Health Care Reform Bill Applicability
The epic healthcare reform bill signed today intolaw requires all Americans to have health coverage, give subsidies to help lower-income workers pay for coverage and create state-based exchanges where the uninsured can compare and shop for plans.
Healthcare Reform Bill Key Components
Improved quality of care. The legislation will ensure that Americans of all ages, from young children to retirees have access to greater quality of care by focusing on prevention, wellness, and strengthening programs that work.
Give Americans portable, secure health care coverage. The legislation will ensure that Americans have portable, secure health care coverage – so that they won’t lose care if their employer drops their plan or they lose their job.
Reduce the deficit and ensure the solvency of Medicare and Medicaid. The legislation will be entirely paid for – it will not add a dime to the deficit. It will also put Medicare and Medicaid on the path to a more fiscally sound future, so seniors and low-income Americans can continue to receive the quality health care benefits for years to come.
Shared responsibility for a quality and affordable health care system. The bill will ensure that individuals, employers, and the federal government share responsibility for a quality and affordable health care system.
Consumers interest first and reducing waste, fraud, and abuse. The legislation will put the interests of consumers first, protect them from problems in getting and keeping health care coverage, and reduce waste, fraud, and abuse.
Increase choice and competition. The bill will protect and improve consumers’ choices.
Healthcare Reform Bill Timeline
Medicare and Medicaid Improvements
Encourages wider use of preventive care in Medicare and Medicaid. Eliminates cost sharing for preventive services to encourage wider use of preventive care for Medicare beneficiaries. Requires State Medicaid programs to cover preventive services recommended to the Secretary of HHS.
Start to fill in the Medicare Part D donut hole. Provides for a 50% discount on brand-name drugs in the Part D donut hole, and immediately shrinks the size of the donut hole by $500 in 2010. The donut hole continues to be narrowed over the coming years until it is fully eliminated by 2019.
Increases reimbursement for primary care services in Medicaid. Brings reimbursement for primary care services in Medicaid up to Medicare levels with 100% federal funding (phased in over several years).
Set benchmarks for expansion of Medicare and medical home pilot programs. Requires the Secretary to set specific benchmarks for expansion of these programs and to test them in a variety of settings and geographic regions.
Extending Medicaid coverage to HIV-positive individuals. Gives States the option of extending Medicaid coverage to HIV-positive individuals and provides enhanced federal matching payments for the costs of care.
Provides 12-month continuous eligibility for children in the CHIP program. Provides continuity of care for children by requiring that states provide 12-month continuous eligibility for children in the CHIP program.
Prohibits insurers from limiting or denying coverage. Prior to the bill’s complete prohibition on preexisting condition exclusions beginning in 2013, reduces the window that plans can look back for pre-existing conditions from 6 months to 30 days and shortens the period that plans may exclude coverage of certain benefits.
Ends health insurances abusive practices. Prohibits abusive practices whereby health insurance companies rescind existing health insurance policies when a person gets sick as a way of avoiding covering the costs of enrollees’ health care needs.
Discourages insurance companies from price gouging. Discourages excessive price increases by insurance companies through review and disclosure of insurance rate increases.
Prohibits lifetime caps on coverage. Prohibits insurance companies from placing lifetime caps on coverage.
Begins adopting and implementing administrative simplification requirements. Begins adopting and implementing administrative simplification requirements to reduce paperwork, standardize transactions, and greatly diminish the administrative burdens and associated costs in today’s health care system.
Ensuring Value. Specifies that health plans spend a minimum of 85 percent of premium dollars on medical care, while making sure that such a change doesn’t further destabilize the current individual health insurance market.
Increase the age for dependent policies through 26. Allows those through age 26 not otherwise covered to remain on their parents’ policies at their parents’ discretion.
Pay for reconstructive surgery for children. Requires plans to pay for reconstructive surgery for children with deformities.
Prohibits employers from reducing retirees’ health benefits. Prohibits employers from reducing retirees’ health benefits after those retirees have retired, unless the reduction is also made to benefits for active participants.
Enhance incentives to states for immediate health reform. Builds on an existing grant program to enhance incentives for states to move forward with a variety of health reform initiatives prior to 2013.
Cobra Policies. Allows individuals to keep their Cobra coverage until the Exchange is up and running.
Immediate help for the uninsured. Creates a $5 billion fund, modeled after the President’s plan, to finance an immediate, temporary insurance program for those who are uninsurable because of pre-existing conditions.
Creates reinsurance program for early retirees. Creates a new temporary reinsurance program to help offset the cost of coverage for companies that provide early retiree health benefits for those ages 55-64.
Establishes the Health Benefits Advisory Committee. Establishes within 60 days of enactment the Health Benefits Advisory Committee providing recommendations on the essential benefits package to the Secretary of HHS for approval.
New long-term care program. Creates a new, voluntary, public long-term care insurance program to help purchase services and supports for people who have functional limitations.
Public Health Improvements
Provides immediate funding for preventive services. Provides immediate funding for preventive services at the community and local level to address public health problems such as obesity, tobacco use, and diabetes.
Provides increased funding for community health centers. Provides increased funding for community health centers that will allow them to double the number of patients served over the next five years.
Increases Primary care, nursing and public health workforce. Increases access to primary care by sustaining the current efforts to increase the size of the National Health Service Corps. Primary care and nurse training programs are also immediately expanded to increase the size of the primary care and nursing workforce.
Promote employer wellness programs. Establishes a grant program for employers to promote healthy behaviors among their employees.
Limits cost-sharing for services in Medicare Advantage plans. Limits cost-sharing for services in Medicare Advantage plans to no more than cost-sharing in traditional Medicare, and provides for bonus payments to high-quality plans.
Essential benefits package recommendation. In preparation for reform, the Health Benefits Advisory Committee reports their recommended essential benefits package to the Secretary of HHS for adoption.
Eases burdens on enrollment in Medicare for low-income beneficiaries. Eases burdens on enrollment so more low-income beneficiaries can get the financial help they need to make health care affordable.
Additional federal funds to states with high unemployment. Assists States in maintaining access to Medicaid services during the recession by extending the current Recovery Act increase in federal Medicaid payments to states with high unemployment rates.
Extension of coverage of Immunosuppressive drugs for kidney transplant patients. Lifts the current 36-month limitation on Medicare coverage of immunosuppressive drugs for kidney transplant patients who would otherwise lose this coverage on or after January 1, 2012.
Medicare low-income protection improvements. Increases the assets test limits in the Part D drug program and Medicare Savings Programs to ensure that more low-income beneficiaries get the financial help they need to make their health care affordable.
Health Insurance reforms. Implements comprehensive health insurance reforms that prohibit insurance companies from engaging in discriminatory practices that enable them to refuse to sell or renew policies due to an individual’s health status. In addition, insurance companies can no longer exclude coverage for treatments based on pre-existing health conditions. The legislation also limits their ability to charge higher rates due to health status, gender, or other factors, and permits premiums to vary only by age, geography and family size.
Public health insurance Option. Creates a new public health insurance plan option that is available only within the Health Insurance Exchange.
Affordability credits. Makes Health Insurance Affordability Credits available through the Exchange to ensure people can obtain affordable coverage. Credits are available for people with incomes above Medicaid eligibility and below 400% of poverty who are not eligible for or offered other acceptable coverage.
Expands Medicaid eligibility. Expands Medicaid to 150% of poverty to ensure that people obtain affordable health care in the most efficient and appropriate manner. The expansion is fully federally funded in 2013 and 2014; thereafter states pay 9% and the federal government pays 91%.
Provides temporary Medicaid coverage for newborn babies. Provides temporary Medicaid coverage for up to 60 days for babies who are born without proof of other health coverage.
Individual responsibility. Requires individuals to obtain acceptable health insurance coverage or pay a penalty of 2.5% of their income that is capped at the cost of the average cost of qualified coverage.
Health Insurance exchange. Opens the Health Insurance Exchange to individuals without other coverage and to small employers with 25 or fewer employees.
Employer responsibility. Employers are required to offer coverage to their workers and their workers’ families with minimum contributions and meet standards for that coverage or pay a penalty of 8% of their payroll to help offset the cost of their workers obtaining coverage through the Exchange.
Protects small businesses. Small businesses with annual payrolls below $500,000 are exempt from requirements to offer or contribute to coverage, including the 8% payroll contribution for failure to provide health benefits to their workers.
Small Business tax credits. Provides certain lower-wage small businesses that choose to provide health coverage with a new tax credit worth up to 50% of the amount paid by a small employer for employee health coverage.
Initiates an affordability test for employer-sponsored coverage. Opens the Health Insurance Exchange to individuals who have an offer of employer-sponsored coverage, but for whom that coverage would be unaffordable because the premium would absorb more than 12% of their family income. People who meet this test will be able to enter the Exchange and are eligible for affordability credits based on their incomes.
Ensuring value in Medicare Advantage. Requires Medicare Advantage plans to spend a minimum of 85 percent of premium dollars on medical care.
Health insurance exchange expands. Opens the Health Insurance Exchange to small businesses with 50 or fewer employees.
Expands health insurance exchange. Opens the Health Insurance Exchange to small businesses with 100 or fewer employees and provides the Health Choices Commissioner the authority, from 2015 forward, to continue expanding the Exchange to larger employers as the system is ready to handle increased capacity.
Employers outside the exchange are required to meet essential benefits package. The grace period ends for employer-sponsored plans to meet the health insurance standards. All employer-sponsored coverage and health insurance offered within the Exchange is required to meet benefit and contribution standards.