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Posts Tagged ‘reform’

Obamacare, Affordable Care Act, California

Ready or not here it comes. The first stages of implementation of the Affordable Care Act are only a few weeks away. Its goal is to provide health care coverage to some 55 million Americans who currently have no health coverage and to expand coverage to those who are underinsured. This monumental plan takes effect January 1, 2014.

Universal coverage is the goal of the plan and will be attained in two ways. First is the individual mandate which requires anyone without any type of health care coverage either through the government or an employer, to purchase an individual policy or face a financial penalty, referred to as a tax. The second way is that employers of more than 50 full-time workers will be required to provide insurance or pay a penalty of $2,000 per worker. If you are one of the millions covered by employer purchased insurance plans, Medicare or Medi-Cal you need not make any changes.

Those who have no employer offered health insurance and thus have to purchase their own coverage may see an increase in rates next year, but it is projected that almost half of these people will be eligible for tax credits to offset the increased premiums. Health insurance marketplaces called exchanges will allow consumers to compare costs and benefits among the available plans and to see if they qualify for tax credits to offset the price of their insurance premiums. These new plans are, for the most part, private (not public) and will compete to earn your business based on price, benefits and quality of service.

You can enroll beginning October 1 at the official website at http://www.coveredca.com, or by telephone at 888-975-1142 toll free.

People with incomes between $23,000 and $94,000 for a family of four, can receive financial help on a sliding scale to help offset costs. The same help is available to single individuals earning up to $46,000.

Those with very low incomes will be enrolled in Medicaid (Medi-Cal in California). As of January 1, 2014 Medi-Cal eligibility income levels will rise to $15,900 for individuals and $23,550 for families.

The first open enrollment period will last from October 1, 2013 to March 1, 2014. One may sign up via the internet, telephone, mail, or in person at designated centers. Once enrolled, it could take several weeks for the new coverage to take effect.

The law states that people cannot be denied coverage or charged higher premiums because of preexisting conditions. However, premiums may vary depending on age, tobacco use, geographic location and family size.

The new law requires that insurance policies cover the following 10 essential benefits:

– Hospitalization and rehabilitation services.

– Outpatient care (office visits) and emergency care.

– Prescription drugs and laboratory services.

– Preventative (wellness) care and mental health services.

– Pediatric and maternity/newborn care.

The law also eliminates lifetime limits on medical expenses, prohibits insurers from dropping or denying coverage, provides for your child to be covered on your policy until age 26, and caps annual out of pocket expenses up to an estimated $6,400 for individuals and $12,800 for families.

This is a monumental change in health care coverage. Soon there will be a significant change in health care delivery. Stay tuned.

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I would like to offer my interpretation of the federal government’s Affordable Care Act, commonly called Obamacare.

First of all, insurance companies will be regulated. There will be coverage under the parent’s policy for children up to age 26. There will be no maximum limit on what an insurance company will pay for an individual’s lifetime of health care coverage, and preexisting illness cannot prevent one from obtaining health insurance.

Preventive care, such as mammograms, colonoscopies and other related services, will be covered by all insurance plans with no out-of-pocket expense.

A Prevention & Public Health Fund will be created to promote general health and wellness programs and initiatives to combat obesity and discourage tobacco use, alcohol and drug abuse and other unhealthy conditions.

Added taxes will be placed on pharmaceutical companies, medical device makers and the tanning booth industry.

The government will regulate and control reimbursement to health care providers — that is, physicians and hospitals.

A commission, acting independently of congressional control, will develop new ways of paying for medical care, with a move away from the fee-for-service model. One such new model is called the Accountable Care Organization. This would function somewhat like an HMO, except that ACO patients would not be required to stay within a network.

In addition, there is the “individual mandate” part of the act. This is a requirement that starting in 2014, all U.S. citizens will be required to purchase health insurance. It pertains mostly to the 30 million people who, for whatever reason, are without health insurance.

About half of these uninsured people have incomes high enough to buy health insurance through state-run health insurance exchanges. The others have incomes low enough that they will be covered by the existing state-run Medicaid programs.

For people who choose insurance through the exchange, premiums will be regulated by the government, which will also provide subsidies to help those who cannot afford to buy insurance. People who work for firms with 100 or fewer employees will also be able to purchase their own coverage through the exchanges. Undocumented immigrants will be barred from purchasing insurance through the exchanges.

There will be a penalty to individuals and companies who choose not to purchase health insurance. This penalty — which the law calls a tax — will top out at $695 per individual and $2,085 per family. There will be no criminal or civil action for refusing to pay the penalty; however, the IRS could withhold tax refunds from those who owe penalties.

In summary, the Affordable Care Act is an attempt by the federal government to help provide health insurance to the 30 million-plus citizens who have no coverage. It makes significant pro-consumer changes to existing health insurance regulations and makes an attempt at offering programs that could improve the health of most American citizens.

There are some major questions being asked about this law, such as: Will there be enough medical providers to care for the newly insured millions of Americans? Will there be enough money to finance this ambitious project, and where will it come from? What happens to states that don’t want to increase their Medicaid programs?

This is a large and complex law with many details that still needed to be worked out. In a future column, I will give my personal assessment of its major provisions.

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I have been asked by numerous people about my view of the recently passed health care reform law.

First, as someone who tends to lean more to the conservative side, I have always been leery of a government-run health care system, because I feared that “big brother”’ would come between and interfere with the important concept of the doctor-patient relationship. I have very serious concerns about what could happen to the quality of medical care in such a system.

In reality, the government already provides health care for a significant percentage of the population in this country through Medicare, Medicaid and the Veterans Affairs health program. Whether these systems are the best they can possibly be is a matter of opinion.

Given the fact of the existing level of government-run insurance, I think the best scenario would be that the majority of us not covered by the government would continue to obtain private health insurance and that such insurance would be affordable and be made more competitive, compassionate and cooperative.

I am of the opinion that our health care system is one of the best in the world, but it has had its major problems.

One problem was that, although the majority of U. S. citizens had health care coverage, millions of people did not. This seems to have been remedied by the new law, which should really be called a “health insurance reform law,” because health insurance coverage was its main objective.

Another problem with our system is that the rate of national spending on health care is staggering and unsupportable. It cannot continue its pace without bankrupting our economy.

The new law has done nothing to lessen the rapidly increasing cost of health care — in fact, I fear it will increase spending, adding to the national deficit.

No political party until now has achieved this level of change in an attempt to improve our health care system, even when it was well-known that changes were necessary. I see this new bill as a step in the right direction, even with its flaws, because it will force us — patients, providers and government — to make important changes. Time will tell how well it works.

The things I like most about the new bill are:

• It provides expanded health insurance coverage for those who have none.

• It ends health insurance company abuses, such as denials based on pre-existing conditions or the ending of coverage after one becomes ill.

• People who are satisfied with their health insurance plans can keep them.

• It allows parents to continue coverage for their children up to age 26.

My concerns about the new bill are:

• The cost to implement this bill will be staggering and will be unable to be supported by increased taxes on the wealthy and the proposed “Medicare savings.” This will lead to increased taxes for all or a restriction of health care.

• Those who have health insurance, both private and Medicare, will pay higher premiums to cover the expanded care provided by the new bill.

• Although the law has provisions to increase the number of primary care doctors, there will not be enough providers for the millions of new patients seeking care.

• There is no provision to decrease the rapidly escalating cost of medical care, which, if not brought under control, could be disastrous for our economy.

The bottom line as I see it is that something needed to be done to shake up the health care system to provide for its long-term healthy existence. The new bill has major flaws, but it is a beginning to promote the necessary changes.

Now, what is absolutely imperative is to develop a plan to rein in the cost of health care. In my next column, I will share my thoughts on how to bring this about.

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