At The Top Of The Ladder

Coming health-care changes you may not know about

0 Comments | Charleston Gazette, The, Jul 10, 2010 | by Mary Agnes Carey

WASHINGTON – Several little-known provisions of the new health- care overhaul law take effect in coming months that could have a lasting impact on the nation’s health-care system.

They include eliminating 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.

Here’s a quick look at some of the changes that are occurring this year:

Prevention for less

What: Insurers won’t be able to require co-payments or deductibles for certain preventive services such as breast cancer screenings every one to two years, cholesterol blood tests and screenings for some sexually transmitted diseases. Insurers also will 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 that any increase in premiums would be minuscule.

When: The change takes effect Sept. 23, which means it applies to plan years that begin after that. For many plans, their new years begin after Jan. 1.

Status: The Department of Health and Human Services says regulations are on their way. Paul Bonta, the associate executive director for policy and government affairs at the American College of Preventive Medicine, predicts that 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 often is 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 requirements for 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 to cover early retirees’ health costs

What: A new program will help employers handle the cost of health care for retirees 55 and older who aren’t eligible for Medicare, the federal program for the elderly. The reimbursements will cover 80 percent of medical claims that are between $15,000 and $90,000 for retirees, their spouses and dependents.

When: Applications are being accepted now to help cover claims that date 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 premiums

What: Insurers must justify premium increases to the federal government and state insurance commissioners. If the hikes are deemed to be unreasonable – federal regulators have yet to define what “unreasonable” means – states could exclude those insurers from offering coverage on the health insurance exchanges.

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 association 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, but 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 earns less than 133 percent of the poverty line, which is $14,400 this year for individuals. Currently, the program doesn’t cover most poor people without children
low deductible health insurance