Barack Obama, President Obama — January 2, 2011 at 11:23 am

Health insurance reform measures that kicked in yesterday


You know that health insurance reform bill that got passed last year? The one that so many on the right claim is a “Big Government takeover of health care” and so many on the left said was completely worthless?

Below are the dozen provisions that kicked in yesterday (from the Kaiser Family Foundation).

Minimum Medical Loss Ratio for Insurers
Requires health plans to report the proportion of premium dollars spent on clinical services, quality, and other costs and provide rebates to consumers if the share of the premium spent on clinical services and quality is less than 85% for plans in the large group market and 80% for plans in the individual and small group markets.

Closing the Medicare Drug Coverage Gap
Requires pharmaceutical manufacturers to provide a 50% discount on brand-name prescriptions filled in the Medicare Part D coverage gap beginning in 2011 and begins phasing-in federal subsidies for generic prescriptions filled in the Medicare Part D coverage gap.

Medicare Payments for Primary Care
Provides a 10% Medicare bonus payment for primary care services; also, provides a 10% Medicare bonus payment to general surgeons practicing in health professional shortage areas.

Medicare Prevention Benefits
Eliminates cost-sharing for Medicare-covered preventive services that are recommended (rated A or B) by the U.S. Preventive Services Task Force and waives the Medicare deductible for colorectal cancer screening tests; authorizes Medicare coverage for a personalized prevention plan, including a comprehensive health risk assessment.

Center for Medicare and Medicaid Innovation
Creates the Center for Medicare and Medicaid Innovation to test new payment and delivery system models that reduce costs while maintaining or improving quality.

Medicare Premiums for Higher-Income Beneficiaries
Freezes the income threshold for income-related Medicare Part B premiums for 2011 through 2019 at 2010 levels resulting in more people paying income-related premiums, and reduces the Medicare Part D premium subsidy for those with incomes above $85,000/individual and $170,000/couple.

Medicare Advantage Payment Changes
Restructures payments to private Medicare Advantage plans by phasing-in payments set at increasingly smaller percentages of Medicare fee-for-service rates; freezes 2011 payments at 2010 levels; and prohibits Medicare Advantage plans from imposing higher cost-sharing requirements for some Medicare covered benefits than is required under the traditional fee-for-service program.

Medicaid Health Homes
Creates a new Medicaid state option to permit certain Medicaid enrollees to designate a provider as a health home and provides states taking up the option with 90% federal matching payments for two years for health home-related services.

Chronic Disease Prevention in Medicaid
Provides 3-year grants to states to develop programs to provide Medicaid enrollees with incentives to participate in comprehensive health lifestyle programs and meet certain health behavior targets

CLASS Program
Establishes a national, voluntary insurance program for purchasing community living assistance services and supports (CLASS program).

National Quality Strategy
Requires the Secretary of the federal Department of Health and Human Services to develop and update annually a national quality improvement strategy that includes priorities to improve the delivery of health care services, patient health outcomes, and population health.

Implementation: Initial strategy due to Congress by January 1, 2011

Changes to Tax-Free Savings Accounts
Excludes the costs for over-the-counter drugs not prescribed by a doctor from being reimbursed through a Health Reimbursement Account or health Flexible Spending Account and from being reimbursed on a tax-free basis through a Health Savings Account or Archer Medical Savings Account. Increases the tax on distributions from a health savings account or an Archer MSA that are not used for qualified medical expenses to 20% of the amount used.

There are another nine provisions that start in 2011 as well.

So, which is it? A socialist Big Government takeover of health care? A worthless piece of legislation that only makes the health insurance companies more powerful? Or is it a big step toward major change in how we pay for the health care of our citizens in this country, one that will provide a solid foundation for future improvements?

I believe it’s the latter. Much the way the first social security laws did or any other major piece of social legislation, the health insurance legislation signed into law by President Obama last year will be looked back upon as the beginning of us getting it right in terms of providing health care for ALL Americans. Sure, it’s got some thing in it that need to be improved and there are things that need to be added to it over time. But this is a fine starting point and I, for one, am proud to have been part of helping ensure that it get passed.

I’m just sayin’…

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