this is what IHC sent out about the new bill

A summary of federal healthcare legislation

People are asking a lot of questions about the federal healthcare reform legislation that was passed by the U.S. House of Representatives late on Sunday, March 21. Here’s a brief summary of what Congress has approved and what is expected to happen, and some links to help you learn more.

A brief overview of the legislation. Generally, the package would extend health insurance coverage. The Congressional Budget Office estimates it would cover an additional 32 million Americans who are currently uninsured, which ultimately would cover about 95 percent of eligible Americans. The legislation also includes new rules that will restrict the ability of health insurance companies to deny or limit coverage.

At the same time, the legislation will result in cuts in payments to healthcare providers and some tax increases. The American Hospital Association has been cautiously supportive of reform; it has endorsed a possible expansion of insurance coverage but is concerned about cuts in Medicare and Medicaid reimbursements.

Background on the legislative process. The House actually passed two bills on Sunday — it passed a bill that had previously been passed by the Senate on Christmas Eve, and a second bill that makes a modification in the Senate bill. The second bill now needs to be passed by the Senate, effectively ‘accepting’ the House changes. President Obama has signed the Senate bill, so it’s now law.

The Senate is expected to begin debate on the second bill later today. The second bill is being considered by the Senate under rules that require only a majority vote for passage — not the 60-vote majority usually required in the Senate to cut off debate.

It’s too early to know what the effects on Intermountain will be. Like other providers, we’re concerned about low reimbursement rates from Medicare and the cost-shifting that results. With regard to any legislation, Intermountain continues to advocate for a greater focus on quality improvement and high-value (rather than high-volume) care.

KEY MEASURES OF THE HEALTHCARE BILL, taken from a summary of a Congressional Budget Office report by the Associated Press and a summary provided by the American Hospital Association:

Expanded insurance coverage: When it’s fully phased in, 95 percent of eligible Americans would have health insurance coverage, compared with 83 percent today. The expanded coverage will be provided by an expansion of public programs and reforms of health insurance plans in the private sector and will begin in 2014.

Insurance mandate: Beginning in 2014, almost everyone in America will be required to be insured or pay a fine. There is an exemption for the poor. People without employer-based health insurance will be able to obtain coverage through health insurance exchanges that the bill requires states to establish (similar to the insurance exchange already formed by the Utah Legislature’s health reform task force).

Insurance market reform: Insurers are barred from placing lifetime dollar limits on policies or from denying coverage to children with pre-existing medical problems. Parents could keep children on their policies up to age 26. In 2014, insurers will be barred from denying coverage to anyone with pre-existing conditions or charging them more, or from charging more for women. A new high-risk insurance pool would offer coverage to the uninsured with medical problems until 2014, when coverage expansion kicks in.

Medicaid: The reform package expands federal-state insurance programs for the poor to cover people with incomes up to 133 percent of the federal poverty level, which is $29,327 a year for a family of four. Childless adults would be covered for the first time, starting in 2014. States will receive federal funds to pay for the newly expanded populations starting with 100 percent federal financing for 2014-2017 and scaled down to 90 percent for 2020 and after.

Taxes: Beginning in 2018, the government will tax healthcare plans that cost at least $10,200 for individuals and $27,500 for families. There will also be increased Medicare payroll taxes on investment income and wages for individuals who make more than $200,000 a year or married couples above $250,000.

Prescription drugs: The legislation gradually closes the so-called “doughnut hole” coverage gap in Medicare’s prescription drug benefit for senior citizens. The doughnut hole refers to a lack of prescription coverage after seniors have spent $2,830 on their meds and before their costs pass the catastrophic limit of $4,550. When that gap in coverage is eliminated in 2020, seniors will be responsible for 25 percent of the cost of their medications until Medicare’s catastrophic coverage kicks in.

Employer responsibility: Starting in 2014, larger employers will pay a $2,000-per-employee fee if the government subsidizes their workers’ insurance coverage. Companies with 50 or fewer workers are exempt.

Subsidies: Tax credits families can use to buy health insurance will be available on a sliding scale for households that make up to four times the federal poverty level, or $88,200 for a family of four. Premiums for a family of four making $44,000 would be capped at around 6 percent of their income.

How you choose your health insurance. Beginning in 2014, small businesses, the self-employed, and the uninsured could pick a plan offered through new state-based exchanges or purchasing pools. People working for medium-to-large firms (including Intermountain) wouldn’t see major changes.

Abortion: The bill tries to maintain a strict separation between taxpayer dollars and private premiums that would pay for abortion coverage. No health plan would be required to offer coverage for abortion. In plans that do cover abortion, policyholders would have to pay for it separately. States could ban most abortion coverage in plans offered through the exchange.

Innovation in healthcare delivery and payment. The bill creates an “innovation center” by 2011 that will test innovative payment and service delivery models that improve clinical outcomes and reduce costs in certain geographic areas.

If you’re interested in more details, here are links to two articles by the Henry J. Kaiser Family Foundation. One is a “consumer’s guide” and the other summarizes the immediate impacts of the bills, assuming the reconciliation bill passes the Senate.

• http://www.kaiserhealthnews.org/stories/2010/march/22/consumers-guide-health-reform.aspx?referrer=search
• http://www.kaiserhealthnews.org/stories/2010/march/22/immediate-effects-health-reform.aspx?referrer=search