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History in the Making
Healthcare Reform Becomes LawEditor’s Note: The vast majority of the time, I love the fact that we’re a monthly publication. The nature of our distribution schedule allows us the luxury of time to delve more deeply into clinical and business issues impacting the healthcare industry. However, I have to admit to having a bad case of “daily paper envy” since the historic House vote on healthcare reform. When it occurred in late March, we were already preparing to go to layout with the April paper, and our print schedule dictated the paper be put to bed while politicians, pundits, providers and consumers were still trying to åfigure out what the new law would look like when it left Pennsylvania Avenue and moved to Main Street.
One thing is already clear … the law has engendered passionate responses — both for and against — from a broad cross section of the country. For some, it could literally be a lifeline … for others, a death knell. Whether or not the new law will ever reach broad implementation also remains to be seen. At press time, more than a dozen state attorney generals had filed suit alleging the law is unconstitutional on various grounds.
Following is some of what we do know on the front end about provisions in the new law. However, this information doesn’t begin to scratch the surface of the 2,000-plus page law. More in depth coverage is planned for the coming months as we begin to dissect pieces and parts of the plan and examine how it will impact the healthcare industry.
It should also be noted that the House passing H.R. 3590, the Patient Protection and Affordable Care Act, was only the first game in a double-header. On the same evening, the House also acted on the Health Care & Education Affordability Reconciliation Act (H.R. 4872), which makes amendments to H.R. 3590. On March 25, the Senate passed the reconciliation measure with some “fixes” and sent it back to the House where it passed that same evening with a 220-207 vote.
For more coverage, turn to page 5, for reactions from a variety of stakeholders issued in the days following passage of the Patient Protection and Affordable Care Act.
The president needed 216. He got 219. By the slimmest of margins … and without a single Republican vote … the House of Representatives passed H.R. 3590, the Patient Protection and Affordable Care Act on March 21.
As he picked up a pen on March 23, President Obama said, “Today, I’m signing this reform bill into law on behalf of my mother, who argued with insurance companies even as she battled cancer in her final days.” When the $940 billion piece of legislation became law, it was the culmination of a nearly century-long push to reform the American healthcare system that began with President Theodore Roosevelt.
At the signing, President Obama said, “While the Senate still has a last round of improvements to make on this historic legislation — and these are improvements I’m confident they will make swiftly — the bill I’m signing will set in motion reforms that generations of Americans have fought for, and marched for, and hungered to see.”
Indeed, just two days later the reconciliation bill was passed by both Houses. Before the celebratory cheers subsided, however, more than a dozen state attorney generals had already filed lawsuits questioning the constitutionality of a law that places costly demands on individual states with no way to opt out. With many provisions not going into effect for several years, Republicans vowed to repeal the law before it could be widely implemented by campaigning vigorously against their Democratic colleagues who supported this version of reform.
To try to ward off a wholesale ousting of Democrats by voters in conservative states, the president immediately launched what amounted to a national public relations campaign to try to explain the reforms to a confused constituency. Interestingly, a USA Today/Gallup Poll released on March 22, found the president’s task, while difficult, might not be impossible. When asked if the new healthcare law was a “good thing” or “bad thing,” 49 percent of adult Americans weighed in as pleased with 40 percent unhappy about the reform package and 11 percent had no opinion.
Unquestionably, the various mandates will benefit some while imposing new burdens on others. Within six months to a year, a handful of changes will be in place, including:
The more sweeping changes happen by 2014 and beyond. At that point, Americans will be required by law to carry “minimal essential coverage” or pay a fine, but the law includes subsidies and establishes exchanges to assist in this goal. Employers with more than 50 employees will also be required to provide insurance for their staff or pay a penalty. The estimate is that an additional 32 million Americans will have coverage when all is said and done.
By 2014 health plans will not be allowed to deny coverage for anyone based on health status or to exclude coverage for pre-existing conditions. Insurers will also be restricted from imposing lifetime benefit caps. Health insurance exchanges will open in each state for use by individuals and small employers. Medicaid eligibility will increase to 133 percent of the federal poverty level (FPL), and credits will be available through the exchanges for those whose income exceeds Medicaid eligibility but is less than 400 percent FPL and who do not have access to other acceptable insurance.
The law also calls for more flexibility in home- and community-based services, research into innovations in delivery and public health services, an emphasis on preventative medicine, and grants for state and local governments for initiatives to improve the health of the community. The healthcare workforce supply is also addressed through the establishment of a National Health care Workforce Commission. Provisions are also made for continuing education and training for healthcare workers.
Individuals making $200,000 annually and couples making $250,000 should expect to pay more taxes to help cover the cost of implementing these reforms. By 2018 an excise tax on “Cadillac” plans will be imposed. Insurance carriers with yearly net premiums of $25 million or more will be required to pay an annual fee beginning in 2011. Payments to Medicare providers will be linked to outcomes and quality of care. Hospitals will see a decrease in DSH payments as the number of uninsured patients drops.
For some Americans, these new mandates have caused a slow burn. That actually might turn out to be a blessing in disguise for anyone hoping for a little heightened color as winter turns to spring. As long as that red face comes either from the sun’s rays or pent up anger, no problem. If, however, someone seeks indoor tanning services after July 1, 2010, they will have to pay a 10 percent excise tax. Tags:NoneBookmark:
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