U.S. Healthcare Reform: A Follow-Up
Stephanie C. Ardito
Principal, Ardito Information & Research, Inc.
In the March 2010 issue of Searcher, I provided a guide to impartial and balanced resources useful for tracking the pending healthcare reform bill in the U.S. Congress. Shortly after publication of the column (The Medical Digital: “Universal Healthcare: A Guide to Unbiased Resources”), Congress passed bill H.R. 3590, the Patient Protection & Affordable Care Act (also known as PPAC) [http://thomas.loc.gov/cgi-bin/bdquery/z?d111:h.r.03590:]. President Barack Obama signed the legislation into law on March 23. A week later, on March 30, Obama signed a separate bill, H.R. 4872, The Health Care & Education Reconciliation Act [http://thomas.loc.gov/cgi-bin/bdquery/z?d111:h.r.04872:]. This new bill resolved differences between the House and Senate versions of PPAC. Since each piece of legislation is nearly 1,000 pages long, I thought it might be useful to provide a follow-up list of resources that simply lay out the major provisions of the bills and time frames for enactment.
Despite passage of the two laws, the legislation continues to come under intense scrutiny. Some states have filed lawsuits questioning the constitutionality of specific aspects of the bills. For example, some states are challenging whether or not the federal government has sovereignty over the states in legislating healthcare reform changes and are contesting PPAC’s provision that individuals and businesses must purchase health insurance or face financial penalties. Consequently, politicians, partisan policy centers and think tanks, and news organizations are being closely monitored by fact-checking groups to catch inaccurate or false statements about the legislation. Some of the fact-checking sources were mentioned in the earlier column, but a number of new ones, mainly from newspapers, have sprung up.
As before, I searched for neutral sources that clearly and unambiguously lay out healthcare’s major changes. I mainly focused on short, easy-to-read summaries or timelines that information professionals and libraries/information centers can pass on to their constituents, whether individuals or human resource departments responsible for their organizations’ health insurance plans. I thought there might be a great deal of overlap of sources with the March column, but, surprisingly, other than the Kaiser Family Foundation, all resources listed below are brand new. For those interested in serious, scholarly research regarding the historical progress of U.S. healthcare reform, this column and the prior column might be a good pairing.
Consumer Implementation Resources
Admittedly, the Democratic Policy Committee (DPC) may not seem the most impartial organization regarding the passed healthcare legislation [http://dpc.senate.gov/dpcissue-hri.cfm]. While DPC breaks down resources by nearly 30 topics [http://dpc.senate.gov/docs/dpcdoc-hri.pdf], most are overwhelming in the breadth and complexity of information provided and not recommended to Searcher’s readers. However, on June 18, DPC furnished a straightforward, nine-page Implementation Timeline on its website [http://dpc.senate.gov/healthreformbill/healthbill65.pdf], covering changes from 2010 to 2018. In addition, for those of you curious about individual state initiatives, see the DPC’s link to the White House’s State by State Information site [http://www.whitehouse.gov/healthreform/downloads]. Here, one can view succinct, two-page reports on benefits and programs being enacted by each state.
A second timeline is available on the Kaiser Family Foundation website [http://www.kff.org/healthreform/upload/8060.pdf]. Kaiser was mentioned several times in my March column as a source of unbiased information as reform legislation moved through Congress. The Foundation’s timeline differs from published timelines in that it breaks down reform changes by date and by category (for example, Medicare, Medicaid, Prescription Drugs, Workforce, Tax Changes, Prevention/Wellness, and Insurance Reforms). The category breakdown within each year makes it easier to pinpoint changes relevant to specific age groups, those with varying incomes, businesses providing healthcare benefits, and the insurance industry itself. Also see Kaiser’s readable, easy-to-understand 13-page summary of the new laws [http://www.kff.org/healthreform/upload/8061.pdf].
A third recommended timeline appears on the Consumer Reports website [http://www.consumerreports.org/health/insurance/health-reform-timeline/overview/index.htm]. A page on the website entitled “Your Guide to a Changing System” [http://www.consumerreports.org/health/insurance/health-insurance.htm] includes a number of straightforward resources for those not insured, those under 26, those over 65, and those with pre-existing conditions. You’ll also see links to reliable and unbiased insurance resources.
Although Families USA is a nonprofit, claiming to be a “non-partisan” organization, its major mission is “dedicated to the achievement of high-quality, affordable health care for all Americans.” However, the group has compiled a list of neutral resources through its Health Reform Central, including a short document entitled “What Will the New Health Reform Law Do in the First Year? [http://www.familiesusa.org/assets/pdfs/health-reform/reform-in-the-first-year.pdf]. For a list of all Families USA publications relevant to the health reform law, see http://www.familiesusa.org/health-reform-central/publications.html.
AARP is another group that supported healthcare reform, but its website also provides unbiased information about how changes will affect people older than 50. (See “A User’s Guide to Health Care Reform” [http://www.aarp.org/health/health-care-reform/info-04-2010/a_user_s_guide_to_health_care_reform.html].) A number of supplementary publications and interactive Health Tools encompass a range of healthcare reform topics and the implications of the legislation on Medicare, small businesses, and moderate- and low-income individuals. AARP’s “Health Care Law Fact Sheets” [http://www.aarp.org/health/health-care-reform/health_reform_factsheets] are quite informative, offering information for targeted groups of people (e.g., women, Hispanics, African Americans, those 50–64, and those over 65), as well as information about specific benefits (e.g., Medicare prescription drugs, preventive and wellness care, and long-term care).
Business Implementation Resources
On June 21, 2010, Business Insider, Inc. (a business news aggregator launched in February 2009) produced “The Complete Guide to Health Care Reform and Your Business” [http://www.businessinsider.com/the-complete-guide-to-healthcare-reform-and-your-business-2010-6], with links to several sources available through Entrepreneur magazine’s website. The Business Insider article succinctly covers the law’s immediate provisions, tax credits, insurance for early retirees, grandfathered insurance plans, high-risk pools, compliance and fines, and what’s coming down the road. The article also includes an added section entitled “Fact or Fiction?” The author outlines and dispels four major rumors about the healthcare reform legislation (reporting of coverage on W-2 forms, issuing 1099s to suppliers and vendors when expenses total more than $600, taxing tanning services, and exempting certain religious groups from reform requirements).
On April 13, 2010, Bloomberg BusinessWeek published an article entitled “How Health-Care Reform Will Affect Small Businesses” [http://www.businessinsider.com/the-complete-guide-to-healthcare-reform-and-your-business-2010-6]. It covers issues such as pre-existing conditions, health exchanges, companies with fewer than 50 employees, and tax credits.
Nixon Peabody, a national law firm, provides extensive resources for employers [http://web20.nixonpeabody.com/healthcare/default.aspx], including an employee “Benefits Alert” and business “Tax Alert.” The website links to top-line news items regarding the healthcare reform legislation and offers free recorded webinars, such as “Health Care Fraud and Abuse: What You Need to do Now,” and “Health Care Reform Compliance: What Every Employer Needs to Know.”
News Alerts, Updating Services, and Fact-Checking
Wolters Kluwer offers free, weekly healthcare reform updates that you can either read on the publisher’s website [http://health.cch.com/netnews/Health-Reform/current.html] or receive through email. Three major categories of news include Federal, State, and General. The publisher’s blog about the healthcare legislation [http://healthcare-legislation.blogspot.com] is also worth reading. Both services summarize and link to industry and consumer surveys. Surveys published in June 2010 included those issued by PricewaterhouseCoopers LLP Health Research Institute [http://www.pwc.com/us/en/health-industries/health-research-institute/index.jhtml], Employee Benefit Research Institute [http://www.ebri.org/surveys/index.cfm?fa=health], and Deloitte Center for Health Solutions [http://www.deloitte.com/view/en_US/us/Insights/centers/center-for-health-solutions/health-care-reform/index.htm].
The Annenberg Public Policy Center at the University of Pennsylvania sponsors FactCheck.org, “a nonpartisan, nonprofit ‘consumer advocate’ for voters that aims to reduce the level of deception and confusion in U.S. politics.” Television advertising, speeches, interviews, and news releases are monitored for inaccuracies. Although the site has a search engine, results are displayed in a haphazard fashion. However, if there is a healthcare reform issue causing confusion, FactCheck.org will likely cover the misconception, backing up facts with reliable sources assembled into a bibliography. Note the site’s page on “Health Care Reform” [http://factcheck.org/tag/health-care-reform], updated frequently, as well as the April 19, 2010, piece titled “More Malarkey About Health Care” [http://factcheck.org/2010/04/more-malarkey-about-health-care]).
The St. Petersburg Times maintains the PolitiFact.com website. Reporters and researchers monitor statements made by members of Congress, the president, cabinet secretaries, lobbyists, people who testify before Congress, and anyone involved in politics. Accuracy of statements are rated on the Truth-O-Meter, and public officials on the Flip-O-Meter. Once or twice a week, subscribers can receive free updates delivered directly to their email accounts. For true-and-false statements about healthcare reform, see http://www.politifact.com/subjects/health-care.
Families USA, mentioned above, has an entire page on its Health Reform Central website devoted to “Roadblocks to Implementation” [http://www.familiesusa.org/health-reform-central/roadblocks-to-new-law.html]. Legislative, legal, and repeal challenges to the healthcare legislation are listed, as well as resources regarding misinformation about the laws.
Hope This Helps
The primary focus of this column has been to compile unambiguous, factually correct, and jargon-free resources that will help the insured and uninsured navigate through the changes legislated by the two healthcare reform bills. From these resources, I’ve prepared a summary of key implementation dates that primarily affect healthcare coverage for individuals and their families. A number of additional reforms involve changes within the insurance, pharmaceutical, medical, and regulatory industries and can be reviewed by referring to any of the timelines listed above.
Key Healthcare Reform Changes and Implementation Dates
June 23, 2010
• Temporary high-risk health insurance pool for uninsured individuals with pre-existing conditions created.
Effective until Jan. 1, 2014
• Temporary reinsurance program established for employers providing coverage to retirees older than 55 who are not eligible for Medicare.
Effective until Jan. 1, 2014
• States are mandated to launch public websites providing health insurance coverage choices.
• The federal government, through the Department of Health and Human Services (HHS) planned to launch its health insurance web portal, http://www.HealthCare.gov, on July 1.
Sept. 23, 2010
• Health insurance companies will be prohibited from canceling existing policies if members become sick or make unintentional mistakes on their applications.
• Insurers will be prevented from imposing lifetime limits on health benefits.
• In 2010, annual limits can be no lower than $750,000.
• In 2011, the minimum will increase to $1.25 million.
• In 2012, the minimum will rise to $2 million.
• Plans issued or renewed after Jan. 1, 2014, will be prohibited from setting any annual limits on benefits deemed “essential.”
• Tax credits to qualifying small businesses providing insurance coverage to workers will be established. .
• Policies that provide insurance only to higher-wage employees will be prohibited.
• Insurance companies will be required to report and justify increased premium rates.
• Insurance companies must spend at least 80% in the individual market or 85% in the employer market of the dollars collected on healthcare services.
• Preventive services — such as immunizations, mammograms, and colonoscopies — will be covered with no out-of-pocket costs.
• Pre-existing condition exclusions for children up to age 19 will be eliminated.
• Young adult dependents can be covered until age 26.
• Women can schedule appointments to see OB-GYNs without a referral from a primary-care doctor.
• Emergency services obtained out of the plan’s network of hospitals will be charged the same as those provided in the plan’s network.
Calendar Year 2010
• Medicare Part D enrollees who fall into the prescription drug coverage gap (“doughnut hole”) will receive $250 rebate checks.
• The goal is to eliminate the gap by 2020.
• 50% discount on all brand-name drugs that fall into the “doughnut hole.”
• Free, annual wellness visits and personalized prevention services for Medicare beneficiaries, with no deductibles or co-pays.
• Community Living Assistance Services and Supports (CLASS), a new program for long-term care services financed by voluntary payroll deductions, will be launched.
• All legal citizens will be required to have health insurance or pay a fine (exemptions available for those with financial hardship).
• Insurance companies can not exclude any individual from coverage based on pre-existing health conditions.
• Insurers will be prohibited from imposing annual limits on the amount of coverage individuals receive.
• Coverage will be ensured for individuals participating in clinical trials, while preventing denial of routine care coverage by insurers.
• Health insurance exchanges will be established in each state for individuals and small businesses (up to 100 employees) to comparison shop for standardized health packages.
• Group health plans will have a maximum waiting period of 90 days.
• Two-year tax credits of up to 50% of premiums will be available to qualifying small businesses.