E-mail updates
Follow on Twitter
Subscribe to RSSBy Michelle Andrews
Kaiser Health News
Two years after its passage, the sweeping health care overhaul remains deeply controversial, with both political parties trying to use it to their advantage in the upcoming elections. As GOP lawmakers constantly deride "Obamacare" and threaten to repeal it, it’s easy to forget that implementation marches on, and a number of notable changes will take effect for consumers this year.
They will, that is, unless the Supreme Court strikes down some or all of the law, including the requirement that nearly everyone have health insurance beginning in 2014. If that happens, all bets are off. Provisions that have already taken effect -- such as allowing adult children to remain on their parents’ health plans until age 26 and the 50 percent discount on brand-name drugs for seniors who reach the so-called donut hole in their prescription drug plans -- could be rolled back, and provisions for 2012 cancelled. The court will hear arguments in the case later this month and a decision is expected this summer.
If the law stands, here are the major new provisions that will affect consumers this year:
Free contraception coverage
Starting in August, the Obama administration's new rules on contraceptive coverage that have generated such controversy take effect. That means that women in a new health plan or in an existing one that has changed its benefits enough to not be considered grandfathered under the law will be able to receive contraceptives without an out-of-pocket charge. In addition, these plans will have to provide a variety of basic women’s health services, including well-woman visits (breast exams, pap smears, etc); screening for gestational diabetes; HPV testing; counseling for sexually transmitted infections; counseling and screening for HIV; and screening and counseling for interpersonal and domestic violence.
Religious employers such as churches are exempt from the new requirement. Colleges, hospitals and other employers that are affiliated with religious institutions are not exempt, but employees at those institutions will receive free contraceptive services from their employer's insurer.
Religiously-affiliated employers have a one-year grace period to implement this change, so some employees may not receive the free benefit until August 2013.
Rebates for consumers
Under the health-care overhaul, insurers have to spend at least 80 to 85 percent of premium revenues on medical claims and quality improvement or else rebate the difference to policyholders. In most group plans, that would mean the employer.
How much consumers can expect to receive remains an open question. An analysis by the National Association of Insurance Commissioners, based on 2010 data, estimated that insurers would have returned $2 billion to consumers had the provision been in force then. The analysis said rebates would have gone to 53 percent of people in individual plans, 23 percent in small-group plans and 15 percent of large-group plan members.
In December, the Obama administration estimated that 9 million Americans might receive rebates totaling up to $1.4 billion, also based on 2010 data. The administration says some reports show insurers have been moderating their premium increases to avoid having to pay rebates. But other policy experts aren't so sure.
"My guess is that rebates will be higher [than the NAIC estimate] in 2011," says Timothy Jost, a law professor at Washington and Lee University who helped prepare the NAIC report. "Insurers seem to have raised their premiums based on projected increases in utilization that never occurred."
Clearer descriptions
Beginning in September, at the start of the open enrollment season, all health plans will have to provide concise, consistent plan information aimed at allowing consumers to easily understand their benefits and compare plans.
Every plan will be required to give people a short summary of coverage and a uniform glossary of terms. It will also have to provide examples of how much the plan would cover if someone had a baby or was managing Type 2 diabetes -- two common situations that should make it easier for people to compare plans.
"This is a big deal," says Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation. "Some of the materials people get explaining their health plan benefits are extraordinarily confusing, and this should make it clearer." (Kaiser Health News is an editorially-independent project of the Foundation.)
Shrinking doughnut hole
The health care overhaul is slowly eliminating the ‘doughnut hole.’ This is the break in Medicare prescription drug benefits that, in a standard plan, begins after total drug spending by the beneficiary and the health plan exceeds $2,930 and continues until the beneficiary has hit the $4,700 out-of-pocket limit.
Last year, Medicare beneficiaries with high drug costs got a 50 percent discount on brand-name drugs once they reached the doughnut hole. This year, they'll see a 14 percent discount on generic drugs as well.
Drug costs will continue to diminish in coming years, until in 2020 the doughnut hole no longer exists and Medicare beneficiaries with drug plans will simply be responsible for 25 percent of their drug costs.
'Accountable Care'
Last December, the administration announced that 32 health-care organizations would participate in a three-year Pioneer Accountable Care Organization programaimed at providing better, coordinated care for 860,000 Medicare beneficiaries. Providers -- including hospitals, clinics and physician groups -- that work together to improve beneficiaries' health and to bring costs down will share in the savings that they achieve.
Although Medicare beneficiaries may not realize that their health-care provider is participating in the program, they may start to notice changes in their care this year, says Debra Ness, president of the National Partnership for Women and Families. She leads the Campaign for Better Care, a coalition of organizations focusing on improving health-care delivery.
"For some of these folks, it may start to feel like they have a team working with them, or like their primary-care provider is developing an individualized care plan," she says. "Compared to what happens now, it could feel like a pretty big change."the
Leave a Comment:
Currently in Iowa, employers can define "full-time" any way they want, as long as they are consistent. This bill forces employers (including all employers with more than 20 employees) to define full-time by the number of hours worked. Right now, if our part-timers (many on SS who don't want to be full time) want a few extra hours when we're busy, we can let them have them without having to add extra people. In 2014 that will change. Because of this stupid bill, we will be forced by the government to tell those part-timers that they are out of luck. And I should say that our company doesn't have anyone part-time that wants full-time.
This entire bill sucks. Oh, and what this article also doesn't mention is that this bill requires ALL employers to provide a private, quiet place for women to breast feed. Now this is something that we would have done anyway if we were asked, but we had to move heaven and earth to make this happen.
This entire bill, along with being unconstitutional for the forced health-care mandate, is a job killer!!!
Nothing more than the people who to have and pay for insurance will get less (no) choice, worse care & service and higher costs so "we" (the government) can give basic (crappy) service to everybody else, scam/game the system to siphon off more money to waste elswhere & bribe others. So how long will it take for the government "Health Nazi's" to start using the power of guv-ment healthcare to start rationing care and punishing those whose behaviour it doesn't "approve" of?
Gender reassignment? (Free!) Your diabetic but we don't approve of your lifestyle? , drink and need a liver?, oh.....your a smoker?.....you first have to complete government mandated "training/re-education" etc. (no treatment for you until you make us happy......displease us and go die somewhere). How many loopholes to get "special" consideration and go to the front of the line?
I can see the HSA ( Health Safety Administration) at your door ; " We have determined that your smoking is endangering your life therfore we mandate that you cease smoking immediately upon penalty of a stiff fine". The government would be monitoring and controlling all behavior related to ones health, since w at that point would be government property (and there are lemmings that would be quite ok with this ). This law gets held up and pases thru the Supreme Court, and you might as well burn the US Flag and the Constitution in the same bonfire
Bill,
You do realize that what you are describing already happens, right? Insurance companies make you pay higher premiums if you are a smoker......
Bill...news flash....the government is and has been involved in just about every single thing you have ever done. Every building you walk in....meets government standards. Every sip of water you take....meets government standards. Every bite of food you take....meets government standards. Every pill, your clothes, your house, your car, your streets......
Government doesn't like what your kid brings into school for lunch...takes it away and gives kid Chicken Nuggets and Fries....
Limits..
Remember it was a DEMOCRAT, that put Japanese Americans in Concentration (oops I meant), Internment Camps, when the government has unlimited power, it stands to reason that they are unlimited as to what they can do TO you,
So...life is good when we have to work until we're in our mid 70's and THEN we lose our estates to pay for our hospital bills.
But if we allow our adult children to stay on our health insurance until they are 26 we lose our freedom.
Got it.
Thank God! This is the greatest of all achievements from the greatest president!!!!
I can't wait to see what he will do next!!!
4 more years!
Obama/Biden 2012 "We Got It Straight In 2008!!!"
Obama and Biden 2012 " Driving the Bus Straight To Hell"
Bill ... if you're going to make these kinds of comments, can you please include some supportive documentation. Please? Your remarks simply do not bring any value to the conversation. This process is called Op-Ed. It is an opinion complemented by an editorial supporting your opinion/views. Understand?
Obama and Biden--The Ren and Stimpy of D.C.
Am I reading this right that I pay the majority of my premium, my employer pays a small percentage or none of it but the employers are going to get billions of dollars of rebates? Man, some employers could really get rich off of this!
Let's get on with "Obamacare"-let's save money-what's to be afraid of? People are afraid of saving money?? c'mon!! I want better care for my future-this will be a great start! Quit whining because a black president got things going--I swear half of this country is racist in one way or another!!
Jade, I observe you as the racist here ,because your first defense of a law that a great many people do not like is that people don't like the law because it was signed by a blackl President? Hate white people much?
Yes Bill....let's continue with the current system...that status quo. That will work, right? Do you have a better solution Bill that covers all Americans?
More health care benefits and lower costs? Sounds real scary to me!
Bottom Line - All the demonizing and ranting by the conservative fanatics in this country has been wrong. The Health Care Reform Bill of 2010 has been good for this country. Finally we are trying to do something positive about health care and get it going and get the discussion going. Yes, there are a few things to work out....... but, the Health Care Reform Bill is not a 'House of Cards' (where one piece tumbles it down). It more like a complex puzzle where some pieces may not fit and need to be changed but the basic framework is there. And more work needs to be done on it. For Repubs though, whose only empty vision is to gain power, it has to be a 'House Of Cards' or they can't accomplish that and their warped vision of reality doesn't work. Unfortunately, they have used an (admittingly brilliant) smokes and mirrors campaign and demagoguery to fool scared and malleable people out there to agree with them on this.
I applaud the courage of President Obama in supporting it.
Yeah, that money would be SO much better spent on tax cuts for rich people and wars.
/sarcasm
If you drive a car, you need to buy insurance by law. Is that government intrusion? Really? Is car insurance unconstitutional? We all pay taxes by law. Is that unconstitutional?
Sure ... a lot of people don't drive, but smart people buy various types if insurances to protect themselves and their families against catastrophic events (e.g. life and homeowners insurance). The one thing that makes sense about mandated health insurance is that eventually EVERY ONE gets sick and/or dies, requiring health care. (Never mind the fact it USED to be a Republican idea.)
I moved back to Canada last year because I lost my health insurance in the US and had/have preexisting conditions which disqualified me from getting insured by any of the larger health insurance carriers. How pathetic is that? (BTW, I don't drink or smoke, nor am I obese or eat a lot of junk food.) I thank God every day that I had dual citizenship and now don't have to worry about going bankrupt due to a catastrophic illness or injury. The system here in Canada isn't perfect, but the World Health Organization ranks Canada much higher than the US, among other industrialized, civilized nations, and I don't have any complaints. All doctor visits are covered, as are surgical procedures. I've paid my employer-provided prescription deductible for the year, so now my 90-day prescriptions cost a $1 each, the pharmacy dispensing fee. If I didn't want to wait for certain elective surgical procedures, I could go outside of the government provided system and pay market rates here in Canada, or go to the US for treatment.
If the US is so giving when it comes to charitable donations around the world, financially supportive of questionable regimes, and so wasteful when it comes to waging un-winnable wars, why are they so resistant to taking care of their own citizens? It makes no sense. The only thing wrong with Obamacare is that it didn't go far enough. He should never have taken the single-payer system off the table in deference to the Republicans. And what have Republicans proposed in place of The Affordable Healthcare Act? NOTHING. I'm so sick of the Republican Party that whines about EVERYTHING Obama does or wants to do, and yet proposes nothing that benefits anyone other than the interests of corporations or the wealthy.
I'll tell you why Republicans are so afraid of universal healthcare ... because it will drive down the costs and eventually destroy the healthcare cartel. Middle class Americans would flock to the government-run exchanges in droves, and would realize there was nothing to be afraid of. In a free-market system, I don't understand why the government just doesn't build hospitals, hire healthcare personnel that aren't simply in it for the money, give Americans the choice and let them decide what they want for themselves, instead of being left out completely or manipulated by the current system. It's a shame that Republicans are such masterful fear-mongers.
grandall,
Great post!
Hmm what is required for an american to get access to Canada's health care system?
I'm afraid only citizenship or residency through employment. Even as a citizen, I had to wait 3 months for coverage to take effect once I moved back here. It's Canada's way of keeping Americans from crossing the border to sponge off the healthcare system here. And believe me, there are a lot of Americans living close to the border who manipulate and sponge off the system here. So don't believe everything you hear about Canadians flocking to the US for healthcare because the system is so bad here.
First of all stop collapsing peoples comments, this is an american website and every time you do that you are violating your own rights morons. Second of all healthcare has always been rationed by the health insurance companies, they are free to charge absurdly high premiums that most people cant afford, and for the ones who can afford it they constantly fight over having to pay for medical care that their own contracts cover. Health insurance companies also are free to charge absurd premiums and then refuse to pay for medical care for customers who have these mythical "pre-existing" conditions, yet the whole point of paying the premium is to have ACESS to medical care, not to only enrich a corporation and then be DENIED access to medical care. Health insurance companies are also free to completely deny coverage because of these mythical "pre-existing" conditions. I call them mythical because the term suggests the someone is responsible for choosing to suffer permanent damage and is thus not allowed access to healthcare for making that decision. This is a completely absurd notion. Since health insurance companies only care about making 100% profit off their customers while paying out 0% in medical care, they are lying about what kind of company they are and should be shut down for fraud. The fact that the knowledge and technology exists to fix health problems is completely pointless if people are denied access to it simply because they are not wealthy enough to pay a $1500.00 a month premium, or 100k or more in medical expenses.
Don't fool yourselves, people. This is not a great country. Not any more. We've put cost above caring. Bitch about the bill all you want... what we've got now is not just a failing system, it has FAILED. 99% of Americans are one car accident... one serious illness... away from becoming homeless due to the outrageous costs of health care and prescription medication. People don't drive in to Canada for the fresh air, y'know; pharmaceutical companies have made it an art form of ripping people off by jacking up the price of medications. Insurance companies practically pride themselves on sniffing out "pre-existing conditions" so they can disqualify someone from getting insurance. We are so far behind every other major country in terms of health care, but we don't even realize it and continue to tout America as "the best"!
Not cost profit, this country only cares about profit.
Standup............: yes, but Obama has done nothing to reduce run away healthcare costs. he has implemented a plan that has accelerated those costs. He ignored all suggestions that would have had an effect on reducing costs, because they came from republicans.
Steve ... the only Republican suggestion I am aware of is the Ryan plan that would change Medicare as we know it today. Doesn't the Ryan plan offer a $15K voucher to the elderly that they can use to go out to the market and try to secure a health insurance provider. Believe me, that voucher won't go very far given current and future projected healthcare costs. And it won't do them a bit of good if they have preexisting conditions that the insurance carrier doesn't like and subsequently denies them coverage. Or, needing one surgical procedure that would wipe out their entire health care "account" for the year (and then some) which would leave them spending potentially vast amounts of their retirement income, if they're lucky enough to have any at all.
Also, what can Obama do to effectively reduce healthcare costs? He doesn't declare or create the laws of the land. That is the job of the House and Senate. They vote and he signs bills into law, or vetoes them. Do you know nothing of how our government works?
The Dems controlled the house, senate and white house when this bill was passed and you ask what Obama could do to reduce costs? Really?
Lets see, we could have started with Tort reform, insurance reform, and immigration reform (to get illegals out of the system). None of these reforms would cost the tax payer a dime and would actually do something to reduce health care costs.
Insurance providers (which we will be forced to buy their product) and lawyers are the two biggest contributors to our health care crisis. But the government chose to ignore these two entities when looking for the solution.
I work in the healthcare industry. Doctors/Surgeons already limit the number of medicare, medicaid, tri-care patients they will see. Under Obamacare, this will only worsen. There are only two ways currently to lower costs; reduce reimbursement or ration care. Canada does both of these. If there is no incentive for the health care provider, there will be far fewer providers to chose from.
We do have the best health care in the world and that is why the world comes here for treatment - including Canadians. If you think the rest of the world has the better access to better care for less cost, you are delusional.
The system is in fact broken, but when you "have to pass the bill to know what is in it", I say "no thank you". Start over. Look at the real causes and get partisan politics out of it.
I hope Obama loses in November and has to take obamacare with him.
the congressional budget office just came out yesterday with a report that this wonderful healthcare plan will cost $1.76 trillion, not the $900 billion as advertised, over the next 10 years. This is more money added to the national debt. I'm sorry liberal socialists of America, but there is nothing free about all these free goodies the Obama administration has been promising you. Our nation will be $16.4 trillion in debt by November, and if Obama is reelected that debt will soar past $22 trillion. Can you see the end of a nation here?
It's a "sick" society that puts profit ahead of doing what's right. But America reaps what it sows in terms of its voting power. Two terms of Bush? Puh-leeze!!! Giving the Republicans the House in 2010? Puh-leeze!!! What have the Republicans done for middle class Americans or the economy since ... NOTHING! Their whole reason for existence for 3 years so far has been to complain about Obama and try to ensure he is a one-term President. Is that responsible governance? No way. What is wrong with 40% of Americans that they identify with and vote for this Party and their obsolete ideology?
Americans are so myopic (unable to see the big picture) and impatient (I want change and I want it now!) that they vote against their own collective best interests. I'll happily be watching the election from Canada this year. I hope the majority of Americans will rise up against corporate interests and vote in their own best interests.
the eight years of the Bush administration unemployment rates fluctuated in the 4% - 5% -6% range. The last month of his presidency it rose to 7.3%. Obama's 3 years have been 9% - 10 % -9% range, now 8.3%. GW Bush 2003 tax cuts went mostly to the lower and middle class. 47% of federal filers pay ZERO tax thanks to GW Bush. Look it up. By the way, the Clinton years, when there was a budget surplus, there was also a republican congress to create that surplus.
Unemployment was rising for the last TWO YEARS of the Bush presidency.
Along with personal bankruptcies, home foreclosures, bank failures, and any and all negative, measurable economic statistics.
You're entitled to your opinion, just not your own set of facts..
Universal health care! Don't you think that insurance companies that profit from the misfortune of others are disgusting? Don't you think that it is criminal to trick people with endless coverage scams? Anything that makes the insurance companies unhappy makes me happy.
Down with the insurance companies!
For those of you who only stay tuned to this liberal news media, you should go over to others and read that it has now been determined that this Obamacare is going to cost about 3 times as much as originally anticipated and we still have another 1 1/2 years before the really sick people are enrolled that do not currently have insurance and can't get it. Health care is going to go down the tubes folks and all because our administration decided that the insurance companies were the ones to protect in this whole mess when it is the insurance companies that have caused/are causing the whole mess to begin with.
m ... is that what the CBO is projecting? Or did you get your facts from some partisan source that supports your views? Also, if the insurance companies are the cause of runaway healthcare costs, why don't we dispose of them and implement a single-payer system? Or implement a government run system in tandem with the current system that will force current insurers to reduce costs to remain competitive?
BTW ... if there weren't liberals in this country, it would "progress" to a plutocracy (under Romney), or a theocracy (under Santorum). Pretty scary alternatives.
Why,?? because the health insurance lobby is well funded and VERY influential. On both sides of the political aisle.
Nothing happens in this country unless corporate America gets a cut. Usually, quite a large one. Not even medical care..
If these radical provisions are implemented, the health care (and therefore the health) of the American citizen is liable to get...... better! And less expensive!!! Can't have that!! Repeal! Repeal!!!
__________________________________________________________________
lol.
Lets stop all this B.S. Just take all of us over 70 and line use up against the wall, no more problem, untill all the young people and politicians get to be 70 then they will scream bloody murder.
Notice all the people screaming are the Government workers or the union people protected from the cradle to the grave, and these people call the rest of us liberal reds, because we paid into S.S. and Medic care all of our life's, now these same people who do not pay into this want to take it away. O happy day, what would happen if you paid in an insurance co. all you life and when you died the insurance co refused to pay, just because you got old. LOL,LOL,LOL.
Last year my health care insurance company increased my monthly premium by 33% and this January they raised my monthly premiun by 18% and it was stated on the increase notice that this increase was due to the new "Health Care Bill"
If you want socialized medical care with long waiting lines and substandard care that exactly what you'll get with ObamaCare! PERIOD!
I know, I'm in the healthcare industry!
To my friends in Illinois...."Vote Mitt Romney" for a stronger, safer, better America!
AND........ President Obama and his Democratic Socialistic Party would like all women to think that the GOP hates women....Pure Bull *#*@
Clean house-- Another Repub spewing more GOP c_____p
Rebate !Rebate the differance, come people, It sounds just like asking the Fox to gaurd the hen house!! . Sure we`ll rebate the differance, trust me we will.