Wednesday, March 24, 2010


Thanks to my friend Ed Tubbs, who lives in Palm Springs, California, I received the following complete and accurate description of what is in the Health Care Reform bill and not the garbage Fox News, the Republican Party and Rush Limbaugh are peddling to the American public.

Factbox: Details Of Final Healthcare Bill (Reuters)

- The House of Representatives approved a sweeping $940 billion healthcare overhaul on Sunday in a two-step process that sends a Senate version of the bill to President Barack Obama for his signature and a package of changes sought by Democrats to the Senate bill.The package of changes now go to the Senate for approval. The Senate is expected to take it up this week. If it passes unchanged it will then go to Obama for his signature. If any changes are made by the Senate, the package of changes will have to go back to the House for further action.

The legislation aims to extend coverage to 32 million uninsured people. Here are key provisions of the Senate-passed legislation and the proposed changes.

INSURANCE MARKET REFORM The legislation would require substantial insurance market reforms that would bar insurers from excluding people for pre-existing medical conditions and prevent them from arbitrarily dropping policy holders.Insurance exchanges would be created in which small businesses and individuals without employer-sponsored coverage would be able to shop for coverage. Plans offered on the exchange would have to meet minimum benefit requirements.The proposed changes would allow dependent children to remain on their parents' health policies until age 26.The Senate bill also requires insurers to spend at least 85 cents of every premium dollar on medical care in small group markets and 80 cents in large group markets. The proposed changes also would require Medicare Advantage insurers to spend at least 85 percent of revenues on medical care.

COVERAGE MANDATES, SUBSIDIES AND MEDICAID Individuals would be required to obtain health insurance. Those who fail to obtain coverage would face fines of up to 2.5 percent of income by 2016.Firms with more than 50 workers who do not offer medical coverage could face fines of $2,000 per full-time employee.Federal subsidies would be provided to help people with incomes up to 400 percent of the poverty level purchase coverage on the exchange. Proposed changes would sweeten those subsidies for lower income people.Medicaid, the government health insurance program for the poor, would be available to everyone with incomes up to 133 percent of the poverty level, which stood at $10,830 for an individual and $22,050, for a family of four. Many states have eligibility requirements below those levels.The proposed changes would get rid of a special deal in the Senate bill that would have provided more money to Nebraska to cover costs of increased Medicaid coverage.

FINANCING The final proposal makes some adjustments to the revenue measures in the Senate-passed bill.The Senate bill included a 40 percent excise tax on high-cost health insurance plans. The proposed changes would delay implementation of the tax until 2018 instead of 2013. The tax would kick in on plans costing $10,200 for individuals and $27,500 for family coverage. A higher threshold is allowed for plans covering mostly women, older workers and retirees as well as those in high-risk professions.The bill calls for raising the payroll taxes for Medicare, the government health insurance plan for the elderly and disabled, to 2.35 percent from the current 1.45 percent for individuals earning $200,000 or more and for couples earning $250,000 or more. The proposed changes would apply the tax at a rate of 3.8 percent to some investment income for those high-income groups.The bill imposes fees on medical device manufacturers, insurance providers and brand-name pharmaceuticals. The proposed changes would delay implementation of those fees.It also puts a 10 percent tax on indoor tanning services that use ultraviolet lamps goes into effect on July 1.
MEDICARE The legislation would freeze payments to insurers that provide coverage to Medicare patients in 2011 and begin reducing the subsidy in 2012.It would also gradually close the gap in drug coverage for Medicare beneficiaries by 2020. Those who enter the coverage gap, the so-called doughnut hole, in 2010 will get a $250 rebate. In 2011 they would get a 50 percent discount on brand-name drugs.Factbox: Healthcare Bill Would Provide Immediate Benefits(Reuters) - The House of Representatives on Sunday approved a sweeping overhaul of the $2.5 trillion healthcare system and forwarded some finishing touches to the Senate for consideration this week.Here is what to expect if the Senate passes the House's changes and President Barack Obama signs the entire package into law.

WITHIN THE FIRST YEAR OF ENACTMENT* Insurance companies will be barred from dropping people from coverage when they get sick. Lifetime coverage limits will be eliminated and annual limits are to be restricted.* Insurers will be barred from excluding children for coverage because of pre-existing conditions.* Young adults will be able to stay on their parents' health plans until the age of 26. Many health plans currently drop dependents from coverage when they turn 19 or finish college.* Uninsured adults with pre-existing conditions will be able to obtain health coverage through a new program that will expire once new insurance exchanges begin operating in 2014.* A temporary reinsurance program is created to help companies maintain health coverage for early retirees between the ages of 55 and 64. This also expires in 2014.* Medicare drug beneficiaries who fall into the "doughnut hole" coverage gap will get a $250 rebate. The bill eventually closes that gap which currently begins after $2,700 is spent on drugs. Coverage starts again after $6,154 is spent.* A tax credit becomes available for some small businesses to help provide coverage for workers.* A 10 percent tax on indoor tanning services that use ultraviolet lamps goes into effect on July 1.

WHAT HAPPENS IN 2011* Medicare provides 10 percent bonus payments to primary care physicians and general surgeons.* Medicare beneficiaries will be able to get a free annual wellness visit and personalized prevention plan service. New health plans will be required to cover preventive services with little or no cost to patients.* A new program under the Medicaid plan for the poor goes into effect in October that allows states to offer home and community based care for the disabled that might otherwise require institutional care.* Payments to insurers offering Medicare Advantage services are frozen at 2010 levels. These payments are to be gradually reduced to bring them more in line with traditional Medicare.* Employers are required to disclose the value of health benefits on employees' W-2 IRS forms.* An annual fee is imposed on pharmaceutical companies based on market share. The fee does not apply to companies with sales of $5 million or less.

WHAT HAPPENS IN 2012* Physician payment reforms are implemented in Medicare to enhance primary care services and encourage doctors to form "accountable care organizations" to improve quality and efficiency of care.* An incentive program is established in Medicare for acute care hospitals to improve quality outcomes.* The Centers for Medicare and Medicaid Services, which oversees the government programs, begin tracking hospital readmission rates and puts in place financial incentives to reduce preventable readmissions.

WHAT HAPPENS IN 2013* A national pilot program is established for Medicare on payment bundling to encourage doctors, hospitals and other care providers to better coordinate patient care.* The threshold for claiming medical expenses on itemized tax returns is raised to 10 percent from 7.5 percent of income. The threshold remains at 7.5 percent for the elderly through 2016.* The Medicare payroll tax is raised to 2.35 percent from 1.45 percent for individuals earning more than $200,000 and married couples with incomes over $250,000. The tax is imposed on some investment income at a rate of 3.8 percent for that income group.* A 2.9 percent excise tax is imposed on the sale of medical devices. Anything generally purchased at the retail level by the public is excluded from the tax.

WHAT HAPPENS IN 2014* State health insurance exchanges for small businesses and individuals open.* Most people will be required to obtain health insurance coverage or pay a fine if they don't. Healthcare tax credits become available to help people with incomes up to 400 percent of poverty purchase coverage on the exchange.* Health plans no longer can exclude people from coverage due to pre-existing conditions.* Employers with 50 or more workers who do not offer coverage face a fine of $2,000 for each employee if any worker receives subsidized insurance on the exchange. The first 30 employees aren't counted for the fine.* Health insurance companies begin paying a fee based on their market share.

WHAT HAPPENS IN 2015* Medicare creates a physician payment program aimed at rewarding quality of care rather than volume of services.

WHAT HAPPENS IN 2018* An excise tax on high cost employer-provided plans is imposed. The first $27,500 of a family plan and $10,200 for individual coverage is exempt from the tax. Higher levels are set for plans covering retirees and people in high risk professions.Q+A: How Does Healthcare Overhaul Affect Medicare?(Reuters) - The sweeping healthcare overhaul the House of Representatives approved on Sunday includes about $455 billion in spending cuts for Medicare and other federal health programs over the next 10 years.Here are some questions and answers about how the reforms will affect the Medicare healthcare program for the elderly.

WILL THE LEGISLATION CUT MEDICARE BENEFITS? There are no cuts to the traditional Medicare benefit. The lion's share of spending cuts are in Medicare Advantage -- a program that uses private firms such as Humana and UnitedHealth Group to deliver Medicare benefits. Many of these providers offer extra coverage and some of those extras could be dropped as Medicare Advantage subsidies are bought more in line with the cost of traditional Medicare benefits. Medicare Advantage payment rates will be frozen in 2011 and then gradually reduced giving companies time to adjust to the changes.

ARE THERE ANY MEDICARE BENEFIT CHANGES IN THE BILL? Yes. Medicare will begin paying for annual wellness visits and increase reimbursements for primary care physicians. Currently Medicare only pays for a general checkup when someone first enters the program and many health analysts believe regular check ups would help improve the overall health of elderly people and provide for better coordination of care.Also the bill provides for an improvement in the Medicare prescription drug program. The current program includes a significant coverage gap that the legislation will eventually close. Currently people fall into this so-called doughnut hole falls after a total $2,700 is spent on drugs. Coverage begins again after $6,154 is spent.In 2010, people who fall into the doughnut hole will get a $250 rebate. In 2011, they will get a 50 percent discount on brand-name drugs. By 2020, the doughnut hole will have been closed and 75 percent of drug costs will be covered.

HOW DOES MEDICARE ACHIEVE OTHER SAVINGS? The legislation aims to capture productivity savings in the health system to save Medicare money.Studies have shown huge cost variations in different parts of the country with little difference in health outcomes. The legislation provides for Medicare to test payment systems that are thought to promote better coordination and efficiency of care while maintaining or improving the quality of care.Lawmakers hope the program will save billions of dollars by avoiding duplication of services and by providing better coordination of care for people with chronic conditions. The main aim of these delivery system reforms is to reward a quality of care rather than a quantity of services.The bill also establishes an independent payment advisory board that will make recommendations on how to save money in Medicare and extend the financial solvency of the program.The bill also provides more money to fight Medicare fraud.

WHAT HAPPENS ON THE MEDICARE PAYROLL TAX? Most taxpayers will not pay the higher Medicare payroll tax. The bill calls for raising the tax to 2.35 percent from the current 1.45 percent for individuals earning $200,000 or more and for couples earning $250,000 or more. The legislation would also apply the tax to some investment income for those high-income groups.(Reporting by Donna Smith; Editing by Deborah Charles)© Thomson Reuters 2009 All rights reservedU.S. Employer Healthcare Costs Up 7.3 Percent In 2009(Reuters) - Average healthcare costs for U.S. employers rose by 7.3 percent in 2009, surpassing inflation and the growth rate in overall healthcare spending, Thomson Reuters reported on Monday.Overall U.S. healthcare spending, including Medicare, Medicaid, and other payers, grew by 4.8 percent in 2009, the report found."In a year when inflation was non-existent, employer healthcare costs continued to surge," Chris Justice of the Healthcare & Science business of Thomson Reuters, who wrote the report, said in a statement."This analysis puts the real-world healthcare challenges facing employers into perspective. These cost increases have come at a particularly difficult time for U.S. companies."Justice and his colleagues analyzed National Health Expenditures data from the Center for Medicare and Medicaid Services Office of the Actuary for the report, available hereThey said the year-over-year increase compared to a rise of 6.1 percent in 2008.The team at Thomson Reuters, parent company of Reuters, analyzed insurance claims data for 144 small, medium-sized, and large companies that provided health benefits to 9.5 million people.Smaller employers with 5,000 or fewer workers saw costs rise the most, with healthcare spending up 9.8 percent.Medium-sized employers of 5,000 to 50,000 people had a 10-percent rise in costs compared to 6.5 percent in 2008. For large companies with more than 50,000 employees, costs rose 5 percent in 2009, down from 5.8 percent in 2008.


Jeanne said...

This was EXCELLENT. It's too bad the bullies in this country want to lie about exactly what this bill is all about. The people it will hurt and the bully insurance companies. It will keep them from continuing to rape the American people. Sad. They have stolen so much money that they can put that to "spinning" what this is all about. This explanation keeps it simple and I thank you.

Bill Corcoran said...

Jeanne: I thought it was excellent too and that is why I posted in on the blog. Thanks for your comment.