Health Centers to allow for nearly a doubling of the number of patients seen by the centers over the next 5 years. Effective beginning in fiscal year 2011.
INCREASES THE NUMBER OF PRIMARY CARE PRACTITIONERS—Provides new investments to increase the number of primary care practitioners, including doctors, nurses, nurse practitioners, and physician assistants. Effective beginning in fiscal year 2011.
HOME CARE—States can offer home and community-based care through Medicaid rather an institution.
HEALTH SAVINGS/ARCHER MEDICAL SAVINGS TAX—Withdrawals before age 65 from health savings accounts for nonqualified medical expenses will increase from 10% to 20%, and from 10% to 15% for Archer medical savings accounts. See (1) in glossary.
MEDICARE PAYROLL TAX—Increase Medicare payroll tax from 1.45% to 2.35% for individuals annually earning more than $200,000 and married couples above $255,000 who file jointly.
EASE SMALL BUSINESS ADMINISTRATIVE BURDEN—Creation of a plan for small businesses to offer tax-free “cafeteria” health care benefits that relieves employers from administering such a program. See (II) in glossary.
2012 & 2013
UNIFORM ELECTRONIC MEDICAL RECORDS—Health care plans must implement uniform standards for electronic exchange of medical information.
FLEXIBLE SAVINGS ACCOUNTS LIMITED—Contributions to flexible savings accounts limited to $2,500 annually and adjusted according to to Consumer Price Index thereafter. See (III) in glossary.
ELIMINATION OF EMPLOYER PART D DEDUCTION—Employers will lose Medicare Part D subsidy tax deduction. See ++
THRESHOLD FOR ITEMIZING INCREASED—The income threshold on those who itemize is increased from 7.5% to 10% of AGI before claiming deductions. (For those 65 and over, this provision starts in 2016.)
MEDICAL DEVICE TAX—A 2.9% tax on the first-time sale of medical devices, except for eye wear, hearing aids, and other items for personal use.
HOSPITAL TAX INCREASE FOR HIGH-INCOME EARNERS—Hospital tax for Medicare Part A will increase 0.9% on investment income for individuals earning more than $200,000 and couples filing jointly who earn over $250,000.
2014
DENIAL /PENALTYFOR PRE-EXISTING CONDITION OR GENDER IS OUTLAWED—As with children in 2010, insurers will no longer be allowed to deny or penalize based on pre-existing condition, gender, or other factors other than fraud.
ANNUAL CAPS OUTLAWED—Plans prohibited from imposing annual limits on coverage.
MEDICAID AVAILABLE TO THE WORKING POOR—Nonelderly citizens earning up to 133% of the poverty level may receive Medicaid. States will receive federal funding to offset the cost of new Medicaid enrollees.
INSURANCE EXCHANGES ESTABLISHED—Individuals and businesses will have an exchange available in every state to comparison shop for the best package. (According to Congressman Hare at an April 1, 2010 town hall at the Galesburg Community Center, shoppers may buy across state lines.)
EMPLOYER COVERAGE OR CONTRIBUTION TO THE SYSTEM MANDATED—Companies employing 50 or more must offer coverage or pay a $2,000 annual tax on each employee above 30 employees, providing any employees receives a tax credit for insurance. Employers offering coverage, but have employees receiving tax credits/subsidies, will pay $3,000 annual tax for each employee receiving tax credit/subsidies. Examples for the above statements: 1) If an employer has 50 workers, offers no coverage, but has an employee who has purchased coverage using a tax credit or subsidy, that employer will be taxed $2,000 for twenty of her/his employees. This would amount to an annual tax of $40,000 that will ostensibly go back into the health care system. The employer’s option is to go to the exchanges and select a plan for all of her/his employees. 2) If an employer has 50 workers, offers coverage, but has seven employees who pay for the coverage with a tax credit/subsidies, then the employer will pay a $3,000 tax for each employee paying for insurance with a tax credit/subsidy. This would amount to an annual tax of $21,000 that will ostensibly go back into the health care system. The employer’s option is to provide coverage that makes the use of tax credits/subsidies by any employee unnecessary, yet meets minimum health care standards.
INSURANCE OR CONTRIBUTION TO THE SYSTEM MANDATED —Citizens are required to have coverage meeting minimum standards or pay a tax. By 2016 the annual noncompliance tax will be $695 or 2.5% of income—whichever is higher. After 2016, the annual noncompliance tax will be set by the Consumer Price Index. Uninsured individuals and families earning too much for Medicaid but less that 4 times the poverty level will be eligible for tax credits/subsidies to purchase insurance that meets minimum standards. (For example, a family of four with a household income of up to $88,000 will be eligible for assistance.
INSURANCE COMPANIES’/PROVIDERS’ TAX—Insurance companies exceeding $25 million in premiums will pay a taxed according to each company’s market share. That is to say, large insurance companies that have a larger percentage of the health care insurance market will pay a greater tax than small companies with a smaller percentage of the market. Any company with $25 million or less in premiums will be exempt.
2018
CADILLAC PLANS TAXED—A portion of employer-provided health plans amounting to $10,201 for an individual and $27,501 for a family will be taxed. For an employee in a high-risk job, the plan must exceed $11,850 for an individual and $30, 950 for a family.
2020
+ MEDICARE PART D DONUT HOLE CLOSED/ ++ BECAUSE DONUT HOLE IS CLOSED, EMPLOYERS NEED NO TAX DEDUCTION FOR PART D.
OTHER ITEMS:
Over 30,000,000 more citizens will be insured, raising the percentage of covered Americans from 84% to 95%.
Every one, including those who refuse to get coverage, will pay into the system. Potentially this could lower individual cost by spreading the burden, but it may not lower overall cost to the nation.**
A proposed 21% cut to doctors has been rolled backed by the House and is waiting for corresponding Senate legislation before or shortly after the cuts take effect on July 1, 2010. This has been an ongoing problem, and Congress “patched over” or “rolled back” these proposed cuts several time during the last decade. As per Representative Hare’s information on April 1, 2010 at the Community Center in Galesburg, the various provisions and new revenues coming to Medicare as a result of the HR 3590 and HR 4872 will extend the solvency of Medicare for 9 years.
Since its inception in 1997, insurance companies participating in Medicare Advantage (Part C) have overcharged the federal government 10% to 14% more than traditional Medicare reimbursements. Under the new law, without reducing benefits these companies will have to accept the traditional Medicare reimbursements. About 1 out of 5 Medicare recipients are enrolled in Medicare Advantage. According to the Piper Report, a healthcare web source, this will be phased in over time. But I have not been able to validate that. It appears from a reading of Title III, Subtle C, Section 3201, that changes in Medicare Advantage will involve grandfathering and phasing in to be completed by 2014.
Medicare fraud and abuse will be addressed by using the model used by the Veterans Administration, which has been far more efficient at holding down costs and detecting and eliminating fraud than Medicare. This according to Rep. Phil Hare at a town hall on April 1, 2010.
President Obama initially had three healthcare objectives: 1) Insure all Americans; 2) maintain choice;3) reduce costs. Later, the president added deficit neutral as a fourth objective. Following is how well H.R. 3590 and H.R. 4872 achieve these goals:
1. Virtually every American will be covered, and those Americans who choose not to buy insurance will have to contribute to the healthcare system. OBJECTIVE MET
2. Due to healthcare exchanges, Americans will have greater choice. OBJECTIVE MET
**3. The Kaiser Family Foundation reported recently that premiums will continue to rise, and it is unclear if the rate of increases will be slowed or increased slightly. UNCERTAIN AS TO WHETHER OR NOT THE OBJECTIVE HAS BEEN MET
4. The Congressional Budget Office (CBO) initially reported that healthcare reform would lower the deficit over ten years by approximately $140 billion and even more over the next ten years. Recently the CBO reported that healthcare reform will cost more than first reported. UNCERTAIN AS TO WHETHER OR NOT THE OBJECTIVE WIL LBE MET
However, to quote Vice President Biden (omitting the the expletive): This is a big***deal—because it is a huge two or three steps towards fixing Medicare and other crucial aspects of our healthcare system.
SOURCES:
blog.taragana.com/…/fact-check-obamas-claim-that-premiums-would-fall-under-his-health-plan-misses-the-fine-print-42234/ — Cached
Gallup.com
Healthinsurancenewsnet.com
Healthreform.gov
H.R. 4872–Health Care and Education Affordability & Reconciliation Act of 2010
H.R. 3590—Patient Protection and Affordable Care Act of 2010
Piperreport.com
GLOSSARY (Based on definitions from Wikipedia):
(I) Archer Savings Account is a tax-deferred medical investment account.
(II) Cafeteria Plan can be established by an employer and allows employees to pick and choose from a variety of benefits.
(III) Flexible Account is essentially a healthcare savings account.
Questions and comments may be posted at www.healthcare.zburg.net
