Health Care Reform

• Preventive Services: From annual checkups to cancer screenings, many preventive services will be free for those who receive Medicare.  No co-pays or deductibles will be required.  By fall of 2011, Medicare patients will have access to a comprehensive health risk assessment and a free personalized prevention plan to help them and their doctors continue to focus on wellness instead of just illness.
  
• Prescription Drug Benefits: Currently, Medicare helps pay up to $2,830 a year for drugs. The coverage stops at that level until the bill for drugs reaches $6,440. This design leaves the recipient responsible for all drug costs between $2,830 and $6,440 annually, leaving a “doughnut hole” in the reimbursement scheme. The new law will close this gap for Medicare prescription drug plans by 2020 through a series of reforms, beginning in July 2010. This year, seniors who fall into the “doughnut hole” will receive a $250 rebate from the federal government. In 2011, they will receive a 50 percent discount on brand-name drugs. Also, seniors will receive a 7 percent discount on generic drugs, which will increase 7 percent every year thereafter. About 80,700 Massachusetts seniors will see their prescription drug coverage improve. .
  
• Medicare Advantage: Beginning in 2012, the law reduces overpayments to Medicare Advantage insurance plans by $132 million over 10 years. This change could cause some insurers to reduce some of the benefits they offer – gym memberships, free eyeglasses and other perks. Others may choose to leave this market, which would require some seniors to have to switch coverage. There are about 198,000 Massachusetts residents enrolled in Medicare Advantage. If you are concerned about changes in your coverage, please call the numbers listed at the bottom of this fact sheet for assistance. 

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• Eliminates pre-existing exclusions for children: Prohibits health insurers from excluding coverage of children because of preexisting conditions, starting this year.
• CHIP extensions and additions: Extends federal funding for the Children’s Health Insurance Program (CHIP) through September 30, 2015, and provides states with additional funding to ensure children have access to this proven successful program. Increases outreach and enrollment grants to help reach more eligible children.
• Pediatric benefits must include oral and vision coverage: Requires coverage of not only basic pediatric services under all new health plans, but also oral and vision needs, starting in 2014. Many health plans do not provide coverage for needed child health services, and 12 percent of children have not had a doctor’s visit in the past year.
• Pediatric health care quality initiatives: Develops children’s quality priorities and promote children’s quality measurement and reporting to improve the care that our nation’s children receive. A recent study found that children receive recommended care less than half of the time. Provides $25 million in funding for the Childhood Obesity Demonstration Project, which was established through the Children’s Health Insurance Program (CHIP) legislation signed by President Obama. The Secretary of Health and Human Services will award grants to develop a comprehensive and systematic model for reducing childhood obesity.
• Coverage for children aging out of foster care: Makes mandatory the current state option to extend Medicaid coverage up to age 26 to foster children who have aged out of the foster care system, effective 2014. Children aging out of the foster care system face many challenges, including finding quality, affordable health insurance.

• Tax credits: Provides premium tax credits for young adults making up to roughly $43,000 a year to ensure that they can afford quality coverage in the new state-based Health Insurance Exchanges which start in 2014.
• Dependent coverage extension: This year, allows young adults to stay on their parents’ health care plan until age 26. (This applies to all plans in the individual market, all new employer plans, and existing employer plans if the young adult is not eligible for employer coverage on his or her own. Beginning in 2014, children up to age 26 can stay on their parent’s employer plan even if they have an offer of coverage through their employer.) This will help cover the one in three young adults who are uninsured.
• More affordable choices: Creates state-based health insurance Exchanges so young adults have a variety of options to decide how much health care coverage they want, including a lower-cost “young invincible” coverage option for individuals under 30 years old.

• Medicaid funding for Puerto Rico and the territories: Includes $6.3 billion in new Medicaid funding for the territories and Puerto Rico. In addition, Puerto Rico may establish a Health Care Exchange and receive $1 billion for subsidies to individuals and families of modest means who participate in the exchange.
• National Institute of Minority Health: Elevates the National Center on Minority Health and Health Disparities at the National Institutes of Health from a Center to a full Institute, reflecting an enhanced focus on minority health. Codifies into the law the Office of Minority Health within the Department of Health and Human Services (HHS) and a network of minority health offices within HHS, to monitor health, health care trends, and quality of care among minority patients and evaluate the success of minority health programs and initiatives.
• Chronic disease control: Invests in care innovations such as community health teams to improve the management of chronic disease.
• Fight health disparities: Moves toward elimination of disparities that Latinos currently face both in their health and in their health care by investing in data collection and research about health disparities. Expands initiatives to increase the racial and ethnic diversity of health care professionals and strengthen cultural competency training among health care providers.

• Increases quality, affordable coverage options for employers: Provides small business with up to 100 employees access to state-based Small Business Health Options Program (SHOP) Exchanges. These Exchanges would include web portals that provide standardized, easy-to-understand information that make comparing and purchasing health care coverage easier for small business employees, and reduce the administrative hassle that small businesses currently face in offering plans. Allows small businesses growing beyond the upper employee limit in the SHOP Exchange to continue to purchase health insurance through the Exchange.
• Small business tax credits: Provides tax credit to small employers with fewer than 25 full time equivalent employees and average annual wages of less than $50,000 that purchase health insurance for employees. The maximum credit will be available to employers with 10 or fewer full time equivalent employees and average annual wages of less than $25,000. To be eligible for a tax credit, the employer must contribute at least 50 percent of the total premium cost.
• Employer responsibility exemptions for small firms: Exempts all firms that have fewer than 50 employees – 96 percent of all firms in the United States or 5.8 million out of 6 million total firms – from any employer responsibility requirements. These 5.8 million firms employ almost 34 million workers.
• Workplace wellness grants: Authorizes grants to help small business employees participate in comprehensive workplace wellness programs.