Make No Mistake About It, Health Care Reform is Coming...
The question which remains would be how to best fix the health care system. Some say it is broken, inefficient & generally a
complicated mess of private actors, third-party payers, public subsidies, and innumerable state and federal regulations? Shall we place our faith in the
government or in the free market? ObamaCare supporters argue that the answer lies in more government?More subsidies, more regulations, a law mandating
individuals buy health-insurance coverage and, of course, more taxes to pay for it all.
The alternative is to base reforms on what works in the other five-sixths of the U.S. economy, where choice and competition
increases quality while driving down prices over time. Can a market-based health care system work? We can begin to answer this question by looking at
Lasik, a medical procedure that's not covered by health insurance. And has gotten better?and cheaper?over time. "How to Fix Health Care" proposes three
simple reforms that will put us on a path to a health-care system that's better, more affordable, and more accessible. And get this, these market-based reforms
can be implemented without creating new government programs or raising taxes.
For a downloadable versions of this and other videos, please go to reason.tv
On March 23, 2010 the Affordable Health Care Act was signed into law by President Obama. This is the major
health care reform bill which many believe would expand health care coverage to 31 million currently uninsured Americans through a combination of cost
controls, subsidies and mandates. It is estimated to cost $848 billion over a 10 year period, but would be fully offset by new taxes and revenues and would
actually reduce the deficit by $131 billion over the same period. The Democratic Policy Committee has posted a summary and more information about the bill.
The Republicans have posted their own summary here.
The bill will not take full effect immediately but instead slowly take shape over the next 10 years with some of the bigger changes
happening in 2014. The bill is projected to give an additional 32 million Americans health-care, lower the cost of the current health care deficit, provide more
choices to the public, and make other health-care companies more accountable. With all the big terms surrounding the health-care industry it's easy for
anyone not familiar with it to get confused. The best way to overcome this is simply to educate yourself on the terms. Follow the link to start getting a grasp on
terms to the health-care industry.
Affordable Health Care Reform Quickbites #01 - INCREASING ACCESS TO AFFORDABLE CARE
The Affordable Care Act Becomes Law
March 23, 2010
On March 23, 2010, President Obama signed the Affordable Care Act. The law puts in place comprehensive health insurance reforms that
will roll out over four years and beyond, with most changes taking place by 2014. Others have already begun.
Affordable Health Care Reform Quickbites #02 - IMPROVING QUALITY AND LOWERING COSTS
Providing Small Business Health insurance Tax Credits
Effective Jan 1, 2010
Up to 4 million small businesses are eligible for tax credits to help them provide insurance benefits to their workers. The first phase of this
provision provides a credit worth up to 35% of the employer?s contribution to the employees? health insurance. Small non-profit organizations may receive
up to a 25% credit.
Affordable Health Care Reform Quickbites #03 - INCREASING ACCESS TO AFFORDABLE CARE
Allowing States to Cover More People on Medicaid
Effective April 1, 2010
States will be able to receive federal matching funds for covering some additional low-income individuals and families under Medicaid for
whom federal funds were not previously available. This will make it easier for states that choose to do so to cover more of their residents.
Affordable Health Care Reform Quickbites #04 - IMPROVING QUALITY AND LOWERING COSTS
Relief for Four Million Seniors Who Hit the Medicare Prescription Drug “Donut Hole”
First checks mailed in June 2010
and will continue monthly throughout 2010 as seniors hit the coverage gap. An estimated 3 million seniors will reach the gap in Medicare prescription drug coverage known as the "donut hole" this year. Each such senior will receive a $250 rebate.
What Is the Donut Hole?
It is the way Medicare drug coverage is structured, you?ll pay a portion of your drug expenses and your plan will pay the rest, up to a certain point ($2,830 in 2010).After the initial coverage limit is reached, the donut hole begins. During the donut hole, you will pick up 100% of the cost of your prescription drugs until you reach another threshold called the "catastrophic coverage". Sound's bad huh?!?! This threshold changes annually. In 2010, it is reached after your costs and the plan's costs total $6,440. After you've reached catastrophic coverage, your plan will start covering a portion of your drug expenses once more this time covering a much larger percentage of the cost (95%). Once you reach catastrophic coverage, the donut hole ends for the rest of the year, but you start all over again with the new year.
Affordable Health Care Reform Quickbites #05 - IMPROVING QUALITY AND LOWERING COSTS
Cracking Down on Health Care Fraud
Many provisions effective now
Current efforts to fight fraud have returned more than $2.5 billion to the Medicare Trust Fund in FY 2009 alone. The new law invests new resources and
requires new screening procedures for health care providers to boost these efforts and reduce fraud and waste in Medicare, Medicaid, and CHIP (Childrens
Health Insurance Program).
Affordable Health Care Reform Quickbites #06 - INCREASING ACCESS TO AFFORDABLE CARE
Expanding Coverage for Early Retirees
Applications for employers to participate in the program available June 1, 2010.
Learn more about the early Retiree Reinsurance Program.
Too often Americans who retire without employer-sponsored insurance and before
they are eligible for Medicare see their life savings disappear because of high
rates in the individual market. To preserve employer coverage for early retirees
until more affordable coverage is available through the new Exchanges by 2014,
the new law creates a $5 billion program to provide needed financial help for
employment-based plans to continue to provide valuable coverage to people who
retire between the ages of 55 and 65, as well their spouses and dependents.
Affordable Health Care Reform Quickbites #07 - INCREASING ACCESS TO AFFORDABLE CARE
Providing Access to insurance for Uninsured Americans with Pre-Existing Conditions
National program established July 1, 2010
A Pre-Existing Condition Insurance Plan will provide new coverage options to individuals who have been
uninsured for at least six months because of a pre-existing condition. States have the option of
running this new program in their state. If a state chooses not to do so, a plan will be established
by the Department of Health and Human Services in that state. This program serves as a bridge to 2014,
when all discrimination against pre-existing conditions will be prohibited. Learn more about the
Pre-Existing Condition insurance Plan.
Affordable Health Care Reform Quickbites #09 - INCREASING ACCESS TO AFFORDABLE CARE
Extending Coverage for Young Adults
Effective for health plan years beginning on or after September 23, 2010
Under the new law, young adults will be allowed to stay on their parents plan until they turn 26 years old (in the case of existing group health
plans, this right does not apply if the young adult is offered insurance at work.) Some insurers began implementing this practice early. Check with your
insurance company or employer to see if you qualify. Learn more about the young adult insurance policy.
Affordable Health Care Reform Quickbites #11 - NEW CONSUMER PROTECTIONS
Prohibiting Insurance Companies from Rescinding Coverage
Effective for health plan years beginning on or after September 23, 2010
In the past insurance companies could search for an error, or other technical mistake, on a customer?s application and use this error to deny
payment for services when he or she got sick. The new law makes this illegal. After media reports cited incidents of breast cancer patients losing coverage,
insurance companies agreed to end this practice immediately.
Affordable Health Care Reform Quickbites #12 - NEW CONSUMER PROTECTIONS
Appealing Insurance Company Decisions
Effective for new plans beginning on or after September 23, 2010
The law provides consumers with a way to appeal coverage determinations or claims to their insurance company, and establishes an
external review process.
Affordable Health Care Reform Quickbites #14 -NEW CONSUMER PROTECTIONS
Regulating Annual Limits on Insurance Coverage
Effective for health plan years beginning on or after September 23, 2010
Under the new law insurance companies use of annual dollar limits on the amount of insurance coverage a patient may receive will be
restricted for new plans in the individual market and all group plans. In 2014, the use of annual dollar limits on essential benefits like hospital stays will be
banned for new plans in the individual market and all group plans.
Affordable Health Care Reform Quickbites #16 - INCREASING ACCESS TO AFFORDABLE CARE
Rebuilding the Primary Care Workforce
Effective 2010
To strengthen the availability of primary care, there are new incentives in the law to expand the number of primary care doctors, nurses and
physicians assistants, including funding for scholarships and loan repayments for primary care doctors and nurses working in underserved areas. Doctors
and nurses receiving payments made under any State loan repayment or loan forgiveness program intended to increase the availability of health care
services in underserved or health professional shortage areas will not have to pay taxes on those payments.
Affordable Health Care Reform Quickbites #17 - IMPROVING QUALITY AND LOWERING COSTS
Preventing Disease and Illness
Funding begins in 2010
A new $15 billion Prevention and Public Health Fund will invest in proven prevention and public health programs that can help keep
Americans healthy ? from smoking cessation to combating obesity.
Affordable Health Care Reform Quickbites #18 - INCREASING ACCESS TO AFFORDABLE CARE
Strengthening Community Health Centers
Effective 2010
The law includes new funding to support the construction of and expansion of services at community health centers, allowing these centers
to serve some 20 million new patients across the country.
Affordable Health Care Reform Quickbites #19 - INCREASING ACCESS TO AFFORDABLE CARE
Payments for Rural Health Care Providers
Effective 2010
Today, 68% of medically underserved communities across the nation are in rural areas, and these communities often have trouble attracting
and retaining medical professionals. The law provides increased payment to rural health care providers to help them continue to serve their
communities.
Affordable Health Care Reform Quickbites #20 - IMPROVING QUALITY AND LOWERING COSTS
Prescription Drug Discounts
Effective January 1, 2011
Seniors who reach the coverage gap will receive a 50 percent discount when buying Medicare Part D covered brand-name prescription drugs.
Over the next ten years, seniors will receive additional savings on brand-name and generic drugs until the coverage gap is closed in 2020.
Affordable Health Care Reform Quickbites #22 - INCREASING ACCESS TO AFFORDABLE CARE
Holding Insurance companies Accountable for Unreasonable Rate Hikes
Grants will be awarded beginning in 2010
The law allows states that have, or plan to implement, measures that require insurance companies to justify their premium increases to be
eligible for $250 million in new grants. Insurance companies with excessive or unjustified premium increases may not be able to participate in the new
health insurance Exchanges in 2014.
Affordable Health Care Reform Quickbites #23 - HOLDING INSURANCE COMPANIES
ACCOUNTABLE
Bringing Down Health Care Premiums
The rebate program will begin January 1, 2011
To ensure premium dollars are spent primarily on health care, the new law generally requires that a least 85% of all premium dollars
collected by insurance companies for large employer plans are spent on health care services and health care quality improvement. For plans sold to
individuals and small employers, at least 80% of the premium must be spent on benefits and quality improvement. If insurance companies do not meet these
goals because their administrative costs or profits are too high, they must provide rebates to consumers.
Figuring out health care rates depends heavily on the medical loss ratio. That's the percentage of insurance premiums that go to pay claims and improve health care services. That ratio equates to TOTAL CLAIMS / TOTAL PREMIUMS. California requires a minimum ratio of 70 percent. In 2011, however, all insurers nationwide will be required to have loss ratios of 80 percent for individual and small group plans, or 85 percent for large group plans.
Insurance companies rely on actuaries to set rates that will ensure they achieve the required loss ratios. To set rates, the actuaries look at costs and use data from the current year and two or three previous years to track trends in:
Unit costs: Specific categories of medical expenses such as PCP, ER or Rx
Utilization rates: How many times patients use different services.
Pharmacy trends: Specific categories of drugs, combining cost and util rates.
The actuary researches any unusual spikes or drops in costs or use rates to see if they are one-time events or signal a significant or ongoing change. Other factors in the calculation:
Company's risk, generally set at 2 percent.
Deductible leveraging: Yearly rate of increase in claims a company will pay when a plan's deductible remains the same but medical costs rise.
Based on past trends and future projections, the actuary projects expected medical expenses and then the level of premiums needed to hit the required loss ratio.
Affordable Health Care Reform Quickbites #24 - HOLDING INSURANCE COMPANIES
ACCOUNTABLE
Addressing Overpayments to Big Insurance Companies and Strengthening Medicare Advantage
Effective January 1, 2011
Today, Medicare pays Medicare Advantage insurance companies over $1,000 more per person on average than is spent per person in
Original Medicare. This results in increased premiums for all Medicare beneficiaries, including the 77 percent of beneficiaries who are not currently enrolled
in a Medicare Advantage plan. The new law levels the playing field by gradually eliminating this discrepancy. People enrolled in a Medicare Advantage
plan will still receive all guaranteed Medicare benefits, and the law provides bonus payments to Medicare Advantage plans that provide high quality care.
Learn more about improvements to Medicare.
Affordable Health Care Reform Quickbites #25 - IMPROVING QUALITY AND LOWERING COSTS
Improving Health Care Quality and Efficiency
Effective no later than January 1, 2011
The law establishes a new Center for Medicare & Medicaid innovation that will begin testing new ways of delivering care to patients. These
new methods are expected to improve the quality of care and reduce the rate of growth in costs for Medicare, Medicaid, and the Children?s Health insurance
Program (CHIP). By January 1, 2011, HHS will submit a national strategy for quality improvement in health care, including these programs.
Affordable Health Care Reform Quickbites #26 - IMPROVING QUALITY AND LOWERING COSTS
Improving Care for Seniors after They Leave the Hospital
Effective January 1, 2011
The Community Care Transitions Program will help high-risk Medicare beneficiaries who are hospitalized avoid unnecessary readmissions
by coordinating care and connecting patients to services in their communities.
Affordable Health Care Reform Quickbites #27 - IMPROVING QUALITY AND LOWERING COSTS
New Innovations to Bring Down Costs
Administrative funding becomes available October 1, 2011
The independent Payment Advisory Board will begin operations to develop and submit proposals to Congress and the President aimed at
extending the life of the Medicare Trust Fund. The Board is expected to focus on ways to target waste in the system, and recommend ways to reduce costs,
improve health outcomes for patients and expand access to high-quality care.
Affordable Health Care Reform Quickbites #28 - INCREASING ACCESS TO AFFORDABLE CARE
Increasing Access to Services at Home and in the Community
Effective beginning October 1, 2011
The new Community First Choice Option allows States to offer home and community based services to disabled individuals through
Medicaid rather than institutional care in nursing homes.
Affordable Health Care Reform Quickbites #29 - IMPROVING QUALITY AND LOWERING COSTS
Encouraging Integrated Health Systems
Effective January 1, 2012
The new law provides incentives for physicians to join together to form Accountable Care Organizations. In these groups doctors can better
coordinate patient care and improve the quality, help prevent disease and illness, and reduce unnecessary hospital admissions. If Accountable Care
Organizations provide high quality care and reduce costs to the health care system, they can keep some of the money that they have helped save.
Affordable Health Care Reform Quickbites #30 - IMPROVING QUALITY AND LOWERING COSTS
Understanding and Fighting Health Disparities
Effective March 2012
To help understand and reduce persistent health disparities, the law requires any ongoing or new Federal health program to collect and
report racial, ethnic and language data. The Secretary of Health and Human Services will use this data to help identify and reduce disparities.
Affordable Health Care Reform Quickbites #31 - INCREASING ACCESS TO AFFORDABLE CARE
Providing New, Voluntary Options for Long-Term Care Insurance
Benefit plan no later than October 1, 2012
The law creates a voluntary long-term care insurance program called CLASS to provide cash benefits to adults who become disabled. The Community Living Assistance Services and Supports (CLASS) Act — would be funded by premiums and would pay enrollees $50 or more per day if they became too disabled to perform normal daily activities like eating and bathing.
What Is CLASS?
The new program — called the Community Living Assistance Services and Supports (CLASS) Act — would be funded by premiums and would pay enrollees $50 or more per day if they became too disabled to perform normal daily activities like eating and bathing.
Employers who chose to participate would sign up their employees, who would then have the ability to opt out. The cash benefits could be applied to nursing-home care, but in an effort to encourage enrollees to stay in their own homes, payouts could cover such things as wheelchair ramps and wages for home health care aides.
Affordable Health Care Reform Quickbites #32 - IMPROVING QUALITY AND LOWERING COSTS
Reducing Paperwork and Administrative Costs
First regulation effective October 1, 2012
Health care remains one of the few industries that relies on paper records. The new law will institute a series of changes to standardize
billing and requires health plans to begin adopting and implementing rules for the secure, confidential, electronic exchanges of health information. Using
electronic health records will reduce paperwork and administrative burdens, cut costs, reduce medical errors and most importantly, improve the quality of
care.
Affordable Health Care Reform Quickbites #33 - IMPROVING QUALITY AND LOWERING COSTS
Linking Payment to Quality Outcomes
Effective for payments for discharges occurring on or after October 1, 2012
The law establishes a hospital Value-Based Purchasing program (VBP) in Original Medicare. This program offers financial incentives to
hospitals to improve the quality of care. Hospital performance is required to be publicly reported, beginning with measures relating to heart attacks, heart
failure, pneumonia, surgical care health-care associated infections, and patient perception of care.
Affordable Health Care Reform Quickbites #34 - IMPROVING QUALITY AND LOWERING COSTS
Improving Preventive Health Coverage
Effective January 1, 2013
To expand the number of Americans receiving preventive care, the law provides new funding to state Medicaid programs that choose to
cover preventive services for patients at little or no cost.
Affordable Health Care Reform Quickbites #35 - INCREASING ACCESS TO AFFORDABLE CARE
Increasing Medicaid Payments for Primary Care Doctors
Effective January 1, 2013
As Medicaid programs and providers prepare to cover more patients in 2014 the Act requires states to pay primary care physicians no less
than 100 percent of Medicare payment rates in 2013 and 2014 for primary care services. The increase is fully funded by the federal government.
Affordable Health Care Reform Quickbites #36 - IMPROVING QUALITY AND LOWERING COSTS
Expanded Authority to Bundle Payments
Effective no later than January 1, 2013
The law establishes a national pilot program to encourage hospitals, doctors, and other providers to work together to improve the
coordination and quality of patient care. Under payment ?bundling,? hospitals, doctors and providers are paid a flat rate for an episode of care rather than
the current fragmented system where each service or test or bundles of items or services are billed separately to Medicare. For example, instead of a surgical
procedure generating multiple claims from multiple providers, the entire team is compensated with a ?bundled? payment that provides incentive to deliver
health care services more efficiently while maintaining or improving quality of care. It aligns the incentive of those delivering care, and savings are shared
between providers and the Medicare program.
Affordable Health Care Reform Quickbites #38 - IMPROVING QUALITY AND LOWERING COSTS
Establishing Health Insurance Exchanges
Effective January 1, 2014
Starting in 2014 if your employer doesn?t offer insurance, you will be able to buy insurance directly in an Exchange - a new transparent and competitive
insurance marketplace where individuals and small businesses can buy affordable and qualified health benefit plans. Exchanges will offer you a
choice of health plans that meet certain benefits and cost standards. Starting in 2014, Members of Congress will be getting their health care insurance
through Exchanges, and you will be able to buy your insurance through Exchanges too.
Affordable Health Care Reform Quickbites #39 - INCREASING ACCESS TO AFFORDABLE CARE
Promoting Individual Responsibility
Effective January 1, 2014
Under the new law, most individuals who can afford it will be required to obtain basic health insurance coverage or pay a fee to help offset
the costs of caring for uninsured Americans. If affordable coverage is not available to an individual, he or she will be eligible for an exemption.
Affordable Health Care Reform Quickbites #40 - INCREASING ACCESS TO AFFORDABLE CARE
Ensuring Free Choice
Effective January 1, 2014
Workers meeting certain requirements who cannot afford the coverage provided by their employer may take whatever funds their employer
might have contributed to their insurance and use these resources to help purchase a more affordable plan in the new health insurance Exchanges. These
new competitive marketplaces will allow individuals and small businesses to buy qualified health benefit plans. Starting in 2014, Members of Congress will
be getting their health care insurance through Exchanges and all Americans will have the choice of buying insurance through them too.
Affordable Health Care Reform Quickbites #41 - INCREASING ACCESS TO AFFORDABLE CARE
Increasing Access to Medicaid
Effective January 1, 2014
Americans who earn less than 133 percent of the poverty level (approximately $14,000 for an individual and $29,000 for a family of four) will
be eligible to enroll in Medicaid. States will receive 100 percent federal funding for the first three years to support this expanded coverage, phasing to 90
percent federal funding in subsequent years.
Affordable Health Care Reform Quickbites #42 - IMPROVING QUALITY AND LOWERING COSTS
Makes Care More Affordable
Effective January 1, 2014
Tax credits to make it easier for the middle class to afford insurance will become available for people with incomes above 100 percent and
below 400 percent of poverty ($43,000 for an individual or $88,000 for a family of four in 2010) who are not eligible for or offered other affordable coverage.
These individuals may also qualify for reduced cost-sharing (e. g. copayments, coinsurance, and deductibles).
Affordable Health Care Reform Quickbites #43 - NEW CONSUMER PROTECTIONS
Ensuring Coverage for Individuals Participating in Clinical Trials
Effective January 1, 2014
Insurers will be prohibited from dropping or limiting coverage because an individual chooses to participate in a clinical trial. This applies
to all clinical trials that treat cancer or other life-threatening diseases.
Affordable Health Care Reform Quickbites #45 - NEW CONSUMER PROTECTIONS
No Discrimination Due to Pre-Existing Conditions or Gender
Effective January 1, 2014
The law implements strong reforms that prohibit insurance companies from refusing to sell coverage or renew policies because of an
individual?s pre-existing conditions. Also, in the individual and small group market, it eliminates the ability of insurance companies to charge higher rates
due to gender or health status.
Affordable Health Care Reform Quickbites #46 - IMPROVING QUALITY AND LOWERING COSTS
Increasing Small Business Health Insurance Tax Credit
Effective January 1, 2014
The law implements the second phase of the small business tax credit for qualified small businesses and small non-profit organizations. In
this phase, the credit is up to 50 percent of the employer?s contribution to provide health insurance for employees. There is also up to a 35 percent credit for
small non-profit organizations.
Affordable Health Care Reform Quickbites #47 - IMPROVING QUALITY AND LOWERING COSTS
Paying Physicians Based on Value Not Volume
Effective January 1, 2015
A new provision will tie physician payments to the quality of care they provide. Physicians will see their payments modified so that those
who provide higher value care will receive higher payments than those who provide lower quality care.
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