Showing posts with label Health Insurance. Show all posts
Showing posts with label Health Insurance. Show all posts

Tuesday, March 23, 2010

Health Reform Makes History - What Does it Mean?

The House voted late Sunday March 21, 2010 (219-212 vote) in favor of sending the Health Reform Bill to President Obama. In addition, the House Democrats made some changes to the Senate's health reform bill (220-211 vote) which now goes back to the Senate. They must pass word-for-word reconciliation. As I post this blog entry, Obama is signing this long-awaited bill for the health of our nation.

32 million uninsured will now have health insurance. Excluded in this number are: illegal immigrants (who are also banned from purchasing in the health insurance exchanges), those eligible for Medicaid who won't enroll until they seek care, and those choosing to pay the fine instead of purchasing health insurance.

Here is a breakdown of (some of) what is included in this historical piece of health legislation.

Effective Immediately up to 6 Months From Now:
1) Insurers can't deny coverage to sick children (due to preexisting health conditions)
2) Free preventive care--screenings and preventive care must be excluded from annual deductibles on any new plans (all other plans affected in 2018)
3) No caps on lifetime benefits and restrictions on annual limits on coverage
4) Young adults allowed to stay on parent's insurance until the age 0f 26
5) Medicare Advantage (Medicare benefits delivered by private firms) gets cuts in spending in 2011
6) Children on Medicaid or state CHIP can't be dropped from now until 2019
7) Excise tax on tanning beds (10%)--"sin" tax
8) Individuals without coverage because of preexisting conditions can purchase it from high-risk pools (to be combined into exchanges in 2014)
9) Rebate of $250 for Medicare seniors in the "donut hole" for prescription drug benefits. First of incremental steps to close the hole (half-closed next year)

Effective in (or just prior to) 2014:
1) Individual Mandate--Everyone must purchase health insurance or pay annual fine of $95 (rises to $695 in 2016) unless they can prove financial hardship.
2) State health insurance exchanges--marketplace of insurance plans--goes into effect
3) Insurers can't deny coverage to adults with preexisting health conditions
4) Insurers required to cover maternity care same as medical procedures
5) Tax credits will start helping pay premiums for working families with incomes up to $88,000 per year
6) Medicaid expanded to cover more low-income people, up to 133% of federal poverty level
7) Medicare payroll tax increase of 1% for individuals making >$200k and couples making >$250k
8) New Medicare tax on unearned income of 3.8% (in 2013)
9) "Donut Hole" closing--Medicare Part D prescription drug coverage gap to be fully closed by 2020

Other items:
In 2018, "Cadillac health plans" are taxed 40% of value of the plan above thresholds (of $10,200 per individual or $27,500 per family)
The bill maintains longstanding federal funding restrictions (known as Hyde Amendment) on abortions. The exception would be in cases of rape or incest, or when the life of the woman would be endangered.

It is estimated by the nonpartisan Congressional Budget Office to cut federal deficits by $143 billion over the next decade. This bill is a landmark piece of legislation to improve the health of our nation's people. In my eyes, this is an incremental step (and focused on health insurance reform), but an amazing step nonetheless.

What are your thoughts about this this historical event, the passing of health reform?

Monday, May 25, 2009

Employers: Rewarding the Healthy



It is well-understood:  being healthy is cheap.  Healthier employees are cheaper employees--less costs fo chronic diseases (e.g. diabetes, obesity, cardiovascular health) and less productivity lost.

Employers really do not have any incentives to provide prevention plans for employees, as the majority of employees don't spend their lifetime at one company and leave for new jobs before employers could reap the financial benefits of investing in preventive behaviors of employees.  Tax benefits for employers could help.  Policymakers are trying to get a larger number of employers to grasp this notion.  A recent survey by Hewitt Associates says that 1/3 of employrs are planning to put more of an emphasis on wellness plans.  Some large corporations already do, such as General MillsDell, and Safeway.  More will like
ly follow suit, especially with the proposed policy changes.  

Sen Baucus (D-MT) and Sen Harkin (D-IA) are propsing tax incentives for employers that offer wellness programs to employees.  This is consistent with Obama's goals for health reform ("invest in prevention and wellness").  A victory for public health--a shift in focus from treating more expensive and downstream diseases, rather than a focus in less-expensive upstream acts of preventing diseases from beginning.  But who loses?
A recent Health Affairs article, "Financial Penalties for the Unhealthy? Ethical Guidelines for Holding Employees Responsible for Their Health," looks at the other side of this issue.  According to federal Health Insurance Portability and Accountability Act (HIPAA) regulations, employers can give rewards/penalties for up to 20% of the total cost of covering an employee.  However, unions and those concerned with personal freedoms are arguing about the blurry ethical line of holding employees responsible and protecting their individual liberties.  Considerations about paternalism, personal choice, privacy protection, access to health promotion, and the complexities of developing obesity are brought up on the opposing side.

Where do you stand?