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The
Nitty Gritty of Health Reform
What
Reforms Go into Place
First |
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Members of Congress from across the country
rose to the occasion on Sunday by voting for
the a national health reform bill. They
then worked in the days since, sometimes into
the wee hours of the morning, to craft some
changes and additional reform measures (the
Reconciliation Bill). While there is a
lot of information out there about what it all
means, below is a break down of the measures
that will happen within the next year to
help Maine small businesses, children, elderly,
uninsured and others.
FOR
SMALL BUSINESSES
SMALL BUSINESS
TAX CREDITS-Offers tax credits to small businesses
to make employee coverage more affordable. Tax
credits of up to 35% of premiums will be
immediately available. Effective calendar year
2010. (Beginning in 2014, small business tax
credits will cover 50% of premiums.)
FOR SENIORS
BEGINS TO CLOSE THE
MEDICARE PART D DONUT HOLE-Provides a $250 rebate
to Medicare beneficiaries who hit the donut hole
in 2010. Effective for calendar year
2010. (Beginning 2011, institutes a 50% discount
on brand-name drugs in the donut hole; also
completely closes the donut hole by
2020.)
FREE
PREVENTIVE CARE UNDER MEDICARE-Eliminates
co-payments for preventive services and exempts
preventive services from deductibles under the
Medicare program. Effective beginning January
1, 2011.
HELP
FOR EARLY RETIREES-Creates a temporary
re-insurance program (until the Exchanges are
available) to help offset the costs of expensive
health claims for employers that provide health
benefits for retirees age 55-64.
Effective 90 days after
enactment
FOR THOSE
PRIVATELY INSURED
NO LIFETIME LIMITS ON
COVERAGE-Prohibits health plans from placing
lifetime caps on coverage.
Effective 6 months after
enactment with annual caps on coverage being
eliminated in 2014. The Maine House and Senate
recently voted in favor a bill that will eliminate
both of these as of Jan. 1,
2011.
TIGHTLY REGULATES ANNUAL LIMITS ON
COVERAGE-Tightly restricts new plans' use of
annual limits to ensure access to needed care.
These tight restrictions will be defined by HHS.
Effective 6 months after
enactment. (Beginning in 2014, the use of any
annual limits would be prohibited for all plans.)
The Maine House and Senate recently voted in favor
a bill that will eliminate lifetime and
annual caps as of Jan. 1,
2011.
FREE
PREVENTIVE CARE UNDER NEW PLANS-Requires new
private plans to cover preventive services with no
co-payments and with preventive services being
exempt from deductibles. Effective 6 months after
enactment.
NEW, INDEPENDENT APPEALS
PROCESS FOR NEW PLANS-Ensures consumers in new
plans have access to an effective internal and
external appeals process to appeal decisions.
Effective 6 months
after enactment.
MORE FOR YOUR PREMIUM
DOLLAR-Requires plans to put more of your premiums
into your care, and less into profits, CEO pay,
etc. This medical loss ratio requires plans in the
individual and small group market to spend 80
percent of premiums on medical services, and plans
in the large group market to spend 85 percent.
Insurers that don't meet these thresholds must
provide rebates to policyholders.
Effective January 1,
2011.
NO DISCRIMINATION
BASED ON SALARY-Prohibits new group health plans
from establishing any eligibility rules for health
care coverage that have the effect of
discriminating in favor of higher wage employees.
Effective 6
months after enactment.
FOR THOSE
UNINSURED
EXTENDING COVERAGE FOR YOUNG PEOPLE
UP TO 26TH BIRTHDAY THROUGH PARENTS' INSURANCE -
Requires health plans to allow young people up to
their 26th birthday to remain on their parents'
insurance policy, at the parents' choice.
Effective 6
months after enactment. Maine law currently
allows this coverage up until a child's 25th
birthday.
GENERAL
REFORMS
COMMUNITY HEALTH
CENTERS-Increases funding for Community Health
Centers to allow for nearly doubling the number of
patients served over the next 5 years.
Effective
beginning fiscal year
2010.
MORE PRIMARY CARE
DOCTORS-Provides new investment in training
programs to increase the number of primary care
doctors, nurses, and public health professionals.
Effective
beginning fiscal year
2010.
HEALTH INSURANCE
CONSUMER ASSISTANCE-Provides aid to states to
establish offices of health insurance consumer
assistance to help consumers file complaints and
appeals. Effective beginning
fiscal year 2010.
CREATES NEW,
VOLUNTARY, PUBLIC LONG-TERM CARE INSURANCE
PROGRAM-Creates a long-term care insurance program
to be financed by voluntary payroll deductions to
provide benefits to adults who become functionally
disabled. Effective January 1,
2011.
OTHER
PROVISIONS TO TAKE PLACE LATER THAN
2010-2011
Makes health insurance more affordable for
low-income and moderate-income families through
subsidies. All families between 133% and 400% of
federal poverty level would have lower health
care costs (total of premiums and
cost-sharing). This would begin in
2014.
Increases federal support to help states
expand their Medicaid programs. For most states,
the federal government would pick up 100 percent
of state Medicaid costs for newly eligible
individuals for the first three years (2014-2016),
95 percent of those costs for 2017, 94 percent for
2018, 93 percent for 2019, and 90 percent
thereafter.
To read about more
reforms that will take place later, you may
find this link
helpful. |
 By the
Numbers- What This Reform Means for Maine
- Improved coverage for 771,000 residents with
health insurance.
- Tax credits and other assistance to up to
359,000 families and 38,900 small businesses to
help them afford coverage.
- Coverage to 51,000 uninsured residents.
- Protection for 1400 families from
bankruptcy due to unaffordable health care
costs.
- Ability for 90,000 young adults to
obtain coverage on their parents' insurance
plans.
- Millions of dollars in new funding for 133
community health centers.
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