Seven Health Care Changes You Might Have Missed,
Some Impact Senior Citizens
For older people: expanded Medicaid, coordinated care
for Medicare-Medicaid patients, help for employers to insure early
retirees, FDA can approve cheaper drugs
July 9, 2010 - You've probably
heard that the new health overhaul law this year will provide an option
for young adults to stay on their parents' health plans and set up
insurance pools for people with pre-existing medical conditions who
can't find insurance. But several lesser-known provisions also take
effect in coming months that could have a lasting impact on the nation's
health care system.
These provisions include
eliminating patients' co-payments for certain preventive services such
as mammograms, giving the government more power to review health
insurers' premium increases and allowing states to expand Medicaid
coverage to low-income adults without children.
While these changes might not have
gotten at lot of attention, they could help build support for the law in
the run-up to the contentious mid-term elections. Here's a quick look at
some of the changes occurring this year:
Prevention For Less
What: Insurers won't be able to
charge co-payments or deductibles for certain
preventive services such as
breast cancer screenings every one to two years, cholesterol blood tests
and some sexually transmitted disease screenings. Insurers will also
have to cover recommended immunizations at no cost to patients. Some
health care analysts have suggested that premiums may rise as a result
of this and other new requirements, but administration officials say any
increase in premiums would be miniscule.
(Editors Note: co-payments are
eliminated next year from Medicare preventive services in new bill.
Click for more.)
When: The change takes effect Sept.
23, which means it applies to plan years that begin after that. For many
plans, their new year begins after Jan. 1.
Status: The Department of Health
and Human Services says regulations are on their way. Paul Bonta,
associate executive director for policy and government affairs at the
American College of Preventive Medicine,
predicts manufacturers of vaccines and diagnostic tests will push for
their products to be labeled preventive services in a bid to have them
covered at no cost to consumers.
Knowing Which Treatments Work
Best
What: A nonprofit research
institute will examine various medical treatments -- by looking at data
and conducting its own studies -- to determine which methods work best.
This is often called "comparative
effectiveness research."
When: The comptroller general of
the United States -- who runs the Government Accountability Office --
will appoint the 17 members of the institute's board of governors, which
will oversee the institute's operations.
Status: Everything about this
institute, from its board members to its findings about treatments, is
likely to generate great interest and potential controversy. The law
says the board's findings can't be interpreted as requiring how doctors
practice medicine or what insurers cover. However, in the quest to
control health care costs, employers, insurers and others may point to
such data as rationales for changes in coverage and treatment patterns.
Helping Cover Early Retirees'
Health Costs
What: A new
program will help employers
handle the cost of health care for retirees age 55 and older who are not
eligible for Medicare, the federal program for the elderly. The
reimbursements will cover 80 percent of medical claims between $15,000
and $90,000 for retirees, their spouses and dependents.
When: Applications are now being
accepted to help cover claims dating back to June 1.
Status: The $5 billion program is
intended to help employers cover retirees' health costs until the health
insurance exchanges state-based insurance marketplaces -- are up and
running in 2014. A cautionary note: the
Employee Benefit Research Institute
found that if the subsidy were provided for all early retirees and their
dependents, the $5 billion would last no more than two years.
Keeping Tabs On Health Insurance
Premiums
What: Insurers must justify premium
increases to the federal government and state insurance commissioners.
If premium hikes are deemed to be unreasonable federal regulators have
yet to define what "unreasonable" means states could exclude insurers
from offering their coverage on health insurance exchanges beginning in
2014.
When: The provision has gone into
effect but federal regulations haven't been issued yet.
Status: The
National Association of Insurance
Commissioners is developing recommendations for federal
regulators about what information insurers should provide to state and
federal officials to justify premium increases. A draft proposed by a
subcommittee of the NAIC has drawn fire from consumer advocates who say
the government should demand much more detailed information. The federal
government won't have the power to regulate rates; however, some states
exercise that authority.
Expanded Medicaid Coverage
What: In 2014, Medicaid, the
state-federal program for the poor, will expand to include everyone who
makes less than 133 percent of the
poverty line ($14,400 this year
for individuals). Currently, most poor people without children aren't
covered by the program. But in the meantime, under the law, states can
expand their Medicaid programs to cover these people, and get federal
aid to do so.
When: States could expand Medicaid
now to cover childless adults and receive some federal funding. In 2014
the federal government will pick up the entire cost of expanding
Medicaid to childless adults and others who qualify.
Status: So far, both Connecticut
and Washington, D.C., have applied and received permission from federal
officials to expand their Medicaid programs right away. Connecticut
officials say that as many as 45,000 childless adults they cover under a
state program will now be covered by Medicaid. That will save the state
$53 million over the next year since it already covers some of the
poorest single adults.
Ann Kohler, director of health
services for the
American Public Human Services Association
and head of the
National Association of State Medicaid
Directors, said many states are worried they don't have the
money or staff to expand now. Computer systems used by states and the
federal government often don't line up, Kohler said, and there may not
be enough doctors to care for all the newly covered individuals.
Care Coordination for 'Dual
Eligibles'
What: Approximately 8.8 million
"dual eligibles" -- individuals who qualify for both Medicare and
Medicaid, many of whom are poor elderly -- could benefit from a new
federal office designed to coordinate their medical care.
When: Immediately. HHS officials
have said they will soon release additional information about the new
office designed to coordinate care.
Status: Jim Verdier, a senior
fellow with
Mathematica Policy Research, a
health policy research firm, said about a dozen states, including
Arizona, Minnesota and Wisconsin, are already working to integrate care
but that the process is complicated. For one thing, rules on how to deal
with this population vary from state to state and also differ from the
federal government's regulations. If Medicare and Medicaid had rules
that were uniform across the country, care for these people would be
easier to coordinate, he said.
FDA Approval For 'Follow-On
Biologics'
What: The health overhaul law gives
the Food and Drug Administration the power to approve lower-cost
versions of
biologic drugs often called
biosimilars or follow-on biologics after drugmakers have 12 years of
market exclusivity. These drugs can be used to treat serious diseases
such as cancer and multiple sclerosis.
When: Later this year, the FDA is
expected to hold the first in a series of meetings to solicit comments
from the public and the industry on how the process should work. Players
on all sides of the debate expect the agency to move slowly in figuring
out how to bring these drugs to the market.
Status: Issues to be decided in the
future include how to define what constitutes a "biosimilar" drug and
how to resolve patent challenges that may emerge.
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(Health Reform Section)
