Here are a few recent articles (and video) on healthcare reform.
health care reform: veering off track
Government intervention in health insurance is nothing new
Sunday, August 2, 2009
Saturday, August 1, 2009
Division B - Medicare and Medicaid
This section on the changes to Medicare and Medicaid eat up pages 215 to page 855. The giant section is divided up as follows:
Title I - Improving Health Care Value
Subtitle A - Provisions related to Medicare Part A
Part 1 - Market Basket Updates
Part 2 - Other Medicare Part A provisions
Subtitle B - Provisions related to Part B
Part 1 - Physician's Services
Part 2 - Market Basket Updates
Part 3 - Other provisions
Subtitle C - Provisions related to Medicare Parts A and B
Subtitle D - Medicare Advantage reforms
Part 1 - Payment and Administration
Part 2 - Beneficiary Protections and Anti-Fraud
Part 3 - Treatment of Special Needs Plans
Subtitle E - Improvments to Medicare Part D
Subtitle F - Medicare Rural Access Protections
Title II - Medicare Beneificiary Improvements
Subtitle A - Improving and Simplifying Financial Assistance for Low Income Medicare beneficiaries
Subtitle B - Reducing Health Disparities
Subtitle C - Miscellaneous Improvements
Title III - Promoting primary care, mental health services and coordinated care
Title IV - Quality
Subtitle A - Comparative Effectiveness Research
Subtitle B - Nursing Home Transparency
Part 1 - Improving transparency of information on skilled nursing facilities and nursing facilities
Part 2 - Targeting enforcement
Part 3 - Improving staff training
Subtitle C - Quality measurements
Subtitle D - Physician payments sunshine provision
Subtitle E - Public reporting on health care-associated infections
Title V - Medicare Graduate Medical Education
Title VI - Program Integrity
Subtitle A - Increased funding to fight waste, fraud, and abuse
Subtitle B - Enhanced penalties for fraud and abuse
Subtitle C - Enhanced program and provider protections
Subtitle D - Access to information needed to prevent fraud, waste, and abuse
Title VII - Medicaid and CHIP
Subtitle A - Medicaid and health reform
Subtitle B - Prevention
Subtitle C - Access
Subtitle D - Coverage
Subtitle E - Financing
Subtitle F - Waste, Fraud, and Abuse
Subtitle G - Puerto Rico and the territories
Subtitle H - Miscellaneous
Title VIII - Revenue-related provisions
Title IX - Miscellaneous Provisions
It's going to be painful but I'm going to slog through it. The key is really understanding the current code, which of course I don't.
Title I - Improving Health Care Value
Subtitle A - Provisions related to Medicare Part A
Part 1 - Market Basket Updates
Part 2 - Other Medicare Part A provisions
Subtitle B - Provisions related to Part B
Part 1 - Physician's Services
Part 2 - Market Basket Updates
Part 3 - Other provisions
Subtitle C - Provisions related to Medicare Parts A and B
Subtitle D - Medicare Advantage reforms
Part 1 - Payment and Administration
Part 2 - Beneficiary Protections and Anti-Fraud
Part 3 - Treatment of Special Needs Plans
Subtitle E - Improvments to Medicare Part D
Subtitle F - Medicare Rural Access Protections
Title II - Medicare Beneificiary Improvements
Subtitle A - Improving and Simplifying Financial Assistance for Low Income Medicare beneficiaries
Subtitle B - Reducing Health Disparities
Subtitle C - Miscellaneous Improvements
Title III - Promoting primary care, mental health services and coordinated care
Title IV - Quality
Subtitle A - Comparative Effectiveness Research
Subtitle B - Nursing Home Transparency
Part 1 - Improving transparency of information on skilled nursing facilities and nursing facilities
Part 2 - Targeting enforcement
Part 3 - Improving staff training
Subtitle C - Quality measurements
Subtitle D - Physician payments sunshine provision
Subtitle E - Public reporting on health care-associated infections
Title V - Medicare Graduate Medical Education
Title VI - Program Integrity
Subtitle A - Increased funding to fight waste, fraud, and abuse
Subtitle B - Enhanced penalties for fraud and abuse
Subtitle C - Enhanced program and provider protections
Subtitle D - Access to information needed to prevent fraud, waste, and abuse
Title VII - Medicaid and CHIP
Subtitle A - Medicaid and health reform
Subtitle B - Prevention
Subtitle C - Access
Subtitle D - Coverage
Subtitle E - Financing
Subtitle F - Waste, Fraud, and Abuse
Subtitle G - Puerto Rico and the territories
Subtitle H - Miscellaneous
Title VIII - Revenue-related provisions
Title IX - Miscellaneous Provisions
It's going to be painful but I'm going to slog through it. The key is really understanding the current code, which of course I don't.
Title 4 - changes to tax code (sections 401-453)
OUCH.
If an individual does not belong to a qualifying plan (including VA, medicare, etc.), they get a 2.5% wallop on their modified adjusted gross income. The tax, however, can't exceed the average cost (premium) of a self-only basic plan offered by an Exchange plan.
There is a religious exemption for health coverage - interesting!
If an employer decides not follow along (good luck with that!) - an 8% tax on payroll wages.
For small businesses, the IRS code gets modified... —Subpart D of part IV of subchapter A of chapter 1 of the Internal Revenue Code of 1986. Wow, it is hard to read!
- the tax credit for SMB is based on 50% of their health coverage expenses
- the credit slides down as the expenses go over 20K
- no credit allowed for employees who get paid over 80K
- SMB means <=25 employees, where an employee makes at least 5K
Section 441 - more taxes!
1% for income between 350K-500K (after 2012, goes to 2%)
1.5% for 500K-1M (after 2012, goes to 3%)
5.4% over 1M (OUCH)
then we get... there will be a study done in 2012 for the years 2009-2019 to determine the reduction in federal expenditures based on Division B (medicare and medicaid changes) of this Act. If this report shows between 150B and 175B in savings over and above the 525B savings expected, the 1% tax above will no apply. If it's > 175B, then the 1.5% tax above does not apply either.
Section 452 appears to be unrelated to the healthcare code and is just a straight tax code change. It is listed as 'codification of economic substance doctrine'. This would seem VERY important, but I have no idea what it means. Any comments?
If an individual does not belong to a qualifying plan (including VA, medicare, etc.), they get a 2.5% wallop on their modified adjusted gross income. The tax, however, can't exceed the average cost (premium) of a self-only basic plan offered by an Exchange plan.
There is a religious exemption for health coverage - interesting!
If an employer decides not follow along (good luck with that!) - an 8% tax on payroll wages.
For small businesses, the IRS code gets modified... —Subpart D of part IV of subchapter A of chapter 1 of the Internal Revenue Code of 1986. Wow, it is hard to read!
- the tax credit for SMB is based on 50% of their health coverage expenses
- the credit slides down as the expenses go over 20K
- no credit allowed for employees who get paid over 80K
- SMB means <=25 employees, where an employee makes at least 5K
Section 441 - more taxes!
1% for income between 350K-500K (after 2012, goes to 2%)
1.5% for 500K-1M (after 2012, goes to 3%)
5.4% over 1M (OUCH)
then we get... there will be a study done in 2012 for the years 2009-2019 to determine the reduction in federal expenditures based on Division B (medicare and medicaid changes) of this Act. If this report shows between 150B and 175B in savings over and above the 525B savings expected, the 1% tax above will no apply. If it's > 175B, then the 1.5% tax above does not apply either.
Section 452 appears to be unrelated to the healthcare code and is just a straight tax code change. It is listed as 'codification of economic substance doctrine'. This would seem VERY important, but I have no idea what it means. Any comments?
Friday, July 31, 2009
Title 3 - shared responsibility (sections 301-324)
This area is a tough read as it lists the impositions on the employer. ugh.
full time employees:
- for an individual, the employer MUST pay 72.5% of the premium of the lowest cost plan offered by the employer.
- for a family, it's 65%
non-full time employees:
TBD
An employee must specifically opt-out of any employer-offered coverage otherwise they automatically get the lowest cost coverage. For employees that opt out, the employer must pay a fee to the HCA. It's not entirely clear to me what the % means, but it's either 8% of all employee wages, or 8% of the premium which would have been paid. There is a sliding scale for employers with payrolls up to 400K.
Section 321 amends Subtitle B of title I of the Employee Retirement Income Security Act of 1974. It doesn't appear to be anything too drastic, just updating definitions and such to reflect this new healthcare act. Section 323 does the same for Part C of title XXVII of the Public Health Service Act.
full time employees:
- for an individual, the employer MUST pay 72.5% of the premium of the lowest cost plan offered by the employer.
- for a family, it's 65%
non-full time employees:
TBD
An employee must specifically opt-out of any employer-offered coverage otherwise they automatically get the lowest cost coverage. For employees that opt out, the employer must pay a fee to the HCA. It's not entirely clear to me what the % means, but it's either 8% of all employee wages, or 8% of the premium which would have been paid. There is a sliding scale for employers with payrolls up to 400K.
Section 321 amends Subtitle B of title I of the Employee Retirement Income Security Act of 1974. It doesn't appear to be anything too drastic, just updating definitions and such to reflect this new healthcare act. Section 323 does the same for Part C of title XXVII of the Public Health Service Act.
Thursday, July 30, 2009
Subtitle C - individual affordability credits (sections 241-246)
what a nice little term 'affordability credits' - sounds so pleasant doesn't it? Another fun one 'credit eligible individuals' - doesn't this sound like someone who has done a good job with their finances and can secure a loan? No, it's almost the exact opposite, it's someone who needs help paying their insurance premiums.
The commissioner (HCA) will have a form that people can fill out to apply for credits (a reduction to their premium). There will of course be a process to determine whether the individual is eligible; the HCA can use the state's Medicaid determination in the process, and in so doing, the HCA will be nice enough to reimburse the state's Medicaid for their time and effort.
In years 1 and 2, credits will only apply to people on a 'basic' plan. In year 3 and after, there will be an option to apply a credit to an 'enhanced' or 'premium' plan.
The credit is specifically not a cash rebate.
So, who would be able to apply for a credit?
- an individual who is lawfully present in a State in the United States (other than as a nonimmigrant described in a subparagraph (excluding subparagraphs (K), (T), (U), and (V)) of section 101(a)(15) of the Immigration and Nationality Act).
in the last section (246), it specifically states that no credits shall be available to persons not lawfully present in the US.
- someone not on an employer-sponsored insurance plan
- family income below 400% of the Federal poverty level for their size of family
- not Medicaid eligible
- after year 2, a family on an employer-sponsored plan but the cost of the plan is > 11% of the family's income
When defining income, we're talking about 'modified adjusted gross income'.
Credits will not be treated like a benefit from the employer (for tax purposes).
The premium credit is applied on a sliding scale based on family income. Essentially, if you are the poorest of the poor, you need to pay about 3% of the premium (if I'm understanding it correctly).
There is also the concept of credits for cost-sharing affordability. If I'm reading this correctly, it applies to HCA paying the insurance companies their % of the premiums.
The commissioner (HCA) will have a form that people can fill out to apply for credits (a reduction to their premium). There will of course be a process to determine whether the individual is eligible; the HCA can use the state's Medicaid determination in the process, and in so doing, the HCA will be nice enough to reimburse the state's Medicaid for their time and effort.
In years 1 and 2, credits will only apply to people on a 'basic' plan. In year 3 and after, there will be an option to apply a credit to an 'enhanced' or 'premium' plan.
The credit is specifically not a cash rebate.
So, who would be able to apply for a credit?
- an individual who is lawfully present in a State in the United States (other than as a nonimmigrant described in a subparagraph (excluding subparagraphs (K), (T), (U), and (V)) of section 101(a)(15) of the Immigration and Nationality Act).
in the last section (246), it specifically states that no credits shall be available to persons not lawfully present in the US.
- someone not on an employer-sponsored insurance plan
- family income below 400% of the Federal poverty level for their size of family
- not Medicaid eligible
- after year 2, a family on an employer-sponsored plan but the cost of the plan is > 11% of the family's income
When defining income, we're talking about 'modified adjusted gross income'.
Credits will not be treated like a benefit from the employer (for tax purposes).
The premium credit is applied on a sliding scale based on family income. Essentially, if you are the poorest of the poor, you need to pay about 3% of the premium (if I'm understanding it correctly).
There is also the concept of credits for cost-sharing affordability. If I'm reading this correctly, it applies to HCA paying the insurance companies their % of the premiums.
Subtitle B (sections 221-226) - Public Health Insurance Option
ah, now we get to the meat and potatoes...
The Secretary of Health and Human Services would run this new health insurance option. It has to follow all of the same rules as any other insurance option under the new Exchange; by definition it also has to only be offered under the exchange. We also get another new deparment - office of the ombudsman of the health insurance option.
The option gets $2B (2,000,000,000) in startup money to cover initial claims before the payment of premiums. The bill literally states that any premiums are to cover the cost of the healthcare and any administrative costs. The $2B is to be repaid to the treasury over a period of 10 years.
In a nutshell, the rates to providers, hospitals, doctors, etc will be the same as done for medicare. For the first 3 years, this will include a 5% uplift, but after year 3 all bets are off. Any service which provides medicare options today will automatically be included as an in-network provider unless they opt out. Anybody else see a serious problem here? Who are the doctors and providers who offer their services for less?
The Secretary of Health and Human Services would run this new health insurance option. It has to follow all of the same rules as any other insurance option under the new Exchange; by definition it also has to only be offered under the exchange. We also get another new deparment - office of the ombudsman of the health insurance option.
The option gets $2B (2,000,000,000) in startup money to cover initial claims before the payment of premiums. The bill literally states that any premiums are to cover the cost of the healthcare and any administrative costs. The $2B is to be repaid to the treasury over a period of 10 years.
In a nutshell, the rates to providers, hospitals, doctors, etc will be the same as done for medicare. For the first 3 years, this will include a 5% uplift, but after year 3 all bets are off. Any service which provides medicare options today will automatically be included as an in-network provider unless they opt out. Anybody else see a serious problem here? Who are the doctors and providers who offer their services for less?
Section 208 - state-based exchanges
Very interesting... the concept would appear to be a good one, or at least a good-will offering. If a state wishes to run its own healthcare exchange, it can do so and it would run in place of the federal exchange. Of course... the state exchange has to follow all of the same rules as the federal exchange, is still under the Commissioner's authority, etc.
The feds would also do a matching grant to assist the state with funding the exchange.
So why... I could see a state like Texas running one to at least make it appear that they are keeping some of their states rights. Or a state like Massachusetts which is already running a 'healthcare for all' option...
The feds would also do a matching grant to assist the state with funding the exchange.
So why... I could see a state like Texas running one to at least make it appear that they are keeping some of their states rights. Or a state like Massachusetts which is already running a 'healthcare for all' option...
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