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 Health Care Reform

On March 23, 2010, President Obama signed into law the comprehensive health reform legislation: The Patient Protection and Affordability Act. This page will help to explain the new law, which includes provisions to expand coverage, control health care costs, and improve the health care delivery system. Read the full bills: the original bill, H.R. 3590 Patient Protection and Affordable Care Act, and H.R. 4872 Health Care and Education Reconciliation Act of 2010.

Table of Contents
How Will the Federal Law Impact Boston Residents
Important Changes in 2010
Changes By 2014
Important Current News
Highlighted Populations:
Women I Seniors I Early Retirees I Families I Children I Young Adults I African Americans I Latinos I Small Businesses I Rural Americans
Other Helpful Information about National Health Reform
Useful Links

How Will the Federal Law Impact Boston Residents?

Since 2006, Massachusetts has also been working to expand health insurance coverage (See Chapter 58 of the Massachusetts General Laws). With health reforms well underway in Massachusetts, the Boston Public Health Commission has published an easy-to-read fact sheet about how the national legislation will impact our state. Click here to read: How the Federal Health Care Reform will Impact Massachusetts.

How the final bill affects Massachusetts

  • The final bill provides Massachusetts with $2.15 billion to ensure we are not inadvertently punished for expanding health coverage before other states did. This is almost $2 billion MORE than the Senate bill provided and $850 million more than the House bill. This money will be used to protect and improve our regional health care, expand research, and both save and create jobs in Massachusetts. 
  • The final bill does NOT alter the Geographic Variation aspect of current Medicare law. This protects billions of dollars per year for our research hospitals. This victory was secured after many hours of internal debate, and by resisting a very aggressive push from those states that would have benefited greatly by our loss. If we had lost this issue, Massachusetts could have lost thousands of jobs very quickly and our health care system would have been harmed irreparably.
  • The final bill protects our Area Wage Index that will bring Massachusetts about $300 million per year from the federal government - funds we do not currently receive.
  • The final bill reduces the cut in Disproportionate Share Hospital payments AND retains language beneficial to Massachusetts. These provisions should protect millions of dollars paid to our hospitals that service our most vulnerable citizens – like Boston Medical Center and the Cambridge Health Alliance.
  • 70,700 small businesses will be helped by the reforms (see Small Business Majority).

The Patient Protection and Affordable Care Act (PPA), Pub. L. No. 111-148, includes a provision that clarifies the meaning of “medical assistance” in the federal Medicaid Act. The clarification confirms the original intent of Congress that states, in providing “medical assistance,” must operate their programs to ensure that beneficiaries actually receive covered services with reasonable promptness, not simply be reimbursed if they manage to acquire services on their own. Read More

 

The Mayor’s Health Line and its partners will continually provide updates about how the federal law will affect Boston and Massachusetts. We will also be posting news and updates on the Mayor's Health Line blog.

 

Important Changes in 2010

  • New help for some uninsured: People with a medical condition that has left them uninsurable may be able to enroll in a new federally subsidized insurance program that is to be established within 90 days (by June 2010).  
  • Discounts and free care in Medicare: The approximately four million Medicare beneficiaries who hit the so-called “doughnut hole” in the program’s drug plan will get a $250 rebate this year. Next year, their cost of drugs in the coverage gap will go down by 50 percent. Preventive care, such as some types of cancer screening, will be free of co-payments or deductibles starting this year. 
  • Coverage for kids: Parents will be allowed to keep their children on their health insurance plan until age 26, unless the child is eligible for coverage through a job. Insurance plans cannot exclude pre-existing medical conditions from coverage for children under age 19, although insurers could still reject those children outright for coverage in the individual market until 2014. 
  • Tax credits for businesses: Businesses (including non-profit organizations) with fewer than 25 employees and average wages of less than $50,000 could qualify for a tax credit of up to 35 percent of the cost of their premiums. 
  • Changes to insurance: All existing insurance plans will be barred from imposing lifetime caps on coverage. Restrictions will also be placed on annual limits on coverage. Insurers can no longer cancel insurance retroactively for things other than outright fraud. 
  • Government oversight: Insurers must report how much they spend on medical care versus administrative costs, a step that later will be followed by tighter government review of premium increases.  

Changes by 2014

 

While much of the law will be put into effect almost immediately, many of the law's changes won't actually begin until 2014. These include:

  • Implementing insurance marketplaces called "exchanges" (similar to the Massachusetts Connector)
  • Rules requiring insurers to accept all applicants, even those with health problems
  • An expansion of state Medicaid programs

 
For more current information and news coverage, check out the resource page at Community Catalyst, the link to their webpage is: http://www.communitycatalyst.org/projects/national_reform/right_now.
 

 

 

Highlighted Populations

 

 

 

 

WOMEN

 

  

 

 

  • Preventive care: Both private plans and Medicare will now cover the full cost of providing preventative services, such as screening services (mammographies and Pap smears) and immunizations.
  • Pre-existing conditions: Under the new reform legislation, insurers cannot deny individuals because of pre-existing conditions, such as a previous Cesarean section birth.
  • Maternity care: Insurers will now have to cover maternity care in basic insurance policies. Caps on maternity coverage, seen in some areas, will also be lifted.
  • Improved conditions for working mothers. Employers will be required to provide a reasonable break time for nursing mothers, along with appropriate space for those mothers to pump breast milk.
  • Gender rating removed. Gender rating will be eliminated in the group and individuals markets with the introduction of insurance exchanges. 

For more information:

Health Reform for Women

 

 

 

SENIORS

                

 

  • 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. 

For more information:

Health Reform for Seniors 

BPHC Fact Sheet: Health Reform for Seniors   

 

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EARLY RETIREES

 

 

  • Funds for early retirees: Provides $5 billion in financial assistance to employer health plans that cover early retirees. 
  • Insurance quality and security: Ensures that early retirees will always have guaranteed choices of quality, affordable health insurance, even if they retire early or lose access to employer-sponsored insurance. Exchanges are of particular benefit to Americans aged 55 to 64, fewer than half of whom work full-time.

For more information:

Health Reform for Early Retirees

 

 

FAMILIES

 

  • Tax credits: Provides tax credits to working families to make sure they can afford quality coverage.
  • Eliminates the "hidden tax" on families: Covers more Americans to reduce cost-shifting that increases premiums for insured Americans. To pay for the medical costs of the uninsured, medical providers pass these costs on to private insurers, which pass them on to families, increasing family premiums by, on average, about $1,000 a year.
  • Insurance quality and security: Creates state-based health insurance Exchanges to provide families with the same private insurance choices that the President and Members of Congress will have, including multi-state plans to foster competition and increase consumer choice. Ensures that families always have guaranteed choices of quality, affordable health insurance whether they lose their job, switch jobs, move or get sick, through the creation of Exchanges.

For more information:

Health Reform for Families

The Georgetown Center for Children and Families has produced an excellent summary of Medicaid, CHIP, and low-income provisions in health care reform and a timeline of the key health reform dates for children and families.

 

CHILDREN

 

  • 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.

For more information:

Health Reform for Children

NEACH has created an overview of some of the key health reform provisions that affect children.

 

YOUNG ADULTS

 

  • 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.

For more information:

Health Reform for Young Adults

 

 

AFRICAN AMERICANS

 

  • 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, which help the nearly 50 percent of African Americans who suffer from a chronic disease.
  • Fight health disparities: Moves toward elimination of disparities that African Americans 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.

For more information:

Health Reform for African Americans

 

 

LATINOS

 

 

  • 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.

For more information:

Health Reform for Latinos

 

 

SMALL BUSINESSES

 

  • 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.

For more information:

Health Reform for Small Businesses

 

 

RURAL AMERICANS

 

 

Lower health care costs in rural areas: Creates state-based health insurance Exchanges to provide the same private insurance choices that the President and members of Congress will have, including multi-state plans to foster competition and increase consumer choice. In many rural states, one insurance company dominates more than 80 percent of the market, meaning that there are often only one or two insurance companies offering health plans in the individual and small group markets.

Increase in rural health care workforce: Invests in the health care workforce to ensure that people in rural areas have access to doctors, nurses, and high quality health care. Beginning next year, the Act will provide funding for the National Health Service Corps ($1.5 billion over five years) for scholarships and loan repayment for primary care practitioners, including doctors and nurses, who work in areas with a shortage of health professionals.

Protects access to care in rural communities: Ensures that hospitals and other providers in rural and remote communities receive the reimbursement they need to offer quality care to patients and keep their doors open. Ensures that rural health care providers receive appropriate Medicare reimbursements to address longstanding inequities that exist among providers from different geographic regions. Helps the many small and rural communities where patients must travel long distances between health care providers to receive medical care.

For more information:

Health Reform for Rural Americans

 

Other Helpful Info About National Health Reform

Thanks to our partners at the Massachusetts Law Reform Institute for these important links:

03/22/2010 EOHHS

Read More

 
03/24/2010 Kaiser Family Foundation

Useful summary in side-by-side format of the Senate Health Reform Bill and the House Reconciliation (fix) Bill. Read More

12/01/2009 Simon Lazarus; American Constitutional Society

From the introduction to the paper: "Recently, some opponents of comprehensive health insurance reform have introduced a new contention - namely, that a cornerstone of the reform bills pen Read More 

A perspective written by Jon Kingsdale, executive director of the Massachusetts Health Connector, the state agency spearheading the drive for universal health coverage.
 
Your Questions Answered: for small businesses, parents, consumers, and seniors.
Healthreform.gov
 
04/30/2010 ProgramsAssociation of Maternal and Child Health Programs
 
04/30/2010 National Conference of State Legislatures
 
04/30/2010 The Commonwealth Fund
 
Timeline of Health Reform Implementation
04/30/2010 Ropes and Gray LLP
 
04/30/2010 National Association of Community Health Centers
 
Congressional Testimony on Health Reform
04/30/2010 National Association of Community Health Centers
 
Health Care Research
04/30/2010 National Association of Community Health Centers
 
Mandatory Health Insurance: Is It Consitutional?
04/30/2010 American Constitution Society for Law and Policy
 
Helping People with Long-Term Care Needs: An Insurance Program to Help People Afford Long-Term Services and Supports discusses the Community Living Assistance for Services and Supports (CLASS) program, a new, voluntary, public long-term services insurance program that is part of health reform. (Updated April 2010).
04/30/2010 Families USA
 
 
Helping People with Long-Term Health Care Needs: Improving Acces to Home- and Community-Based Services in Medicaid
04/30/2010 Families USA
Read More
 
What Will the New Health Reform Law Do in the First Year? discusses how health reform will help people with pre-existing conditions, young adults, people on Medicare, small businesses, community health centers, and others in its first year (April 2010).
04/30/2010 Families USA
 
04/30/2010 Ropes and Gray LLP

 

Useful Links

Kff.org: The Kaiser Family Foundation Web site has a lot of thorough information. To get started, under "New & Noteworthy," click on "summary of the law" for a good synopsis, and on "timeline" to see when various provisions of the law are scheduled to kick in.
 
Familiesusa.org: Families USA is a nonprofit advocacy organization for health-care consumers. Click on the link to "Health Reform Central" to see just about everything you need to know about the new law. To get a recap of the major changes, click on the link that begins "Help is on the way" on the homepage.
 
Healthinsuranceproviders.com: Click on "Health Care Reform" to see a timeline that's less descriptive than Kaiser's, but easier to grasp visually. The site belongs to an online insurance broker; if you're looking for health insurance, be sure to shop around other sites and brokers.
 
Whitehouse.gov/health-insurance-consumer-protections: This is straight from the Obama administration. Keep in mind, it helped write the law. Tune out the superlatives and compare the information with the facts from advocacy groups such as Medicare Rights Center.
 
Consumerreports.org/health: From Consumer Reports, a range of useful information. Scroll to the bottom of the page, and click on "Health-care reform."
 
Bankrate.com: From a Web site where borrowers hunt for low mortgage rates and savers look for high-interest CDs, there's a summary with a good focus on costs. Type "reform" into the search box, and click on "What's in it for you."
 
Marchofdimes.com: The March of Dimes summarizes key new provisions for women and children. Click on "In the news."
 
 
Whitehouse.gov/healthreform: Putting Americans in Charge of Their Health Care is the White House's online center for all things health reform. Whether you own a small business, have private health insurance, or have Medicare, this website provides a variety of helpful materials, including details on what's in the law, a list of the law's immediate benefits, and frequently asked questions about the health reform.
 
Medicarerights.org: The Medicare Rights Center summarizes key new provisions for seniors; click on the big box that says "learn more about health reform and Medicare."
 

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