How the Healthcare Reform Law Could Help Us

[rebecca1995]

Folks,

CNN has a good summary of changes to the healthcare/insurance industry brought about by the new law, and when they'll take effect:

http://www.cnn.com/2010/POLITICS/03/23/health.care.timeline/

I'm pasting here the changes that could affect people (Americans) on the Forum:

Within the first year

Young adults will be able stay on their parents' insurance until their 27th birthday.

Seniors will get a $250 rebate to help fill the "doughnut hole" in Medicare prescription drug coverage, which falls between the $2,700 initial limit and when catastrophic coverage kicks in at $6,154.

Insurers will be barred from imposing exclusions on children with pre-existing conditions...

Insurers will not be able to rescind policies to avoid paying medical bills when a person becomes ill.

Lifetime limits on benefits and restrictive annual limits will be prohibited.

New plans must provide coverage for preventive services without co-pays. All plans must comply by 2018.

New plans will be required to implement an appeals process for coverage determinations and claims.

2011

Medicare will provide free annual wellness visits and personalized prevention plans. New plans will be required to cover preventive services with no co-pay

States can offer home- and community-based services to the disabled through Medicaid rather than institutional care beginning October 1.

A 50 percent discount will be provided on brand-name drugs for Prescription Drug Plan or Medicare Advantage enrollees. Additional discounts on brand-name and generic drugs will be phased in to completely close the "doughnut hole" by 2020.

2013

Health plans must implement uniform standards for electronic exchange of health information to reduce paperwork and administrative costs.


2014

Insurers can no longer refuse to sell or renew policies because of an individual's health status. Health plans can no longer exclude coverage for pre-existing conditions. Insurers can't charge higher rates because of heath status, gender or other factors.

Health plans will be prohibited from imposing annual limits on coverage.

Health insurance exchanges will open in each state to individuals and small employers to comparison shop for standardized health packages.

Credits will be available through exchanges for those whose income is above Medicaid eligibility and below 400 percent of poverty level who are not eligible for or offered other acceptable coverage.

Medicaid eligibility will increase to 133 percent of poverty for all nonelderly individuals to ensure that people obtain affordable health care in the most efficient and appropriate manner. States will receive increased federal funding to cover these new populations.

Also, from the New York Times:

Another provision that appears to take effect right away is an expansion of Medicare to cover certain victims of environmental health hazards, which was aimed specifically at the town of Libby, Mont.

As Robert Pear reported in the Times in December, the beneficiaries are people who were exposed to asbestos from a vermiculite mine. The provision was inserted by Senator Max Baucus, Democrat of Montana and a lead author of the Senate health care measure.

 

[Tammie]

In general for those on Medicare, this bill will HURT us a lot; not help.....Medicare already pays so little many/most docs won't take it. This is going to lower the amt that it pays even further, so it will bascially be worthless....not to mention that they are taking money from a place that is already almost out of money (Medicare) to help fund this - how does that make any sense?

And once again I feel the need to point out that Medicare is NOT JUST FOR SENIORS!!!!!! I am so sick of everything that mentions Medicare only talking about seniors. People with disabilities are completely ignored in all this.:Retro mad:

 

[Hope123]

I think we need more details, especially in regards to funding, but I am glad this bill passed.

My understanding is part of funding would come out of higher taxes for those making $200K (per person or $250K as families) or above and they would be taxed on their insurance and investment income. To give everyone perspective here, $250K is the top 3% of incomes in the US. I used to make in the six figures but wouldn't have begrudged the extra $2500 taxes or so per year to help those uninsured. Neither do my neighbors. I live in a humble apartment but in a wealthy nieghborhood and all our reps voted for the bill (and bragged about it to boot).

In terms of doc visits, it may take a while to see results but my understanding is that Medicare payments to primary care physicians will be increased. The problem I see is more one of supply: since specialists make more, there has been a decline in the number of trainees going into primary care over the last two decades.

 

[Tammie]

I have seen it reported over and over and over, even by people who are very much for this bill, that Medicare payments are going to be lowered. Nowhere have I seen anythign even suggesting that there is a possibility that they will be raised.

 

[Lesley]

The problem with medicare payments to doctors is a problem that occurs every year, and is separate from health care reform. It is the result of a formula adopted in the 90s that is outdated. The formula doesn't keep up with increases in healthcare costs, but rather than fix the formula Congress just fixes it temporarily each year. They always fix it.

It wasn't included in health care reform because opponents used it to try to argue that the reforms were too expensive, even though they are costs that will be incurred regardless of the fate of health care reform.

Both the House and Senate already passed temporary fixes that expire at the end of the month. After they finish the last piece of health care reform this week, they are expected to fix it for another month, then work on a fix that will take them through the November election. Anything longer term won't happen until after that. Doing it bit by bit, with doctors threatening to drop Medicare patients all the while is agonizing for patients, but not fixing it is not in any politician's best interest. And that seems to be what really matters in the end.

 

[sarahg]

I have seen it reported over and over and over, even by people who are very much for this bill, that Medicare payments are going to be lowered. Nowhere have I seen anythign even suggesting that there is a possibility that they will be raised.

One thing I have read is that they are slowly going to lower payments for PRIVATELY administered medicare plans, to encourage their eventual phase out. They cost more than the public medicare plan, with no real difference in service or outcomes. The added cost right now is going to the private insurance companies administering the program and not to doctors and hospitals. I have read this is where the bulk of cuts to medicare are going to.

Another cost reduction to medicare is that they are going to set up a panel to try and get rates be more fair. Like if 2 cities have the same cost of living, the same kinds of medical costs generally ,same ratio of medicare patients to the rest of patients and a lot more complicated sounding similarities, but one city is getting 3 times as much reimbursment for the same procedures...they will try and make this more even. It's a lot more complicated than that, and I will be the first to admit I don't fully understand it, and that there is the potential for abuse and error on the part of the panel. But they are not accross the board cuts to all doctors and all hospitals. The intention is that they will make cuts to the overchargers. But I am always skeptical of intentions that seem like they could go awry so I don't know how that will play out, and I don't have a full understanding of their mandate or authority.

 

[julius]

It blows my mind to see people who are upset about this. I gotta hand it to Fox "news" though, they are masters of manipulation. They could get a baby to hate you for offering it candy!

I'm sure that 6 months or a year from now, when people realise that Carl Marx isn't going to swoop down from the sky and claim The Soviet Socialist Republic of America for his own, they will have the realisation that.....Hey!...hang on....this is really nice!

If you live in the UK, Canada, the Netherlands....uh....any developed nation(!) you already know this. Sure, there are problems, but there are always problems...don't worry about it. These problems are like the common cold compared to the leprosy you have all just been cured of.

So, congratulations USA! I am really happy for you.

(BTW, welcome to the first world)

 

[JillBohr]

It blows my mind to see people who are upset about this. I gotta hand it to Fox "news" though, they are masters of manipulation. They could get a baby to hate you for offering it candy!

I'm sure that 6 months or a year from now, when people realise that Carl Marx isn't going to swoop down from the sky and claim The Soviet Socialist Republic of America for his own, they will have the realisation that.....Hey!...hang on....this is really nice!

If you live in the UK, Canada, the Netherlands....uh....any developed nation(!) you already know this. Sure, there are problems, but there are always problems...don't worry about it. These problems are like the common cold compared to the leprosy you have all just been cured of. So, congratulations USA! I am really happy for you.

(BTW, welcome to the first world)

Thank you Julius! I have lived in the Netherlands and Germany and know first hand their health care system. My first son was born in the Netherlands and my second in Germany. Personally, I think Germany was far superior to the Netherlands as far as healthcare is concerned and far superior to anything I have experienced in the U.S. It is strange how people have been Fox News brain washed. I do not speak to many people about this but I know one mother that is very upset about this and her sister and brother-in-law just lost their house and had to move in with her parents because of her brother-in-laws health problems. Weird. I do wish we had single payer or a public option but we move in small steps. At least we are moving in the right direction.

 

[*GG*]

This will be a disaster, preferential treatment for the "elites" and politicians etc and I would say that it will take more than 6 months to 1 year for all of the "unintended consequences" come out!

I mean the gov't has done a HORRIBLE job with CFIDS, so why do people have confidence that things will get better for US? The US is the greatest country on the Earth and I am not so certain that this will remain with all of the giveaways. Our forefathers are rolling in their graves! I pride myself on my Independence and Liberty. Why do you think people will want to keep working hard and pay for all the people sucking off of the gov't teats? What incentive will people have to work hard and try to accumulate wealth when the gov't is going to end up taking about 1/2 if not even more in the future! Good for Canucks, but not for freedome lovers! Glad my parents left that wasteland and I grew up in the USA. Much more opportunity!

I mean more Drs are likely to leave the field and MILLIONS more of people are going to go into the system, and you do not think the System will decline?! You must be from another planet! It's very simple math, that is why the Majority of Americans were against this, but since they shoved it down our throats, they will pay a price, sooner or later!

Taxes will rise because of all of the NEW Bureaucracy and inefficiencies and waste, which will likely lead to more rationing, so say goodbye to innovation and effective costly meds, especially for us older folks. I work for gov't and it is very wasteful and inefficient. Why do you think I can still work with this condition?

Problems like in the UK? That does not sound so bad. Sarcasm! A truly bad time for the USA but I think the pols will get a big wake up call this Fall, don't just listen to the Lamestream media!

Fox News Rules! Stay in Space!

Progressive garbage! I'll die before or when this country is driven into the ground by Cool Aid drinkers!

It blows my mind to see people who are upset about this. I gotta hand it to Fox "news" though, they are masters of manipulation. They could get a baby to hate you for offering it candy!

I'm sure that 6 months or a year from now, when people realise that Carl Marx isn't going to swoop down from the sky and claim The Soviet Socialist Republic of America for his own, they will have the realisation that.....Hey!...hang on....this is really nice!

If you live in the UK, Canada, the Netherlands....uh....any developed nation(!) you already know this. Sure, there are problems, but there are always problems...don't worry about it. These problems are like the common cold compared to the leprosy you have all just been cured of.

So, congratulations USA! I am really happy for you.

(BTW, welcome to the first world)

 

[JillBohr]

I pride myself on my Independence and Liberty. Why do you think people will want to keep working hard and pay for all the people sucking off of the gov't teats? What incentive will people have to work hard and try to accumulate wealth when the gov't is going to end up taking about 1/2 if not even more in the future!

So those that are unable to work are a bunch of leeches, eh? What a strange post to put on website in which many people suffer from severe ME/CFS. btw- If you work for the government, your salary is being paid by taxpayers. signed, Jill (aka Teat Sucker)

 

[Hope123]

Yeah, I find it interesting too that people are against the bill, especially people who are sick, but I think this comes from not understanding healthcare policy in the US, which is very complicated. I worked in healthcare and did some reading on this in the past.

I went from having a more or less Cadillac health plan before CFS connected to my employer (no co-pays at all, cover in vitro fertilization/ acupuncture, extra coverage for out-of-network docs, etc.) to the threat of not having any health insurance at all. Luckily, I was able to get Medicare. For people who are single and sick, can't get Medicare, can't get work that gives them health insurance because of CFS (they work part-time or for a small business or for themselves), recover fully but have CFS in their background, or were sick as children and age out of their parent's plans and still sick, they have a very tough time getting any even basic coverage at all. Certainly, the gov't hasn't done a great job with CFS but having some basic coverage is better than none.

I have relatives in Canada and Asia and they love their healthcare system. Some of them have chronic and serious illnesses as well but the question of finances has not been an issue. Contrary to what some people think, the Canadian gov't determines some level of basic coverage for everyone but if you work, you might get extra financial support from your workplace for instance for medications. And in places like the UK or Germany, people who have money have the option of buying private/ extra insurance or getting that through work. (Please correct if I'm wrong, international posters.) I don't expect a Cadillac plan from the gov't but I do appreciate at least some basic level of care. The US is the only first world country to not have a national health insurance plan.

Paying taxes is not the true issue but rather if taxes are spent wisely towards those things the people of a country value. My neighbors are from Sweden and we occasionally chat when I bump into them. They paid high taxes there but their government covers things like childcare for working women and paternity/ maternity leave up to I think 16 months per child, with at least 2 months for the dad. There is no mad dash to find good childcare like my friends with kids have to do.

To some degree, I feel like maybe people who don't want to participate in any insurance plan can opt out but they should sign a waiver saying if they are in an emergency, get a serious illness, etc. and can't pay for it, they cannot expect any help from the government and if death or bankruptcy are the options, so be it and no complaining. This is the situation now anyways. But the economics of a national health plan will only work out if everyone is signed up.

 

[Tammie]

One thing I have read is that they are slowly going to lower payments for PRIVATELY administered medicare plans, to encourage their eventual phase out. They cost more than the public medicare plan, with no real difference in service or outcomes. The added cost right now is going to the private insurance companies administering the program and not to doctors and hospitals. I have read this is where the bulk of cuts to medicare are going to.
.

Actually the private Medicare companies DO cover a lot more than regular Medicare, and the copays are far less for certian things. For instance, if you want to see a counsleor with regular Medicare, you have to pay 45% of the fees yourself. That is pretty much unaffordable for most people on medicare. Private companies copays have been as low as $0 for this. Drug costs are another big difference between regualr medicare and private sompanies, not to mention that some alt treatmetns and some specialists' care is covered by the private comapnies and at a lower copay than it is thur reguarl medicare. And some private companies offer many exrtas like: help with some supplements, transportation, and payment for fitness center fees (granted that is not something that PWCs will be using, but there are a lot of people who do). Further, with the private companies people have mroe choices as to which plans best fit their needs.

 

[Tammie]

I am so incredibly sick of people trying to say that the reason people are against the plan is bc we are all influenced by Fox news or afraid of socialism, or just toeing the party line, or any other B/S like that.

Guess what? I NEVER watch Fox news - I do not watch any TV news at all actually bc I do not have TV reception in my apt. I get my information from reading a variety of sources, including parts of the actual bill. And, I am good at figuring out if a particular source is biased. I can think for myself and determine what I believe without being swayed by what others think. Actually, it seems that many of those who are for the bill have forgotten how to think for themselves. (& no I am truly not referring to anyone in particular here. I think that the majority of people on this site are well educated and intelligent.)

I am not worried about this plan bc I am afraid it is socialist, but rather bc I think it will make things worse for a lot of people and is promising thigns it cannot deliver.

And, I have NEVER voted based on a particular politcial party. I vote based on the issues.

 

[Tammie]

check this out. As per my former college advisor ( a law and political science professor) via facebook this-
http://www.csmonitor.com/USA/Politi...re-reform-bill-101-what-the-bill-means-to-you

is the least bias-tainted and most factual reporting of how this will actually affect people and the timelines for when certain things will change. There are 8 brief parts to the coverage describing different situations (eg, seniors, students, etc.)
.

Thanks for the link. I already saw it, but others may wish to read it.

Of course, as everything else associated with this bill, it completely ignores people with disabilities. I am unbelieveably fed up with this utter lack of acknowledgement that we even exist, let alone that we are affected by this, too. Almost 20% pf the people on SS are people with disabilities, so obviously there are a lot of us. You would think that someone might realize that just as the bill impacts us, we impact society and the economy, and especially health care (since we tend to need more of it than the general population). If nothign else, politicians should remember that we do vote.

 

[sarahg]

Tammie, I really appreciate your views on this. It's really interesting. I worry about the unintended consequences of a lot of legislation...because that's how the legislative system in this country works. And then on top of the unintended consequences we have a 2 party system that really (although they'd never dare admit it) is in agreement about things most of the time. So all the laws we get are these subtle variations of the same approach...with just enough to please the differences of both parties so that real progress is rarely made. Ok that was my mini rant.

Anyway, it's really interesting about the private medicare plans. I'm not far enough into this (SS appeal 5/18) that it concerns me directly, so I don't know from experience. I've had sooooo many bad experiences with private insurers denying, approving and then denying, etc. that it is hard for me to remember that some of them really do have good benefits. Until this point the best insurance I have ever had (this after 4 private companies) is medicaid. And in a way that's sad. I count my blessings that I have it, but it is kind of crazy that medicaid is better than being on either of my parents insurance plans when I was still in school ( my dad is a Dr. and my mom is a social worker, so they have what would be considered pretty decent plans) in terms of what they actually AGREE to cover in the end. But I know medicare is a lot different from medicaid. And there is the problem that while they do cover a surprising array of things no questions asked, it is next to impossible to find good doctors that take it. I've found they either take it because they are idealistic and really do want to make a difference, or they are such bad doctors that it's the only way they can get patients.


The disibility aspect has really been bothering me. And there is some interesting stuff in the bill, but for the most part it the media could care less about reporting it. There is some shifting to home care rather than herding people into nursing homes, I know there are CFS people in this situation that would much rather not be. But the thing that really intrigues me the most is the no preexisting conditions thing (which isn't going to matter til 2014 if we can make it that far without them messing it up even more) If people with any disease or disability start to feel well enough to work, they can't work so much that they lose their healthcare, (if they are lucky enough to get insurance with that job, the preexisting condition won't be covered for a year or so, if ever) But if they give up the benefits and take the job with no coverage, there is a great risk they will become just as ill again without treatment and then they can't hold a job and they have to reapply for benefits all over again. This may not apply to CFS as much as to some other conditions, but I have seen people get stuck in it and it's sad. People who want to work more (than the SS allowed amount) and contribute more, barred from doing so because it would mean going without the care that makes them able to work in the first place.

I had a point to make but this is sooooo long already, and my brain is ready for a rest.

 

[*GG*]

I concur. Just the politicians promising things that we/they cannot deliver within the constraints that they said it would. This will cost trillions more! Whatever, I will just crawl under a rock and die.

I am so incredibly sick of people trying to say that the reason people are against the plan is bc we are all influenced by Fox news or afraid of socialism, or just toeing the party line, or any other B/S like that.

Guess what? I NEVER watch Fox news - I do not watch any TV news at all actually bc I do not have TV reception in my apt. I get my information from reading a variety of sources, including parts of the actual bill. And, I am good at figuring out if a particular source is biased. I can think for myself and determine what I believe without being swayed by what others think. Actually, it seems that many of those who are for the bill have forgotten how to think for themselves. (& no I am truly not referring to anyone in particular here. I think that the majority of people on this site are well educated and intelligent.)

I am not worried about this plan bc I am afraid it is socialist, but rather bc I think it will make things worse for a lot of people and is promising thigns it cannot deliver.

And, I have NEVER voted based on a particular politcial party. I vote based on the issues.

 

[Lesley]

Under health care reform, Medicaid reimbursement rates for primary care will be increased to be the same as for Medicare. Right now they are apparently 72% less! Hopefully that will help increase the number of providers.

 

[*GG*]

Never said that, I just don't think that this plan by the gov't is the solution. I have no idea who you are or what your situation is. Yup, someone needs to work for the govt't!.

If you are able bodied and do not work you are a leech, especially if you have some skills/talent. My brother was quadraplegic in a wheelchair and he still wanted to work and did what he could with his circumstance. He is a person that I thought of when I put myself thru college, how he could make it, day by day, but that is my mentality now also!

Making people comfortable in their poverty will just lead to more poverty. You reap what you sow, I would make much more money if I did not have to take a day off a week for rest! I don't think it's a strange post, this bill is going to lead to a lot more misery, so we should take everyone else down with us?

Safety nets are fine, but these things are always pressured to expand by progressive bleeding heart liberals, I am not callous, I do have empathy, I am a real sufferer also!

What good will that do? I don't want to burden my family and their children anymore than I need to. They would support me if I needed it, I think, I know this is not everyone's situation, but I think charities could do a better job in helping. I think if somebody has worked hard and attained success, why should the gov't come in and take their wealth and distribute it to people who do not want to take care of themselves? Shouldn't people be able to distribute their wealth as they see fit? I know I do! I will donate to causes that I find acceptable, I do not need the gov't to distribute more of my goods.

So those that are unable to work are a bunch of leeches, eh? What a strange post to put on website in which many people suffer from severe ME/CFS. btw- If you work for the government, your salary is being paid by taxpayers. signed, Jill (aka Teat Sucker)

 

[CJB]

<s>
Paying taxes is not the true issue but rather if taxes are spent wisely towards those things the people of a country value. My neighbors are from Sweden and we occasionally chat when I bump into them. They paid high taxes there but their government covers things like childcare for working women and paternity/ maternity leave up to I think 16 months per child, with at least 2 months for the dad. There is no mad dash to find good childcare like my friends with kids have to do.

<s>

Precisely. I get too much war for my tax dollars and not enough social safety net.

The healthcare bill is not what I wanted, but something had to be done. The status quo is not sustainable. Everyone knows that.

 

[julius]

I get too much war for my tax dollars and not enough social safety net.

And don't forget, you got a really good deal on some bailouts recently too! War and bailouts...that's where tax money belongs, not in helping those in need.