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In a previous post, we shared with you how Medicare is being expanded to include tobacco cessation programs, ensuring that beneficiaries are given the opportunity to undergo such programs when these can be more helpful and effective, which is before the onset of disease.
Preventive care is not just a Medicare provision, but a provision that includes everyone, regardless of age. After all, it is not just seniors who have smoking habits; come to think of it, there may be more yuppies that are into smoking when compared to seniors.
Health care reform recognizes that being able to prevent disease from occurring is just as important as meeting the health care demands of patients. It is for this reason that cancer prevention tools, including such programs as annual mammograms for women over 40, regular pap smears, HPV vaccination, tobacco cessation counseling or medication, and screening tests for colon cancer for adults over 50.
New health plans are also mandated to offer coverage sans cost-sharing services, for services such as obesity screening, counseling from physicians or health professionals in order to promote sustained weight loss, blood pressure screening, counseling on the daily use of aspirin in order to reduce the risk of a stroke, and screening for high cholesterol and diabetes.
Children are also taken care of by healthcare reform, through the availability of new health plans for children without cost-sharing. Among these services are well-baby and well-child doctor’s visits every few months and screenings for such childhood problems as obesity and depression.
A survey conducted by the U.S. Centers for Disease Control and Prevention (CDC) revealed that 15.4 percent of Americans were not covered by health insurance in 2009, an increase from 14.7 percent the previous year. That translates to 46.3 million uninsured Americans, according to a report by Reuters. This figure includes more than 6 million children under the age of 18.
This will hopefully be corrected by the Patient Protection and Affordable Care Act, which will make health insurance mandatory for Americans and will allow young adults to stay covered through their parents’ health plans longer, among other things. Upon its expected full implementation in 2014, the new health care reform law will be able to expand health insurance coverage to an estimated 32 million uninsured Americans.
Most of those who were uninsured were of the younger set, as Americans above the age of 65 are covered by Medicare. For 2009, 17.5 percent of Americans under 65 and 21 percent of adults from the age of 18 to 64 were uninsured.
The article mentioned a study from Harvard Medical School published in September, which determined that almost 45 thousand people die in the United States each year because they do not have health insurance coverage and are not able to get the appropriate medical care.
The survey also showed that 21 million people below the age of 65 were covered by public health plans while 14.4 million people over the age of 65 and 37.7 million children were covered by private insurance. Almost 30 percent of young adults between the ages of 18 and 24 did not have health insurance coverage.
One of the provisions of the HR 3590 or the Patient Protection and Affordable Care Act (PPACA), due for implementation before the end of the year, is the allowing of young adults to stay on the health insurance of their parents until they reach the age of 26.
This change in coverage requirement has a lot of people excited, and there are some insurers that have already begun to offer extended coverage to families who choose to purchase their coverage directly. Employers have also revealed that parents are already turning to benefits departments for more information about the provision.
According to estimates released by the Health and Human Services Department on Monday, the extended coverage will result in a premium increase of nearly 1 percent for employer plans. Estimates reveal that the new benefit will cost $3,380 for each dependent. This will increase the premium for employer plans by 0.7 percent by 2011. This increase will be added to the expected 6.5 to 7 percent increase in premiums even without health care reform.
As it is, employers usually allow their employers to retain children who are in college on their health plans until they graduate. With health care reform, however, it will no longer be necessary for a young adult to stay in school to continue to be covered by health insurance. Extended coverage for young adults also cannot be charged more than other dependents, or be provided with less benefits.
An estimated 1.2 million young adults are expected to avail of the provision, with more than half of them currently uninsured.
There are quite a number of provisions in the Patient Protection and Affordable Care Act (PPACA) that will go into effect in January 2014. We have shared with you a few in a previous post, and we continue our discussion on the other provisions.
A new voluntary long-term care insurance program will be created under CLASS Act, where individuals who pay premiums voluntarily into the program and who, due to disability or chronic illnesses, become eligible, will be able to receive benefits that they can use to cover expenses for a home or assisted-living facility. Meanwhile, an employed individual who uses more than 9 and a half percent of his or her income to pay for health insurance premiums can buy insurance policies from a state-controlled health insurance option.
Starting January 2014, health insurance exchanges will be established, and insurance premiums for individuals whose income is up to 400% of the poverty line as well as single adults will be subsidized. Three years after, in January 2017, states can apply to the Secretary of Health and Human Services to waive certain sections of the law. This is allowed for as long as the state can show a detailed alternative coverage that are either at least as comprehensive or as affordable for a comparable number of the residents of the state.
By 2018, it is expected that all existing health insurance plans must include approved preventive care and checkups without the need to co-pay. This is also the year when the new 40% excise tax on Cadillac insurance plans will be introduced.
We pick up from a previous post and continue to share with you the provisions of HR 3590 – the Patient Protection and Affordable Care Act (PPACA) – that will take effect after 2010.
Starting on the first day of January 2011, it will be mandatory for insurers to spend 85% of large-group and 80% of small-group plan premiums on health care or towards the improvement of the quality of healthcare; otherwise, they will be bound to return the difference to their customer in the form of a rebate.
We already mentioned a couple of things that are supposed to take into effect in January 2014, which included prohibiting insurers from discriminating against people with pre-existing medical conditions. Also scheduled to be implemented by January 2014 is the offering of tax credits for small businesses that have less than 25 employees and that provide health care benefits for their employees.
There will be a tax penalty of $2,000 per employee that will be imposed on employers that have more than 50 employees but do not offer health insurance for those who work for them full-time. There will also be an annual penalty of $95 or 1% of their income, whichever is higher, for individuals who do not purchase health insurance. This is a base amount that will eventually increase to $695 or 2.5 percent of income, whichever is higher, by 2016.
Restaurant chains that have twenty or more locations will, by January 2014, be required to display they caloric content of their food on their in-store and drive-through menus and vending machines.
In a previous post, we shared with you the provisions of HR 3590 – the Patient Protection and Affordable Care Act (PPACA) – that will take effect immediately, or within the next month. Beyond these provisions, however, are others that will take effect later in the year or in years still to come, and this is what we will have to look forward to.
Come September 23, 2010, the following provisions are among those that will be implemented. First, dependent children can stay on their parents’ insurance plan until they become 26 years old. Insurers will henceforth be barred from discriminating against people younger than 19 on the basis of pre-existing medical conditions; they are also no longer allowed to charge deductibles and co-payments for Level A or B preventive care as well as medical screenings in all new insurance plans.
For those who are impacted by the Medicare Part D coverage gap, a $250 rebate will be provided to them, as is the guarantee that half of the gap will be removed by year 2011. It is expected that this gap will be totally non-existent in ten years’ time.
Insurers will not be as free to place annual spending caps as they are now, and these will no longer be allowed altogether by 2014; neither will they be allowed to drop policyholders when they get sick. The will, however, be required to show the details of their administrative and executive expenses, and they are required to put an appeals process in place to determine coverage and claims on all new plans.
The debate over the health reform bill went on for about a year before it was finally signed into law in March 2010. The bill contains a number of provisions that will take effect at various times: some will be effective at the enactment of the bill, while others have timelines that will see actual implementation in nine days, six months, and two four years hence.
The bill has ten titles, and below are the key provisions that are to go into effect immediately.
The enactment of HR 3590 has authorized the Food and Drug Administration to approve generic versions of biologic drugs. The agency can also allow biologic manufacturers exclusive use of these drugs for 12 years before the development of generics.
The percentage of Medicaid drug rebate for brand name drugs has been increased to 23.1%, and this rebate is now included in Medicaid managed care plans. For non-innovator, multiple source drugs, the Medicaid rebate increased to 13.1% of average manufacturer price.
In addition, research on Comparative Effectiveness is to be supported through the establishment of the non-profit Patient-Centered Outcomes Research Institute. Task forces on Preventive Services as well as Community Preventive Services will be established. These will take care of the development, updating and dissemination of recommendations regarding clinical and community prevention services.
Ninety days after enactment – on June 21st – adult Americans who have pre-existing conditions will be given the opportunity to belong to a temporary high-risk pool. This arrangement, however, will eventually be superseded by a health care exchange that will take effect in 2014.
While President Barack Obama was making his bid for the presidency, one of the things that he made clear was that he was going to prioritize fixing health care if he makes it to the White House. And that he did, formally taking the first step on the road towards health care reform in March of 2009.
About a year later, H.R. 3590, the Patient Protection and Affordable Care Act (PPACA), was signed into a law.
The law had quite a journey before reaching this point. The President’s preference was for the reform to be enacted before Congress broke for summer recess, but this was not to happen. During this recess, Congress members went home to gather the opinion of their respective constituents regarding the proposed reform through town halls. It was also at this time that the Tea Party movement and other conservative groups voiced out their opposition to the proposals, and they made his opposition known through the town halls.
A year-long series of debates and negotiations, tweaks and overhauls, soon followed. The Senate voted in favor of ending the debate on December 23, and passed their bill the day after. Up until January, however, things were still not set in stone for health care reform. Eventually, the House decided to give up its bill, the Affordable Health Care for America Act, and pass the Senate bill instead.
The House passed the bill on March 21, 2010, and the President signed it into law on March 23.
