Health Care Reform

Health Care Reform Is Law... Now What?

Thank You Health Reform Event at City Ha
CIR National President Dr. L. Toni Lewis thanks Rep. Charles Rangel and Rep. Nydia Velasquez on the steps of New York City Hall on April 1, 2010.

CIR will regularly update this page with information about how this health reform law impacts you, your patients, and your hospitals. We'll also have a lot to say about ways we can make our health care system even better and will share with you the best indendent resources on reform from around the Web.

After a year of a public debate that dominated the news, you would think that everything has already been said about the health care reform bills that were signed into law this March. But clearly that’s not the case. In part because some details were being tweaked right up until the bills passed both houses of Congress, and in part because so much of the public debate focused on the politics of reform and not on the substance of the proposal, many are left wondering when and how the new laws will affect them.

Below is an overview of how the health reform law is structured and what changes you can expect in the years to come.

The Big Picture on Health Care Reform:
Expanding coverage:

Expanding Medicaid and CHIP in 2014 to cover all individuals and families up to 133% of the poverty level (about $29,500 for a family of four). Increasing reimbursement for Medicaid to match Medicare rates by 2013.
Creating “health insurance exchanges” in each state in 2014. Like Orbitz for health insurance, insurance companies would offer plans with identical required benefits, allowing individuals and small businesses to compare on price and quality.
Members of Congress will be required to buy their own insurance from these exchanges.
Requiring businesses with more than 50 employees to either provide benefits or pay a fine if any of their employees are receiving subsidies, and requiring all individuals to provide proof of coverage or pay a fine.

Reining in Insurance Companies:

New regulations would forbid the practice of excluding patients with pre-existing conditions (for children in 2010 and adults by 2014), as well as the practice of rescissions – cancelling customers’ policies for a reason other than fraud.
For the first time, regulating the insurance industry’s medical loss ratio – the ratio of premium dollars taken in to dollars spent on providing care, as opposed to administration or profit – requiring all large employer-sponsored plans to spend at minimum 85% of premiums on medical services by 2011 (80% for the small business and individual markets).

Requiring all new insurance plans to cover preventative services and screenings starting in 2010 and to eliminate cost-sharing for preventative services for new and existing plans.
Allowing children and young adults to stay on their parents’ plans until age 26, beginning this year.
Prohibiting different price rating on the basis of gender, health status, or occupation. Requires that different pricing based on age cannot exceed a 3:1 ratio. (2014)
Prohibits insurers from requiring prior authorization for emergency room care or OB/GYN services, starting this year.

Making coverage affordable:

Small businesses will be eligible for refundable tax credits to cover up to 35% of the cost of premiums for their employees this year. In 2014, that tax credit goes up to 50% of the premium.
Individuals and families buying from the exchange who are below 400% of the poverty level (about $88,000 for a family of four) will receive subsidies on a sliding scale so their premiums will not exceed a percentage of their income (roughly 2-10%).
Out-of-pocket expenses will be capped each year for those purchasing from the exchange and, eventually, those covered through their jobs.

Supporting the physicians of tomorrow:

Incentives for primary care physicians, including expanded scholarships and loan repayment through the National Health Service Corps, tax relief for physicians paying state-issued student loans, and additional low-interest loans, scholarships, loan repayment programs for primary care and general surgery – all beginning this year.

A 10% bonus in Medicare for primary care and some general surgery physicians, and a 5% bonus for mental health providers beginning in 2011.
Federal funding for five-year demonstration projects at the state level to reform the medical malpractice tort system, starting next year.
Establishing for the first time a National Commission on Health Care Workforce and a fully-funded Prevention and Public Health Investment Fund.
A $250 million Health Care Fraud and Abuse Control Fund to pay for a decade’s worth of investigation and enforcement in Medicare and Medicaid.
In 2012, Medicare begins experimenting with alternative payment models to encourage quality of care, rather than quantity of care. These include adequate reimbursements for accountable care organizations, the patient-centered medical home, bundled payments for episodes of care, etc.
Creates and fully funds a Patient-Centered Outcomes Research Institute to conduct comparative effectiveness research and inform physicians of the latest results.

There’s much more to the new law. The above description barely scratches the surface.

Best Resources on the Web for the Health Care Reform Law

These analytical resources come from some of the best policy organizations or have been recommended by media outlets (like The Washington Post) as being particularly helpful in helping to parse how the new law affects health care for you, your hospital, and your patients. Have a suggestion for adding to this list, email Tim Foley, CIR's Communications Director.

How Health Reform Really Works -- Center for American Progress

Ellen-Marie Whelan, NP, PhD, the Senior Health Policy Analyst and Associate Director of Health Policy at the Center for American Progress explains how the recently passed health care reform bill will give Americans better care and reduce the deficit. [VIDEO]

Timelines for Health Care Reform Implementation -- The Commonwealth Fund

An Internist's Practical Guide to Understanding Health System Reform -- American College of Physicians

A thorough analysis of "what happens when" with a particular eye on how delivery system and payment reform will affect patients and physicians.
An Internist's Practical Guide to Understanding Health System Reform

The New Health Care Law and You -- AARP

A great summary of provisions relating to Medicare, the Medicare Part D "donut hole", Medicare Advantage plans and other aspects of the law that applies to senior citizens and Medicare patients. Go to AARP's site.

Health Reform -- Kaiser Family Foundation

A full summary of all provisions, a premium subsidy calculator, and in-depth discussions of implementation. Go to KFF's site.

The Sustainable Growth Rate Formula and Health Reform -- Center on Budget and Policies and Priorities

A history of the Medicare SGR and its relation (or non-relation) to the health care reform law passed this year. Go to CBPP's site.

HealthReform.gov

A site run by the Dept. of HHS with information on the new law, frequently updated. HHS is already moving on making a number of implementation decisions, and is posting that information as soon as it becomes available. Go to HealthReform.gov.