National Health Care Legislation

March 29, 2010

By Padmini Arhant

Last week, President Barack Obama and the Democrats in Congress achieved a historic victory in passing the health care legislation.

The legislative components and the effective period are presented below:

According to the New York Times report March 22, 2010

By Robert Pear and David M. Herszenhorn – Thank you.

Source: Speaker of the House, Congressional Budget Office, Kaiser Family Foundation, MCCLATCHY – TRIBUNE

HIGHLIGHTS OF THE HEALTH CARE OVERHAUL LEGISLATION, WHICH WILL:

1. 90 days after enactment: Provide immediate access to high-risk pools for people with no insurance because of pre-existing conditions.

2. 6 months after enactment:

Bar insurers from:

Denying people coverage when they get sick

Denying coverage to children with pre-existing conditions

Imposing lifetime caps on coverage

Require insurers to:

Allow young people to stay on their parents’ policies until they turn 26

3. Within a year: Provide a $250 rebate to Medicare prescription drug beneficiaries who reach the coverage gap called the “doughnut hole”

4. Jan 1, 2011: Require individual and small group market plans to spend 80 percent of premium dollars on medical services; large group plans would have to spend at least 85 percent

5. 2013: Increase the Medicare payroll tax on dividend, interest and other unearned income for singles earning more than $200,000 and joint filers making more than $250,000

6. 2014: Provide subsidies for families earning up to 400 percent of poverty level ($88,200 a year for a family of four)

Require most employers to provide coverage or face penalties

Require most people to obtain coverage or face penalties

7. 2018: Impose 40 percent excise tax on high-end insurance policies

8. 2019: Expand health insurance coverage to 32 million people

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Late deals added to bill’s revisions – By Alan Fram Associated Press – March 22, 2010 – Thank you.

The latest changes to the bill include:

Tax-exempt insurers would have to pay a new fee levied on insurers on only half their premiums.

An Aug.1, 2010, deadline on new doctor-owned hospitals to apply to the government for eligibility to serve – and get paid for Medicare patients would be extended to Dec. 31.

A new 2.9 percent excise tax on medical devices would be lowered to 2.3 percent.

But it will be broadened to apply to some lower-cost devices it hadn’t initially covered, though hearing aids, contact lenses and other items would be excluded.
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Review and Analysis – By Padmini Arhant

There have been numerous questions by the anxious uninsured and they are being presented in this analysis.

Congressional Report dissection:

Clarification from the legislators would be helpful in understanding the criteria in the following categories:

1. 90 days after enactment: Provide immediate access to high-risk pools for people with no insurance because of pre-existing conditions.

From the concerned individuals – the uninsured with pre-existing conditions but are unsure of their acceptance in the high-risk pool due to variations in the health issue.

A. Who are the qualifiers under the ‘high-risk’ pool in the ‘insurers’ language?

B. Should the insured expect escalation in premium costs due to their ‘pre-existing’ diagnosis as compared to the healthy individuals?

C. If there is a difference in coverage costs; by what percentage will it affect them?

As per the Associated Press report, March 24, 2010 –

D. “But a provision to protect children in poor health has a gap. Insurers would still be able to deny new coverage to kids with health problems until 2014.”

Is it possible for these kids to access care under ‘high-risk’ pool, which is expected to be effective in three months from now, i.e. June 2010?

Therefore, specifics are required in this respect.
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2. 6 months after enactment – October 2010,

The legislative component reverses the status quo for those who are currently insured and,

A. Have difficulties on coverage during their illness including children with pre-existing conditions.

B. Parents are permitted to keep their adult offspring until age 26, on their policy.

C. It prohibits the insurers from limiting coverage and policy cancellation when the patients require treatment.

Unequivocally, it’s a crucial piece of legislation.

However, it could have been made effective immediately rather than a six months delay, due to the nature of the problem.

As it’s well known that in health situations, the cost and cure factor is dependent upon early intervention.
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3. Within a year i.e. in 2010 the legislation involves $250 rebate to Medicare prescription drug beneficiaries upon them reaching the ‘doughnut hole’ or the coverage gap –

Any financial relief to senior citizens and others dealing with enormous health care costs is a welcome change.

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4. Jan 1, 2011 – Enactment calls for ‘marketplace’ insurers to invest premium dollars on medical services by 80 percent for individuals and small plans, whereas the large groups by 85 percent respectively.

Monitoring is essential to ensure such practice among the insurers.

In the absence of oversight, the law would be redundant.

That’s why the independent and non-profit ‘National Consumer Health Rights Agency,’ would be ideal to deliver the service.

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5. 2013: Increase the Medicare payroll tax on dividend, interest and other unearned income for singles earning more than $200,000 and joint filers making more than $250,000

This was the proposal from the House of Representatives to generate revenue for the health care overhaul.

It appears to be preset to meet with the ‘PAYGO’ budgetary requirement to pay for expenditures with funds for the program in progress.

A prudent fiscal policy that is necessary to address the national deficit and approved by the Congressional Budget Office. It’s an important feature of this legislation.

The Republican opposition projected the negative implication of this particular rule on Medicare recipients quoting that ‘the Medicare quality would be affected.’ They need to explain their position.

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6. 2014: Provide subsidies for families earning up to 400 percent of poverty level ($88,200 a year for a family of four)

Require most employers to provide coverage or face penalties

Require most people to obtain coverage or face penalties

7. 2018: Impose 40 percent excise tax on high-end insurance policies

8. 2019: Expand health insurance coverage to 32 million people

In reference to Points 6, 7 and 8:

Perhaps, the funds from the Medicare payroll tax mentioned above are allocated for the subsidies and Medicaid beneficiaries.

Similarly, the 40 percent excise taxes on high-end insurance policies set up to eventually expand health insurance coverage to the targeted 32 million uninsured in 2019.

Again, the same reason stated under 2 C of the analysis, applies to these rules of law.

The people who can’t afford health insurance are most vulnerable to health problems that ultimately become the tax payer responsibility as experienced up until now.

Hence, the law being effective in 2014, four years away from the signed legislation and the reality of the 32 million people being covered in 2019 is a legitimate cause for disappointment among the uninsured.

The authorities owe a plausible explanation to the suffering population regarding the distant period setting for the effectiveness of the law, especially 2014 and 2019.

What is happening to this segment between now and then?

Are there provisions for tax credits to the middle class families and Medicaid expansion to cover the interim premium costs by the uninsured and the unaffordable groups in the society?

If so, how is it being paid for?

Since the revenue from Medicare payroll tax and the excise tax are scheduled in 2013 and 2018, to fund the federal subsidies to lower income families in 2014 and the 32 million uninsured in 2019 respectively,

The health insurance reform cannot be truly evaluated until after 2014.

Besides, the health insurance legislation based on ‘private for profit’ strategy is subject to market rates in 2014 and beyond.

Meanwhile, the legislation tackles the problems faced by the “insured” groups in the society that are significant and guaranteed to save lives.

According to the media reports, the House and the Senate leaders confirmed the available votes to implement a ‘Public Option’ in the health care legislation through reconciliation process within the year.

Indicating that – “We have the votes and we need the will to move forward.”

It’s the best hope for the average citizen in the health insurance reform, considering the anticipated changes becoming law not until 2014 and 2019.

Having passed the legislation, the lawmakers can amend the bill to accommodate the genuine requests from the average citizens for whom the reform was initiated.

It’s a matter of honoring the people’s will in a democracy.

Thank you.

Padmini Arhant

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