Health Care Reform – History Of Fiscal Folly
Health Care Reform – History Of Fiscal Folly
Health Care Reform Law Gets Devastating Critique
Health Care Reform Law Gets Devastating Critique
- You cannot take close to one trillion dollars away from one group of people and spend it on another group of people and somehow leave those footing the bill better off.
- You cannot give millions of people large increases in health care without creating any new doctors, new nurses or other paramedical personnel.
- You cannot arbitrarily reduce what you are paying health care providers by billions of dollars and still expect to get the same quantity and quality of health care.
- You cannot give millions of patients and thousands of doctors new incentives to waste medical resources and then expect health care spending to go down.
Healthcare Reform Bill Summary
Healthcare Reform Bill Summary
Part VII
Health insurance plan changes that impact individuals and employers (both fully insured and self-funded plans unless otherwise noted) over the next few years:
High-Level Overview Health Reform Law: Key Provisions for Large Employers
Medicare and Medicaid-related provisions
- Retiree drug subsidy. Beginning in 2013, employers may no longer deduct the retiree drug subsidy when offering qualified coverage under Medicare Part D.
- Part D donut hole. Provides $250 rebate for Part D enrollees who enter the “donut hole” coverage gap (2010 only); 50 percent brand discount on drugs in the gap beginning in 2011. The donut hole is eliminated by 2020.
- Medicaid. Beginning in 2014, states are required to provide health insurance premium assistance and wrap-around benefits to any Medicaid beneficiary who is offered employer-sponsored coverage, if it is cost-effective to do so.
Other
- Administrative simplification. The law also requires HHS to adopt a single set of operating rules for electronic transactions to create uniformity (e.g., health insurance claims or equivalent encounter information, eligibility and claims status, enrollment and disenrollment, premium
payments, and referral certification and authorization). Group health plans will have to certify compliance with these standards.
- CLASS Act. Creates a new government-run voluntary long-term care insurance program (CLASS Program). Employers must automatically enroll employees and facilitate payroll deductions. Employees may choose not to participate.
Revenue-raising provisions
- Starting July 1, 2010, impose a 10 percent tax on tanning services.
- Beginning in 2011, the pharmaceutical industry will pay annual industry fees. The fee will be phased in and will hold steady at $2.8 billion a year after 2019.
- Beginning in 2013, manufacturers of medical devices will pay a 2.3 percent excise tax on sales of medical devices.
- Beginning in 2013, the Medicare payroll tax rate will increase by 0.9 percent for individuals who make more than $200,000 and couples that make more than $250,000.
- A new 3.8 percent tax will be added on income from interest, dividends, annuities, royalties and rents for those at the same income threshold.
- Beginning in 2014, a non-deductible health insurance premium tax will be imposed on insurers ($8 billion in 2014, $11.3 billion in 2015 and 2016, $13.9 billion in 2017 and $14.3 billion in 2018. After that, it will increase in an amount proportional to overall health insurance premium growth).
Not to be used for implementation purposes
IMPORTANT: This document is designed to provide a general overview of the new health reform law. It does NOT attempt to cover all of the law’s provisions and should NOT be used as the legal advice for implementation activities. We encourage you to seek any professional advice, including legal counsel, regarding how the new requirements will affect your specific plan.
This summary provided by Humana One Health Insurance and Humana Small Business Health Insurance.
Facts About Healthcare Reform Bill
Facts About Healthcare Reform Bill
Part VI
Health insurance plan changes that impact individuals and employers (both fully insured and self-funded plans unless otherwise noted) over the next few years:
High-Level Overview Health Reform Law: Key Provisions for Large Employers IN 2011:
- Medical loss ratio (MLR). An insurer must publicly report on its MLR and spend at least 85 percent of large group health insurance premiums on medical services or provide rebate payments to enrollees.
- Spending accounts. Health savings accounts (HSAs) and flexible spending accounts (FSAs) may no longer be used to purchase over-the-counter drugs unless prescribed by a doctor. increases tax for nonqualified HSA withdrawals from 10 percent to 20 percent, and for Archer MSA withdrawals from 15 percent to 20 percent.
- HHS studies. HHS is required to study the group health insurance plan markets to compare employer characteristics and determine whether the new health insurance market reforms are likely to cause adverse selection in the large group market or to encourage small and midsize employers to self-insure. HHS and the Department of Labor must also collect information on self-funded health insurance plans. These studies could lead to additional employer reporting requirements.
- Uniform explanation of coverage. Within 12 months of the law's enactment, HHS, in consultation with the National Association of Insurance Commissioners, will develop uniform standards and definitions for summaries of benefits and coverage explanations. Within 24 months of enactment, group health insurance plans must provide enrollees and applicants with coverage documents that meet these standards. Additionally, enrollees must be notifi ed 60 days in advance of any material modification to coverage that wasn't included in the most recent summary.
IN 2012:
- Comparative effectiveness fee. A new fee is imposed on group health insurance plans to fund comparative effectiveness research ($1 per participant through 2013; $2 through 2019).
- Release of Medicare claims data. The private sector may purchase standardized data extracts of Medicare Parts A, B and D claims data to combine with their own claims data to evaluate provider performance measures on quality, efficiency, and the effectiveness of care.
IN 2013:
- FSA contributions. Contributions to flexible spending accounts are limited to $2,500 a year.
IN 2014:
- Pre-existing conditions. Group health insurance plans can no longer impose pre-existing conditions exclusions for any person of any age.
- Annual limits. Annual limits on essential health benefits are prohibited.
- Guaranteed issue. Health insurance companies must accept every employer who applies for health insurance coverage.
- Clinical trials. Coverage of routine patient care costs is mandated for participation in approved clinical trials (does not apply to grandfathered plans).
- Exchanges. State health insurance exchanges are up and running for small businesses and individuals. States can allow large employers to participate beginning in 2017. (Note: the federal definition of a large employer is an employer with 101 or more employees. States can modify the definition to 51 or more employees until January 1, 2016).
- Cost-sharing limits. Cost sharing imposed under group health insurance plans is limited to current health savings account amounts (does not apply to grandfathered plans).
- Waiting periods. Waiting periods cannot exceed 90 days.
- Wellness. Expands health insurance plan wellness incentives up to 30 percent of total coverage costs (up to 50 percent with HHS approval).
- Essential benefits. Essential benefit plan is created, which mandates the level of benefits that must be included in health insurance plans offered in the exchange, as well as in the individual and small group health insurance markets outside the exchange. (Self-funded health insurance plans and grandfathered plans are exempt from this requirement).
- Reinsurance. A temporary reinsurance program will be established for the individual market and funded by individual and group health insurance plan assessments ($25 billion in 2014-2016).
IN 2018:
- Taxes. A new excise tax goes into effect for high-value, "Cadillac" health insurance plans: 40 percent for amounts over $10,200 for individuals and $27,500 for family plans, paid by health insurance companies and plan administrators.
Not to be used for implementation purposes IMPORTANT: This document is designed to provide a general overview of the new health reform law. It does NOT attempt to cover all of the law's provisions and should NOT be used as the legal advice for implementation activities. We encourage you to seek any professional advice, including legal counsel, regarding how the new requirements will affect your specific plan.
This summary provided by Humana One Health Insurance and Humana Small Business Health Insurance.
Health Care Reform Bill Facts
Health Care Reform Bill Facts
Part V
Health insurance plan changes that impact individuals and employers (both fully insured and self-funded plans unless otherwise noted) over the next few years:
High-Level Overview Health Reform Law: Key Provisions for Large Employers Group health plan changes
Under the new law, employers/employees have the right to keep the coverage they had as of March 23, 2010 and are exempt from many reforms. These group health plans are considered “grandfathered plans.” Collectively bargained plans that were ratifi ed before the date of
enactment are grandfathered until the date that the last collective bargaining agreement related to coverage ends.
Changes that impact large employers (both fully insured and self-funded health insurance plans unless otherwise noted) over the next few years:
IMMEDIATELY:
- Federal rate review. The Department of Health and Human Services (HHS) will establish a process for federal review of fully insured health insurance premium rate increases.
IN 90 DAYS:
- Reinsurance for early retirees. A temporary reinsurance program will be established for employers providing health insurance coverage to early retirees over age 55 who are not eligible for Medicare. The federal government will provide $5 billion to fund the program. Participating employers or insurers will be reimbursed 80 percent of retiree claims between $15,000 and $90,000.
The program will be effective through 2013.
IN SIX MONTHS:
For new health insurance plans or plans renewed six months after the law’s enactment date (includes “grandfathered plans”):
- Lifetime and annual limits. Health Insurance Plans may not impose lifetime limits on the dollar value of essential benefits. Annual limits will be restricted (to be determined by HHS).
- Rescissions. No rescissions are permitted, except in cases of fraud or intentional misrepresentation.
- Coverage for adult children. Children may stay on their parents’ health insurance policies until age 26 if coverage isn’t available through their work, regardless of their marital status. Any employer contribution toward the premium is a tax deductible business expense for the employer and not taxable income for the member.
- Pre-existing conditions. Health Insurance Plans may no longer impose pre-existing conditions exclusions for children under 19.
For new health insurance plans or plans renewed six months after the law’s enactment date (does not include “grandfathered plans”):
- Preventive services. New health insurance policies must cover the full cost of preventive care as recommended by the U.S. Preventive Services Task Force, recommended immunizations, preventive care for infants, children and adolescents, and additional preventive care for women.
- Appeals. New minimum requirements for internal and external health insurance claim appeals processes.
- Patient protections. Health Insurance Plans that require or provide for a primary care provider (PCP) designation must allow each member to designate any in-network PCP, or pediatrician for children, accepting new patients. Plans may no longer require an authorization or referral to an Ob-Gyn. Prior authorization or increased cost-sharing for emergency services is also prohibited.
- Nondiscrimination rules. Nondiscrimination rules that apply to self-funded health insurance plans are expanded to fully insured health insurance plans. Plans cannot base an employee’s eligibility or continued eligibility on hourly or annual salary.
Not to be used for implementation purposes
IMPORTANT: This document is designed to provide a general overview of the new health reform law. It does NOT attempt to cover all of the law’s provisions and should NOT be used as the legal advice for implementation activities. We encourage you to seek any professional advice, including legal counsel, regarding how the new requirements will affect your specific plan.
This summary provided by Humana One Health Insurance and Humana Small Business Health Insurance.
Health Care Reform – Democrats Admit Premiums to Rise
Health Care Reform – Democrats Admit Premiums to Rise
Wednesday, April 21, 2010
Today, the New York Times reports Democrats are scrambling to prevent the predicted health insurance premium increases that are coming for millions of families as a result of their big government health care Insurance Reform overhaul. Just one month after becoming law, Democrats, “fearing that health insurance premiums may shoot up in the next few years,” are attempting to “fix” the new law that they promised would make health care more affordable. Unfortunately, when it comes to fixing health care, Democrats invariably rely on giving the government more authority and control.
Americans and Congressional Republicans have repeatedly cited the rising cost of health insurance as their number one concern related to health care, but after spending one trillion dollars, cutting Medicare by one-half trillion dollars and increasing taxes by over one-half trillion dollars, the Democrats’ health care reform overhaul law fails to make health insurance coverage more affordable. The Congressional Budget Office (CBO) has repeatedly warned that the Democrats’ plan would increase health insurance premiums, something the Democrats now realize, as reported by the New York Times. Conversely, CBO predicted the Republican Alternative would actually lower health insurance premiums without increasing the deficit, cutting Medicare, or raising taxes.
Impact on Individual Health Insurance Market Premiums in 2016
Under Various Democrat Proposals According to CBO
|
Proposal |
Change in Health Insurance Premiums Compared to Current Law Projections |
|
Senate Democrats’ Bill (H.R. 3590)* |
$2,100 increase |
|
House Democrats’ Bill (H.R. 3962)** |
$1,900 increase |
|
House Republican Bill (H.R. 4038)*** |
$1,050 decrease |
President Obama asserted that under the Democrats’ scheme, “you’re going to be able to get lower costs.” The President and Congressional Democrats also promised under the new law seniors’ Medicare would be unharmed, middle class taxes would not go up and the law would not increase the deficit. In the rush to score a political win, what else weren’t the Democrats being forthcoming about regarding health care reform?
IQHSA.com is your complete solution for quality low cost health insurance in Arizona.
Summary Health Care Reform
Summary Health Care Reform
Part IV.
Health insurance plan changes that impact individuals and employers (both fully insured and self-funded plans unless otherwise noted) over the next few years:
High-Level Overview Health Reform Law: Key Provisions for Large Employers
Overview
The health reform package is made up of two parts: a bill that passed the Senate on Christmas Eve, passed the House on March 21, and was signed into law by the President on March 23, and a second piece of legislation: the House’s reconciliation bill, which makes changes to the original
law, passed both chambers on March 25, and was signed by the President on March 30. Many of the provisions in the law will not take effect for several years. At the earliest, provisions that affect employer-sponsored health plans will take effect six months from the date of enactment – in late September. Even then, those early provisions will not affect plans until they renew for the next plan year.
The health reform law has thousands of pages and hundreds of provisions. So it’s important to remember that before many of those provisions are put in place, additional laws and regulations will need to be developed. That could be a lengthy process. Here are some highlights of the major provisions.
Individual responsibility
Starting in 2014, everyone must have health insurance coverage or pay a penalty, which will be enforced by the Internal Revenue Service. The penalties will be phased in over time:
- In 2014, an individual without a health insurance plan must pay whichever amount is greater: $95 or 1 percent of income.
- For 2016 and beyond, that penalty rises to $695 or 2.5 percent of income, whichever is greater (the $695 is indexed from 2016 on).
- Families will pay half the penalty for children, with a cap of $2,085 per family.
- There will be exemptions to this requirement, such as in cases of fi nancial hardship and other limited circumstances. Subsidies to buy private health insurance in new state exchanges will be available in the form of tax credits and cost-sharing assistance for people above Medicaid eligibility but below 400 percent of the federal poverty level. Medicaid eligibility will be increased to 133 percent of the federal poverty level.
Changes that affect your business and the employees who depend on you.
Employer responsibility
New employer group health insurance penalties and obligations
Starting in 2014, employers don’t have to offer their employees health insurance coverage, but most of them with more than 50 employees will pay an assessment if they don’t, or if they offer health insurance coverage that isn’t affordable. Full-time and part-time employees are included when determining whether an employer has 50 employees (based on current full-time employee equivalency rules).
- Employers with 50 or more employees that do not offer “minimum essential health insurance coverage” will pay $2,000 for each employee over the fi rst 30 employees if one of their employees gets a tax subsidy to buy health insurance under an exchange.
- Employers with 50 or more employees that do offer minimum essential health insurance coverage but have at least one full-time employee receiving subsidized coverage under an exchange will pay whichever is less: $3,000 for each employee receiving a premium credit or $2,000 for each full-time employee. Employers must provide “free choice” vouchers to employees with incomes below 400 percent of the federal poverty level if the employee’s contribution to health insurance coverage is between 8 percent and 9.8 percent of income and the employee chooses to purchase coverage in the exchange. No penalties will be imposed on employers with respect to employees who receive these vouchers. Employers with more than 200 employees that offer health insurance coverage must automatically enroll new full-time employees in health insurance coverage. Employees may opt out.
Not to be used for implementation purposes
IMPORTANT: This document is designed to provide a general overview of the new health reform law. It does NOT attempt to cover all of the law’s provisions and should NOT be used as the legal advice for implementation activities. We encourage you to seek any professional advice, including legal counsel, regarding how the new requirements will affect your specific plan.
This summary provided by Humana One Health Insurance and Humana Small Business Health Insurance.
Summary Of Health Care Reform Bill
Summary Of Health Care Reform Bill
Part III.
Health insurance plan changes that impact individuals and employers (both fully insured and self-funded plans unless otherwise noted) over the next few years:
IN 2018:
- Taxes. A new excise tax goes into effect for high-value, “Cadillac” health insurance plans: 40 percent for amounts over $10,200 for individuals and $27,500 for family health insurance plans, paid by health insurance companies and health plan administrators.
Medicare and Medicaid-related provisions
- Part D donut hole. Provides a $250 rebate for Part D enrollees who enter the “donut hole” coverage gap (2010 only). Beginning in 2011, there will be a 50 percent brand discount on drugs in the gap. Members will pay less for generic drugs in the gap as well: 93 percent in 2011, which phases down to 25 percent by 2020. The donut hole is eliminated by 2020.
- Retiree drug subsidy. Beginning in 2013, employers may no longer deduct the retiree drug subsidy when offering qualified coverage under Medicare Part D.
- Medicaid. Beginning in 2014, states are required to provide health insurance premium assistance and wraparound benefits to any Medicaid beneficiary who is offered employer-sponsored health insurance coverage, if it is cost-effective to do so.
- Medigap. The National Association of Insurance Commissioners will create new model plans for benefi t packages C and F that include nominal cost sharing. The new models will be available in 2015.
Other
- Administrative simplification. The law also requires HHS to adopt a single set of operating rules for electronic transactions to create uniformity (e.g., health insurance claims or equivalent encounter information, eligibility and claims status, enrollment and disenrollment, health insurance premium payments, and referral certification and authorization). Group health insurance plans will have to certify compliance with these standards.
- CLASS Act. Creates a new government-run voluntary long-term care insurance program (CLASS Program). Employers must automatically enroll employees and facilitate payroll deductions. Employees may choose not to participate.
Revenue-raising provisions
- Starting July 1, 2010, impose a 10 percent tax on tanning services.
- Beginning in 2011, the pharmaceutical industry will pay annual industry fees. The fee will be phased in and will hold steady at $2.8 billion a year after 2019.
- Beginning in 2013, manufacturers of medical devices will pay a 2.3 percent excise tax on sales of medical devices.
- Beginning in 2013, the Medicare payroll tax rate will increase by 0.9 percent for individuals who make more than $200,000 and couples that make more than $250,000.
- A new 3.8 percent tax will be added on income from interest, dividends, annuities, royalties and rents for those at the same income threshold.
- Beginning in 2014, a non-deductible premium tax will be imposed on health insurance comapnies ($8 billion in 2014, $11.3 billion in 2015 and 2016, $13.9 billion in 2017 and $14.3 billion in 2018. After that, it will
increase in an amount proportional to overall health insurance premium growth).
This summary provided by Humana One Health Insurance and Humana Small Business Health Insurance.
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Summary About Health Care Reform
Summary About Health Care Reform
Part II.
Health insurance plan changes that impact individuals and employers (both fully insured and self-funded plans unless otherwise noted) over the next few years:
IN 2011:
• Medical loss ratio (MLR). A Health insurer must publicly report on its MLR and spend at least 80 percent of small Business group premiums on medical services or provide rebate payments to enrollees.
• Spending accounts. Health savings accounts (HSAs) and flexible spending accounts (FSAs) may no longer be used to purchase over-the-counter drugs unless prescribed by a doctor. Increases tax for nonqualified Health Savings Account (HSA) withdrawals from 10 percent to 20 percent, and for Archer MSA withdrawals from 15 percent to 20 percent.
• HHS studies. HHS is required to study the group health insurance plan markets to compare employer characteristics and determine whether the new health insurance plan market reforms are likely to cause adverse selection in the large employer group health insurance market or to encourage small and midsize employers to self-insure. HHS and the Department of Labor must also collect information on self-funded plans. These studies could lead to additional employer reporting requirements.
• Uniform explanation of coverage. Within 12 months of the law’s enactment, HHS, in consultation with the National Association of Insurance Commissioners, will develop uniform standards and definitions for summaries of health insurance benefits and health insurance coverage explanations. Within 24 months of enactment, group health insurance plans must provide enrollees and applicants with coverage documents that meet these standards.
IN 2012:
• Comparative effectiveness fee. A new fee is imposed on group health insurance plans to fund comparative effectiveness research ($1 per participant through 2013; $2 per participant through 2019).
IN 2013:
• FSA contributions. Contributions to flexible spending accounts are limited to $2,500 a year.
IN 2014:
The federal definition of a small group employer is defined as an employer with 1-100 employees. States can modify the definition to 1-50 employees until January 1, 2016.
• Pre-existing conditions. Group health insurance plans can no longer impose pre-existing condition exclusions for any person of any age.
• Annual limits. Annual limits on essential health insurance benefits are prohibited.
• Guaranteed issue. Health insurance companies must accept every employer who applies for health insurance coverage.
• Rating restrictions. Rating restrictions go into effect for new fully insured small group health insurance plans. Insurance companies cannot base premiums on health status, claims experience or gender. Health Insurance Premiums can only vary by:
– Age (no more than 3:1)
– Geography
– Family size
– Tobacco use (no more than 1.5:1)
• Merged markets. States are allowed to merge the individual and small group health insurance markets.
• Clinical trials. Health Insurance Coverage of routine patient care costs is mandated for participation in approved clinical trials (does not apply to grandfathered plans).
• Exchanges. State health insurance exchanges are up and running for small businesses group health insurance and private individuals health insurance to buy coverage.
• Essential benefits. Essential health insurance benefit plan is created, which mandates the level of health insurance benefits that must be included in plans offered in the exchange, as well as in the private individual health insurance and small group health insurance markets outside the exchange. Deductibles limited to $2,000 for individuals and $4,000 for families in the small employer group health insurance market (self-funded plans and grandfathered plans are exempt from this requirement).
• Cost-sharing limits. Cost sharing imposed under group health insurance plans is limited to current health savings account amounts (does not apply to grandfathered plans).
• Waiting periods. Waiting periods cannot exceed 90 days.5
• Wellness. Expands health insurance plan wellness incentives up to 30 percent of total coverage costs (up to 50 percent with HHS approval).
• Reinsurance. A temporary reinsurance program will be established for the private individual health insurance market and funded by individual and group health insurance plan assessments ($25 billion in 2014-2016).
This summary provided by Humana One Health Insurance and Humana Small Business Health Insurance.