06 May 2010

Health Care Reform - Understanding the Details


Amazingly many older Americans remain confused and fearful about what health care reform means and how and when the changes will become effective.  Here, from the Kaiser Family Foundation, are some highlights to answer those questions:

1) By 2014 most people will be required to have health insurance.  Those not qualifying for hardship exemptions and decline to buy insurance will be assessed a penalty.

2) Those lacking access to health care will be able to get coverage through a health Insurance Exchange with subsidies guaranteeing affordability.  Small business owners will also have access to similar exchanges.  Each exchange must include at least two multi-state and one non-profit option.  Optional levels of coverage will be offered with premium subsidies for families at up to 400% of the poverty level (currently $88,000).

3) Employers with 51 or more employees can choose not to provide health insurance, however they will be assessed a penalty for each employee receiving subsidized insurance through an exchange.  No mandate requires employers to provide insurance!  But, those who decline will find that there is a cost attached to their decision.

4)  New regulations will prohibit insurance companies from denying coverage for pre-existing conditions or for jacking up premiums based on gender or current or previous health status.

5) Medicaid will expand to 133 percent of the federal poverty level (currently $29,327) for a family of four.

6) Lifetime limits on health care coverage will be banned.  No longer will catastrophic illness, disease or accident mean bankruptcy!

7) Dependent adults will remain covered under their parent's policies up to age 26.

8) Seniors should know that there are no death panels and that such decisions will remain between patient, family, clergy of choice and health care professionals.

9) Older Americans will benefit from the bill's ending of over payment to Medicare Advantage plans,  phased elimination of the Part D "doughnut" hole,  elimination of co-payments for "wellness" and "preventative" treatments, and provisions providing support and assistance to those elders who choose to "age in place".

The Christian Science Monitor reports, "Buried within the ..health care reform law is a small provision that in years to come could have a major effect on the kinds of treatments that American patients receive.

This provision requires the federal government to set up... a “Patient-Centered Outcomes Research Institute.” It sets aside $500 million in seed money for this new nonprofit organization, which is supposed to become a national guiding force for comparative effectiveness research.

Comparative effectiveness research takes a particular health problem, then pits different ways of treating that problem against one another, in an attempt to find which, if any, is a more effective way to maintain or restore patient health".

Meanwhile, as the question of cost was central to the debate, the Congressional Budget Office reports, "...the law will reduce the number of uninsured by 32 million people in 2019 and while the new health care legislation will tote a heft cost of $938 billion over ten years, the changes will act to reduce the deficit by $124 billion.

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