Health Care Reform: The New Law

Transcription

1 Health Care Refrm: The New Law Prfessr Sidney D. Watsn April 7, 2010 On March 23, 2010 President Obama signed int law the Patient Prtectin and Affrdable Care Act (H.R. 3590). On March 29, the President als signed the Health Care and Educatin Recnciliatin Act f 2010 (H.R. 4872), which includes a series f amendments t H.R previusly negtiated and agreed upn by the Demcratic leadership f the Huse and Senate. The new health care refrm law is the mst imprtant piece f federal scial legislatin since passage f Medicare and Medicaid in The new Patient Prtectin Act guarantees Americans access t affrdable health insurance by refrming private health insurance, expanding Medicaid and imprving Medicare. The Cngressinal Budget Office estimates that by 2019 the new law will reduce the number f uninsured by 32 millin, insuring 95% f Americans and legal immigrants. The Act als guarantees that cmprehensive insurance is available t the 25 millin Americans wh are underinsured because they have insurance that des nt prvide adequate cverage. The refrm law will be fully implemented in 2014 and this brief prvides an verview f what refrm will lk like then. Hwever, a number f prvisins take effect this year. Fr mre infrmatin n these, see the brief What Happens Immediately. PRIVATE HEALTH INSURANCE REFORMS The Patient Prtectin Act changes hw private insurance cmpanies d business t guarantee access t health insurance, prhibit discriminatin based n health status, and cntrl health care csts. Guaranteed issue Prhibits private insurance cmpanies frm turning dwn individuals because f preexisting medical cnditins r rescinding plicies except in cases f fraud. Yung adults up t age 26 may be cvered by their parents plans. Stp insurance cmpanies frm charging higher premiums because f pre-existing cnditins, gender, r ccupatin, and limit the extent t which insurance cmpanies can charge higher premiums because f age (3:1). Plans will still be able t vary premiums based upn family size and gegraphic area and may charge smkers 50% mre. Waiting perids fr cverage will be limited t 90 days. Cmprehensive cverage Requires health insurance plans t cver a standard benefit package that includes preventive care, hspital, physician, prescriptin drugs, mental and behaviral health, 1

2 substance use, dental and visin care fr children, rehabilitative and habilitative services and devices, and ther services with the details t be develped by HHS. N deductibles r cpayments fr preventive services. Financial prtectins Prhibits annual r life time limits n cverage. Basic plans will have t cver, n average, 60% f the cst f cvered benefits, and insurers culd ffer three ther benefit plans, cvering 70% t 90% f csts. The Cngressinal Budget Office says that plicies bught in the individual insurance market cver, n average, 55% t 60% f medical csts. Cverage in the emplyer-spnsred market is typically arund 80%. Requires annual ut f pcket spending caps fr cnsumers, set at current HSA limits, $5,950 fr individuals and $11,900 fr families in 2010, with additinal prtectins fr thse wh qualify fr sliding scale premiums. Limits deductibles in the small grup market t n mre than $2,000 fr individuals and $4,000 fr families, with additinal prtectins fr thse wh qualify fr sliding scale premiums. Premium Prtectins Caps insurance cmpany administrative verhead and prfits, requiring insurers t use premiums t pay fr medical care. Insurance cmpanies must spend at least 85% f premiums n medical care in the grup market and 80% in the individual market. Strengthens versight f insurance premium rates and rate increases. Mre affrdable individual and small grup cverage Creates state-based Health Insurance Exchanges s peple wh use the small grup and individual market get the same ecnmies f scale as larger emplyers where verhead csts typically run as high as 30-40%, cmpared with 5-10% in the large emplyer market. Individuals will be able t chse amng a variety f types f plans, with individuals making their wn trade-ffs between lwer premiums and higher ut f pcket csts. The Exchanges will nt replace emplyer-spnsred benefits. The Exchanges will be fr thse wh d nt have cverage r frm whm emplyers spnsred cverage is t expensive. Emplyees whse emplyer plans d nt cver, n average 60% f the cst f cvered benefits r that cst the emplyee mre than 9.5% f incme have the ptin f using the Exchange. Small businesses with up t 100 emplyees may pt t use the Exchange, giving their emplyees access t all plans ffered by the Exchange. States als have discretin t allw larger emplyers t use the Exchange. The Exchanges will cver abut 26 millin Americans, including many wh nw purchase individual plicies. New health insurance ptins The new Health Insurance Exchanges will ffer a new health insurance ptin similar t the Federal Emplyees Heath Benefits Plan t be negtiated by the agency respnsible fr the FEHBP. The new FEHPB-like ptin will include at least tw multi-state plans, including at least ne nt-fr-prfit plan. These new FEHBP-like plans will be anther ptin n ne will be required t enrll in them fr thse Americans wh use the Exchange t purchase health insurance. 2

3 This new FEHBP-like ptin will have t cmply with all the new rules fr health insurers and must supprt itself thrugh premiums. The Act als creates a new prgram t fster creatin f new nt-fr-prfit, cnsumercntrlled private plans, called cnsumer cps. Premium subsidies t make health insurance affrdable Premium subsidies, in the frm f refundable tax credits, will be available t families earning between % f the federal pverty level, ($29,327 t $88,200 fr a family f fur in 2009) t help purchase insurance thrugh the Exchanges. Thse with lwer incmes will be eligible fr Medicaid (see belw) $43,320 $58,280 $73,240 Subsidies will be n a sliding scale s premium csts will 4 $88,200 range frm 2% t 9.5% f incme. Subsidies will als be available t reduce ut f pcket csts Yearly 400% fr thse with incmes up t 400% FPL. With premiums nw averaging $4800 fr an individual plan and $13,000 fr family cverage, these subsidies are necessary t make insurance affrdable fr averageincme families wh d nt have an emplyer cntributing twards their insurance csts. The act als prvides tax credits t small emplyers t help them pay fr the cst f emplyee health insurance. MEDICAID The Act expands Medicaid s it prvides safety net cverage fr all lw incme Americans. Presently, almst half f thse earning belw pverty cannt qualify fr Medicaid. Expands Medicaid t cver all lw-incme wrking families and individuals under age 65 with incmes up t 133% f the federal pverty level, $24,348 fr a family f 3. At present, in Missuri nn-disabled adults withut children cannt qualify fr Missuri n matter hw pr and parents wh earn as little as $4,584 a year fr a family f 3 are ineligible. Enhanced federal match means that the federal gvernment will pick up the full cst fr thse wh are newly eligible frm , 95% fr the next tw years, and 90% after that. At present, the federal gvernment cvers, n average, abut 57% f Medicaid csts natinwide and 63% f the cst in Missuri. In 2010, because f federal stimulus funding, Missuri is receiving a 74% federal match. Increases Medicaid reimbursement fr primary care t Medicare rates, funded 100% by federal mney in 2013 and The State Children's Health Insurance Prgram (SCHIP) cntinues until 2019 t allw time fr children t transitin t cverage thrugh the new Exchanges. 133% 1 $14,400 2 $19,380 3 $24,348 4 $29,328 5 $34,296 Yearly 133% The Medicaid expansin will cver an estimated 16 millin uninsured individuals frm wrking families. MEDICARE The Refrm law strengthens Medicare cverage fr senirs and peple with disabilities. Prescriptin drug cverage wuld be mre affrdable by reducing and then finally clsing the Part D dughnut hle. Preventive services will n lnger be subject t c-pays r deductibles. 3

4 Prvides 10% payment enhancement fr primary care physicians and general surgens. Requires private Medicare Advantage t spend at least 85% f premiums n medical care, limiting verhead and prfit. SHARED RESPONSIBILITY Everyne is wrried abut hw t pay fr health refrm, but the key t making cverage affrdable is fr everyne t d his r her part. Thse withut cverage will be asked t pay health insurance premiums n an affrdable sliding-scale based n incme, whether they are yung and healthy r lder with cmplex medical needs. Yunger adults will pay lwer premiums than lder adults. The individual mandate prvides fr a penalty nly if affrdable cverage with premiums csting n mre than 8% f incme is available. There are als exemptins fr thse facing financial and ther hardships, and incmes belw the tax filing threshld ($9,350 fr an individual and $18,700 fr married cuples in 2007). The penalty is the higher f $695 per adult r 2.5% f incme up t the average premium level, with a family maximum f $2,085. Emplyers are als expected t d their part, which will level the playing field between thse cmpanies that prvide cverage and thse that d nt. There is n emplyer mandate. The Act assesses a penalty against larger emplyers, thse with mre than 50 emplyees, nly if at least ne emplyee receives an insurance premium subsidy. The penalty is the smaller f $2,000 fr each emplyee wh receives a premium credit r $750 per emplyee, nt cunting the first 30 emplyees. Assistance t small businesses. Small emplyers, thse with 50 r less emplyees, are nt subject t the emplyer cntributin. Small businesses als benefit frm the mre affrdable cverage available in the Exchange, regardless f health status f emplyees. Small businesses are als eligible fr new tax credits t help subsidize the cst f emplyee health insurance premiums. One-third f the uninsured, 13 millin peple, wrk fr businesses with fewer than 100 wrkers. Paying fr Refrm While the federal budget price tag fr expanded health cverage seems staggering abut $938 billin ver ten years this amunts t less than 2-3% f ttal health care spending. Overall, cunting private as well as public spending, it will cst mre t d nthing. Cngressinal rules require that all bills cnsidered n the Huse and Senate flr be federal budget neutral. The CBO estimates that the new law will reduce the federal deficit by $124 billin ver 10 years. Abut half the cst f health refrm will be financed by slwing the grwth f Medicare prvider payments by abut 1% a year an amunt hspitals and ther prviders agreed is reasnable given savings that result frm cmprehensive health refrm designed t prvide all Americans with health insurance. Other Medicare savings cme frm cuts in the prices f brand name drugs sld t senirs and eliminating verpayments t Medicare managed care plans. Additinal savings cme frm price cuts fr drugs purchased by state Medicaid prgrams. 4

5 New fees will be impsed n health insurers, drug makers and medical devices, and indr tanning studis. New Medicare payrll tax increase n certain interest and dividend incme f taxpayers earning ver $200,000 fr an individual r $250,000 fr a cuple. The Senate bill als places an excise tax n very high cst health insurance plans valued at $10,200 fr individual cverage and $27,500 fr family cverage beginning in Presently, the average cst fr cverage in the emplyer market is $4800 fr individual plans and abut $13,000 fr family cverage. 5