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At a Glance: Historic Health Reform Legislation
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he Patient Protection and Affordable Care Act signed into law on March 23 includes a large number of health-related provisions to take effect over the next four years. The provisions include: n Expanding Medicaid eligibility. n Subsidizing insurance premiums. n Providing incentives for businesses to provide health care benefits. n Prohibiting denial of coverage/claims based on pre-existing conditions. n Establishing health insurance exchanges. n Supporting medical research. Changes coming soon Some near-term changes to expect : n An end to coverage denial due to pre-existing conditions and ending of coverage once people get sick. n Children can stay on their parents insurance until age 26. n No policy can be more than three times the lowest policy cost in its age band rating. n Insurance companies are subject to a tax if they do not expend 85 percent of their premium revenue on medical and related services. Future changes States will set up insurance exchanges so people can compare and shop for policies. In addition, people will be required to get health insurance or else face phased-in financial penalties. Similar penalties will be phased in for large employers who do not offer insurance to their employees. People with low incomes will receive premium subsidies.
Cost control measures in the bill include both positive and negative sides, such as: n Programs that provide incentives and support to improve quality of care. n Penalties for hospitals with high readmission rates. n Reduced reimbursement for some specialties, such as imaging and radiology, to discourage over-use. Medicare In terms of Medicare, the Act: n Starts to phase out the coverage gap under the Medicare prescription drug benefit, with a view to closing the gap by 2020. n Changes how Medicare Advantage payments are determined and creates an incentive system to reward high quality plans with higher payments. n Moves up reductions in payments to disproportionate-share hospitals to 2014 and reduces the cuts. n Changes the assumptions used to calculate Medicare reimbursement for advanced imaging services (assuming the machines are in use 75 percent of the time rather than 50 percent). n Increases funding for the Health Care Fraud Abuse Control program.
n Delays the effective date of the Community First Choice Option. n Changes state FMAP rates for newly eligible populations, and changes income counting rules for certain populations. n Increases the territories’ spending rate caps beginning with the second quarter of FY2011. n Provides additional program integrity funding through indexing of the Medicaid Integrity Program for fiscal years beginning with 2010. n Modifies Medicaid disproportionate-share hospital payment reductions. Coping with more access and demand To help cope with the demand expected from this expansion of access, and to encourage more doctors to enter the field and physicians to participate in the programs, primary care physicians will get higher reimbursements. There will also be workforce incentives, including loan repayment, for primary care physicians in underserved areas or in the expanded public health service corps. The number of available residency slots expands. Trauma and long-term care The Community Living Assistance Services and Supports, or CLASS Act, and the National Trauma Care Act Medicaid also were included in the new legislaIn terms of Medicaid and CHIP, the tion. The latter authorizes funding Act: support for trauma centers, while the CLASS Act provides the foundation n Increases primary care physician for more widespread purchase of payment rates for selected patient long-term care insurance to help peotreatments. ple care for the disabled. It has a voln Revises the definitionto make make the average manufacturer price more untary, long-term care program that closely reflect the manufacturers’ aver- pays cash to enrollees who suffer at least two limitations in daily activities, age prices. such as eating, bathing and dressing.