By Deirdre Y. Cheek, Esq.
America's health prognosis improved 219%. In an up or down televised roll call vote, the United States House of Representatives voted 219 to 212 in favor of the Patient Protection and Affordable Care Act, H.R.3590. After nearly 100 years of good intentions, frustrating talks, countless hours of passionate debate, decades of false starts and stall tactics, and numerous White House administrations, the United States Congress on a cloudless seemingly ordinary day in the Nation's Capital worked feverishly on the final passage of landmark health care legislation.
Yes, just one year and two months after President Barack Obama took office, he delivered on his signature domestic policy agenda item He, along with House Speaker Nancy Pelosi, Majority Leader Steny Hoyer, and Majority Whip James Clyburn, worked tirelessly to resuscitate health care reform in America. Together along with millions of Americans, they successfully achieved the most sweeping health care reform legislation since the passage of the Social Security Act of 1965, which established Medicare and Medicaid.
Passage of H.R. 3590 is a giant step forward. President Obama indeed has delivered; but to be fair, it is not all that he had promised. As passed, the bill does not include a public health option. Nevertheless, it provides certainly much more access and coverage to affordable health care than many Americans had. In remarks following the final passage of the bill, President Obama stated "This legislation will not fix everything that ails our health care system. But it moves us decisively in the right direction."
The bill extends health care coverage to 32 million Americans who are currently uninsured. The Congressional Budget Office, an independent non-partisan federal agency that provides economic data and analysis to Congress, estimated that the bill would cost the American public approximately $940 billion over ten years and would reduce the deficit by $143 billion over the same period and projected more than $1 trillion deficit reduction in the next decade.
So what's in the bill?
The bill has short term and longer term changes that we all should be aware of and that are expected to expand access to quality affordable health care for all Americans. Highlighted below are a few of the major provisions outlined according to when they will be enacted.
Starting 2010
Pre-existing conditions. Effective September 23, 2010, six months after the bill passage, insurance companies are prohibited from denying coverage to children who have pre-existing conditions. (Beginning in 2014, this prohibition will apply to all persons.)
Ban on lifetime limits on insurance coverage. Effective September 23, 2010, insurance companies and group health plans are prohibited from placing lifetime caps on how they pay out policy holders or rescinding coverage of a policy holder, except in the case of fraud or misrepresentation.
Temporary high-risk insurance pool. Effective June 23, 2010, ninety days after the bill passage, Americans who have been uninsured for at least six months and have pre-existing conditions will be eligible for subsidized coverage through a temporary high risk pool to be established by the Department of Health and Human Services. The pools will not impose any exclusions and plans are required to cover no less than 65% of medical costs and to limit out of pocket spending to $5,950 for individual policies and $11,900 for family policies.
Begin to close the Medicare Part D "Doughnut Hole" for seniors. Effective immediately, the bill provides a $250 rebate to Medicare beneficiaries who hit the coverage gap limit in prescription drug coverage.
Young adult health coverage extension. Effective September 23, 2010, insurance companies are required to allow young adults up to their 26th birthday to remain on their parents' insurance policy, including young adults who are married but their dependents are not covered.
Small business tax credit. Effective for the 2010 tax year, small businesses that employee fewer than 25 employees and average annual wages under $50,000 will be eligible for tax credits to offset their premium costs provided they contribute at least 50% of their employees' premiums.
Defined Claims Appeal Process. Effective September 23, 2010, all new health plans must define a clear process for the insured to appeal claims or decisions regarding coverage.
Starting 2011
Mandatory benefits reporting. Beginning January 1, 2011, employers are required to disclose the value of benefits related to each employee's health insurance coverage on W-2 forms.
Reimbursement for over-the-counter drug costs. Beginning January 1, 2011, flexible spending accounts are prohibited from reimbursing over-the-counter drugs unless prescribed by a medical provider.
Discounts to Medicare Part D enrollees. Beginning January 1, 2011, Medicare beneficiaries will be eligible to receive 50% discounts on all brand-name drugs in the "doughnut hole."
Free preventive care under Medicare. Effective January 1, 2011, the bill eliminates co-payments for preventive services and exempts preventive services from deductibles under the Medicare program.
Starting 2013
Limits on Flexible Spending Accounts. Beginning January 1, 2013, employees will only be allowed to contribute $2,500 annually to their flexible spending account.
Development of health care choice compacts between states. By July 1, 2013, the Department of Health and Human Services, in coordination with the National Association of Insurance Commissioners, must issue regulations governing the creation of healthcare choice compacts that would permit states to enter into an agreement to allow for purchase of qualified health plans across states lines, beginning 2016.
Starting 2014 and Beyond
Healthcare insurance requirement for all U.S. citizens and legal residents. Effective January 1, 2014, all U.S. citizens and legal residents will be required to purchase minimal essential health care insurance coverage that can be obtained through national insurance exchanges, public programs, employers, or individual market. Individuals will be required to demonstrate on their tax form that they have the minimal essential coverage or pay fines of $95 per individual or up to $285 for a family.
Employer coverage mandate. Effective January 1, 2014, employers with more than 50 employees must provide health insurance or pay a fine of $2,000 per full time worker each year if any worker received federal subsidies to purchase health insurance.
State insurance exchanges. Beginning January 1, 2014, each state will be required to establish an American Health Benefit Exchange and a Small Business Health Options Program exchange that would allow individuals and small employers to comparison shop for insurance policies.
Qualified health plan requirements. Effective January 1, 2014, the new law requires that qualified health plans must include the following health services, at a minimum, ambulatory care, emergency care, hospitalizations, maternity and newborn care, mental health care, rehabilitative programs and preventive treatment, chronic disease care, and pediatric care.
Pre-existing conditions. Beginning in 2014, the prohibition against denial of coverage for pre-existing conditions will apply to all persons.
The provisions of the health care reform legislation highlighted above only skims the surface of what is included in the 906-page bill. We encourage everyone to review the legislation for yourself and to consult your health care provider, insurer, or employer about how the new law may have specific impact on you. Being proactive about your health care and understanding your rights and responsibilities under the American health care system is not only expected of you as a U.S. citizen but also as citizen of the Kingdom of God. The Bible admonishes us to prosper and be in health even as our soul prospers. III John 2. To do this one must first become informed.
As part of the health reform legislation, President Obama announced a Patient's Bill of Rights - a basic set of consumer protections that end some of the health insurance companies' worst abuses. The Patient's Bill of Rights will begin to take effect in September 2010.
