Wednesday, August 1, 2012

Obamacare Gives Women Health Security

Forty-seven million women are getting greater control over their health care and access to eight new prevention-related health care services without paying more out of their own pocket beginning Aug. 1, 2012, Health and Human Services (HHS) Secretary Kathleen Sebelius announced today.

On July 31 Republicans in the House of Representatives for the thirty-four time since they took control of the House voted to repeal the Affordable Care Act, to emphasis their not only their opposition to the Obamacare, but their war on women.

Specifically, the eight preventive-care provisions that, as of today, will no longer entail any out-of-pocket costs for 47 million American women are:

  1. Well-woman visits.
  2. Gestational diabetes screening that helps protect pregnant women from one of the most serious pregnancy-related diseases.
  3. Domestic and interpersonal violence screening and counseling.
  4. FDA-approved contraceptive methods, and contraceptive education and counseling - Birth control covered by insurance companies, free of co-pays.
  5. Breastfeeding support, supplies, and counseling.
  6. HPV DNA testing, for women 30 or older.
  7. Sexually transmitted infections counseling for sexually-active women.
  8. HIV screening and counseling for sexually-active women.

The Rachel Maddow Show," July 31, 2012

Previously some insurance companies did not cover these preventive services for women at all under their health plans, while some women had to pay deductibles or copays for the care they needed to stay healthy. The new rules in the health care law requiring coverage of these services take effect at the next renewal date – on or after Aug. 1, 2012—for most health insurance plans. For the first time ever, women will have access to even more life-saving preventive care free of charge.

According to a new HHS report also released today, approximately 47 million women are in health plans that must cover these new preventive services at no charge. Women, not insurance companies, can now make health decisions that will keep them healthy, catch potentially serious conditions at an earlier state, and protect them and their families from crushing medical bills.

The Affordable Care Act requires many insurance plans to provide coverage for and eliminate cost-sharing on certain recommended preventive health services.

In addition, pursuant to the Affordable Care Act, in August 2011, the Department of Health and Human Services (HHS) Health Resources and Services Administration published guidelines on women’s preventive services that require health insurance plans to cover certain recommended preventive services specifically for women, without charging a co-pay, co-insurance or a deductible beginning in plan years starting on or after August 1, 2012.

The Guidelines are based on recommendations to the Department from the Institute of Medicine (IOM). The Department provided for an exemption for certain religious employers, and a transition is provided for certain additional non-profit organizations with religious objections to contraception coverage.

“President Obama is moving our country forward by giving women control over their health care,” Secretary Sebelius said. “This law puts women and their doctors, not insurance companies or the government, in charge of health care decisions.”

The health care law has already helped women in private plans and Medicare for the first time gain access to potentially life-saving tests and services, such as mammograms, cholesterol screenings, and flu shots without coinsurance or deductibles. Today’s announcement builds on these benefits, generally requiring insurance companies to offer, with no copay, additional vital screenings and tests to help keep women healthy throughout their lives.

These services are based on recommendations from the Institute of Medicine, which relied on independent physicians, nurses, scientists, and other experts as well as evidence-based research to develop its recommendations. These preventive services will be offered without cost sharing beginning today in all new health plans.

Group health plans and issuers that have maintained grandfathered status are not required to cover these services. In addition, certain nonprofit religious organizations, such as churches and schools, are not required to cover these services. The Obama administration will continue to work with all employers to give them the flexibility and resources they need to implement the health care law in a way that protects women’s health while making common-sense accommodations for values like religious liberty.

For women who are pregnant or nursing, the new preventive services include gestational diabetes screening as well as breast-feeding support, counseling and supplies. Health services already provided under the health care law include folic acid supplements for women who may become pregnant, Hepatitis B screening for pregnant women, and anemia screening for pregnant women.

Women Medicare beneficiaries may already receive such preventive services as annual wellness visits, mammograms, and bone mass measurement for those at risk of osteoporosis and diabetes screening. Approximately 24.7 million women with Medicare used at least one free preventive service in 2011, including the new annual wellness visit.

Because of the Affordable Care Act, secure, affordable coverage is becoming a reality for millions of American women and families. Men and children are also able to take advantage of preventive services at no extra charge under the health care law. These services include flu shots and other immunizations, screenings for cancers, high blood pressure and cholesterol, and depression.

Last month the Medical Loss Ratio Provision provision of the Affordable Care Act benefiting both women and men kicked in. The Medical Loss Ratio Provision of the Act requires health insurance companies to spend 80% of the consumers’ premium dollars they collect — 85% for large group insurers — on actual medical care rather than overhead, marketing expenses and profit. Failure on the part of insurers to meet this requirement will result in the insurers having to send their customers a rebate check representing the amount in which they under-spend on actual medical care. (Reference)

The Kaiser Family Foundation estimates that rebates to health insurance customers this year will total more than $1.3 billion. Roughly 30 percent of people who buy individual or small group insurance will receive a refund, as will 20 percent of people who buy large group insurance. The refund rate for people with individual insurance is highest in Texas, where 92 percent of consumers will receive a refund. The amount refunded will be highest in Alaska ($305 per person) and Maryland ($294 per person). Full state-by-state data on refund rates and amounts for different insurance market sizes is available in the report.

These refunds are only part of the cost savings created by the Affordable Care Act. When deciding on how much to charge consumers for insurance this year, insurance companies knew that if they charged too much relative to how much they spent on patient care they would have to provide rebates at the end of the year. Presumably, consumers are already paying less for health insurance than otherwise would have been the case because many insurers moderated their rate increases. The Kaiser Family Foundation earlier this year released a report documenting how the federal Affordable Care Act of 2010 is already reducing the cost of health care for individuals and businesses.

The Affordable Care Act, according to a Washington Post/ABC News survey, is now backed by 47 percent of Americans, up from 39 percent in April 2012. Opposition to the law in the wake of the Supreme Court decision upholding it is also down, from 53 to 47 percent.

When the DBN wrote about that January 19, 2011 vote to repeal Obamacare we included a partial list of health insurance industry reforms that Republicans want to repeal. The list is given here, again.

  1. No lifetime limit on coverage for 105 million Americans.

  2. Up to 17 million children with pre-existing conditions can no longer be denied coverage by insurers.

  3. 6.6 million young adults up to age 26 have taken advantage of the law to obtain health insurance through their parents’ plan.

  4. Free coverage for comprehensive preventive services for millions of women starting in August.

  5. 86 million Americans, including 32 million seniors in Medicare, have already received free preventive services.

  6. 5.3 million seniors have already saved $3.7 billion on their prescription drugs.

  7. Since the health care law was enacted in March 2010, 4.2 million private sector jobs have been created – many of them in the health care industry.

  8. The Small Business Health Care Tax Credit has already been used by 360,000 small businesses to help insure 2 million workers.

  9. $1.1 billion in rebates from health insurance companies this summer will benefit nearly 13 million Americans.

  10. The health care law reduces the deficit by $124 billion over the next 10 years and over $1 trillion over the following decade.
Any of the thirty-three Republican bills to repeal Obamacare brought to the House floor since January 2011, if passed by the Senate and signed by Pres. Obama, would add roughly $230 billion to the deficit by 2021 and leave about 54 million non-elderly Americans uninsured by 2019, according to CBO projections.

Here are some of the private health insurance industry reforms mandated in the legislation that Republicans want to repeal:

  • Health Insurers cannot deny children under age 19 health insurance because of preexisting conditions. (Reference) A ban on preexisting condition exclusions for adults will take effect in 2014.
  • Small businesses will get tax credits covering up to 50% of employee premiums for 2009 and 2010. (Reference)
  • Seniors will get a rebate to fill the so-called "doughnut hole" in Medicare drug coverage, which severely limits prescription medication coverage expenditures over $2,700. As of 2012, 50 percent of the doughnut hole will be filled. (Reference)
  • The cut-off age for young adults to continue to be covered by their parents' health insurance rises to the 27th birthday. (Reference)
  • Lifetime caps on the amount of insurance an individual can have will be banned. Annual caps will be limited, and banned in 2014. It says that health insurance companies can no longer tell customers that their health care coverage will be terminated because they have hit a "lifetime limit" on claims. And there are now restrictions on yearly spending limits. too. (Reference)
  • Adults with preexisting conditions may buy into a temporary national high-risk pool, at different rates than people without them, until health insurance exchanges come online. While high-risk coverage will not be cheap, it is still better than total exclusion from health care access. And the high-risk pools provide some cost benefit from a wider pool of insured adults. This is a way to phase out the old "preexisting conditions" exclusions insurance companies use to use to deny health care coverage. Health insurance exchanges will eliminate the program in 2014. (Reference)
  • Free preventative care - New plans must cover checkups and other preventative care (mammograms, colonoscopies, etc.) without co-pays. All plans will be affected by 2018. (Reference)
  • No more rescission. Effective immediately, insurance companies can no longer cut someone when he or she starts filing claims for high treatment cost diseases like cancer. (Reference)
  • Insurers have less ability to change the amount customers have to pay for their plans. (Reference)
  • Authorizes early funding of community health centers in all 50 states. Community health centers provide primary, dental and vision services to people in the community, based on a sliding scale for payment according to ability to pay.
  • Insurers must now reveal how much money is spent on overhead - All insurers must post their balance sheets on the Internet and fully disclose administrative costs, executive compensation packages, and benefit payments. (Instead of just "administrative fee", they have to be more specific).
  • Any new plan must now implement an appeals process for coverage determinations and claims. Insurers need to have an appeals process for when they turn down a claim, so customers have some manner of recourse other than a lawsuit when a claim for coverage is denied. (Reference)
  • This tax will impose a ten percent tax on indoor tanning services. This tax, which replaced the proposed tax on cosmetic surgery, would be effective for services on or after July 1, 2010. (Reference)
  • New screening procedures will be implemented to help eliminate health insurance fraud and waste. (Reference)
  • Medicare payment protections will be extended to small rural hospitals and other health care facilities that have a small number of Medicare patients. (Reference)
  • Non-profit Blue Cross organizations will be required to maintain a medical loss ratio -- money spent on procedures over money incoming -- of 85 percent or higher to take advantage of IRS tax benefits.
  • Chain restaurants will be required to provide a "nutrient content disclosure statement" alongside their items, so people can have an easier time making choices to eat healthy. Expect to see calories listed both on in-store and drive-through menus of fast-food restaurants sometime soon. (Reference)
  • The bill establishes a temporary program for companies that provide early retiree health benefits for those ages 55-64 in order to help reduce the often-expensive cost of that coverage.
  • The Secretary of Health and Human Services will set up a new Web site to make it easy for Americans in any state to seek out affordable health insurance options The site will also include helpful information for small businesses. (Reference)
  • A two-year temporary credit (up to a maximum of $1 billion) is in the bill to encourage investment in new therapies for the prevention and treatment of diseases.
  • The Medical Loss Ratio Provision of the Act requires health insurance companies to spend 80% of the consumers’ premium dollars they collect — 85% for large group insurers — on actual medical care rather than overhead, marketing expenses and profit. Failure on the part of insurers to meet this requirement will result in the insurers having to send their customers a rebate check representing the amount in which they under-spend on actual medical care. (Reference)
  • The Act allows the Food and Drug Administration to approve more generic drugs (making for more competition in the market to drive down prices) (Reference)
  • The Act establishes a non-profit group, that the government doesn't directly control, PCORI, to study different kinds of treatments to see what works better and is the best use of money. (Reference)
  • Insurance companies can no longer deny insurance coverage because of a "preexisting" disability, or because they are, or have been, a domestic abuse victim. (Reference)
  • People in a "Medicare Gap" get a rebate to make up for the extra money they would otherwise have to spend. (Reference)
  • For people who make over $200,000 a year, taxes go up less than 1 percent after January 1, 2013. (Reference)
  • High preexisting condition insurance coverage rates are totally eliminated. Everyone pays the same rate the same regardless of their medical history beginning on January 1, 2014. (Reference)
  • Beginning on January 1, 2014, if you can afford insurance but do not get it, you will be charged a fee. If you opt to not buy insurance, you'll have to pay a penalty fee on your tax form, unless you just can't afford it. The Supreme Court ruled this mandate is Constitutional, as long as it's considered a tax on the uninsured and not a penalty for not buying insurance. (Reference)
  • Medicaid can now be used by everyone up to 133% of the poverty line (basically, a lot more poor people can get insurance) (Reference)
  • Businesses with over 50 employees must offer health insurance to full-time employees, or pay a penalty.
  • Insurers now can't do annual spending caps. Their customers can get as much health care in a given year as they need. (Reference)
  • The Act limits how high of an annual deductible insurers can charge customers. (Reference)
  • The Act establish health insurance exchanges and rebates for the lower and middle-class, basically making it so they have an easier time getting affordable medical coverage. (Reference)
  • The Act requires Congresspersons and Congressional staff to use the same insurance offered to people in the insurance exchanges, rather than Federal Insurance. Basically, we won't be footing their health care bills any more than any other American citizen. (Reference)
  • If any state its own health insurance that gives citizens the same level of care at the same price as the Affordable Care Act, they can ask the Secretary of Health and Human Resources for permission to do their plan instead of the Affordable Care Act. So if they can get the same results without, say, the mandate, they can be allowed to do so. Vermont, for example, has expressed a desire to just go straight to single-payer (in simple terms, everyone is covered, and medical expenses are paid by taxpayers). (Reference)
Only one in four Americans said they support full repeal of the reforms, according to a January 2011 Associated Press-GfK poll, and 30 percent strongly opposed the law, the lowest figure since September 2009. The drop is particularly notable among Republicans. Forty-nine percent said they're against the law, down considerably from 61 percent just after the November 2010 elections.

ObamaCare Is Winning the Fight on Fraud and Abuse


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