Healthcare Changing

"...but we have to pass the bill so you can find out what is in it" Nancy Pelosi 03/09/2010 Legislative Conference for the National Association of Counties (NACo)

You will notice that the title of this article is "Healthcare Change" and not "Healthcare Reform". As Speaker Pelosi said in the above quote, all of us are still wondering what this legislation will do to the healthcare system as we know it, or in other words, what benefits it will provide, what benefits it will take away, what it will cost and who will pay for it? I am not sure the Patient Protection and Affordable Care Act will do exactly what the title of the law says.

We will briefly address some of these questions in this newsletter and revisit them as the dust clears. Here are some highlights (as we understand the bill a day after it was signed into law), presented in the order in which they go into effect, followed by some recent events precipitated by the new law and a "final comment":

Effective Immediately:

·         Children may remain on parents' policy until age 26 and may not be excluded because of pre-existing conditions.

·         Children on Medicaid or State Children's Health Plans may not be dropped until 2019.

·         Adults benefiting from State Medicaid programs may not be dropped until 2014 (State Insurance Exchanges begin then) - However, a State may drop these individuals at an earlier date to close a budget gap.

·         Small companies (fewer than 25 employees with average annual wages less than $50,000) which offer health insurance to their employees will receive a tax credit up to 35% (may increase to 50% by 2014).

·         Insurance companies may not drop individuals from coverage due to sickness.

3 Months:

·         Indoor tanning sessions will be taxed at 10%.

·         Those who have not been able to obtain coverage for 6 months due to pre-existing conditions will be able to get insurance from special "high risk pools" (these "pools" will become part of the State Insurance Exchanges in 2014).

·         Temporary Reinsurance Program reimburses companies who provide retiree health care to retirees between the ages of 55 and 65 for claims between $15,000 and $90,000. This provision ends in 2014.

6 Months:

·         Medicare participants who are in the prescription drug "doughnut hole" will receive a subsidy of up to $250.

·         For newly written policies, preventive care and screenings will not be subject to a deductible.

·         Lifetime coverage caps disappear.

·         Individuals may not be dropped from coverage (except for fraud).

·         Extends Medicaid to many low-income individuals (2014), States may do so before then.

2011

·         Medicare participants in the "doughnut hole" will receive a 50% subsidy.

·         Voluntary long-term (in home or nursing home) assistance plan is to be made available.

·         Cuts to Medicare Advantage plans start being made.

·         Companies have to report value of healthcare on W-2.

·         Prescription drug manufacturers to pay annual fee on certain branded prescription drugs.

·         Community health centers which treat low-income and underserved individuals get increased assistance.

·         Manufacturers and importers of medical devices to pay an annual fee.

·         Physicians may not refer patients to hospitals in which they have an ownership interest.

2012

·         Non-profit "insurance co-ops" will be created to compete with for profit carriers.

·         "Accountable Care Organizations" organizations may be created by physicians, hospitals and carriers to provide lower cost care.

2013

·         An additional 0.9% of all earned income will be added to the current 1.45%  for Medicare (there is no limit on the amount of income taxed) for individuals earning over $200,000 or couples earning over $250,000.

·         Employee pre-tax contributions to flexible spending plans will be limited to $2,500 per year (increased with inflation thereafter) - this is an unseen tax increase.

·         Excise tax of 2.3% applied to medical device sales (hearing and vision aids are excluded).

·         Medicare payments to be based on "quality" of care.

·         Gender based premium rates abolished.

·         Elimination of tax deduction for employers who receive Medicare Part D retiree drug subsidy payments.

2014

·         Businesses with more than 50 employees will have to offer health insurance or pay a penalty of $2,000 times the number of employees minus 30.

·         Businesses that offer coverage to only a portion of their workforce may face a $3,000 penalty.

·         Part-timers now counted in determining the number of employees.

·         Adults with pre-existing conditions may not be refused coverage.

·         Higher premiums for those with chronic illnesses may no longer be charged.

·         Maternity to be covered as any other medical condition.

·         Individuals without coverage and not able to prove hardship will pay a $95 annual fine (increases to $695 in 2016). Fines are per person with families capped at $2,250.

·         State insurance exchanges created for companies with fewer than 100 employees, called Small Business Health Options Programs or "SHOP Exchanges".

·         Tax credits to those whose income is less than 400% of the Federal poverty level, for lowest earners tax credit may pay for entire healthcare cost.

·         Medicaid expanded to individuals making up to 133% of the Federal poverty level ($14,404 for an individual and $29,326 for a family of four).

2018 and In General

·         "Cadillac" healthcare plan tax of 40% of the value of a plan with a premium of $10,200 for an individual or $27,500 per family (indexed for inflation). Lexus protests nick name of this tax

·         Medicaid to US Territories increased over 9 years by $6.3 billion.

·         Medicare reimbursement rates will be lowered (the employee wage rates and rent portions of the rate formulae will be decreased).

Recent Events

·         Fourteen State Attorneys General file suit to stop healthcare law.

·         Varying physician groups consider dropping Medicaid care.

·         Boeing will take a $150 million charge in the first quarter due to the new law

·         Insurer Prudential Financial Inc. said Monday that it will take a $100 million charge in the first quarter in relation to the recent health care overhaul legislation

·         AT&T said last week it would take a $1 billion charge in the first quarter

·         AK Steel Corp., 3M Co., Caterpillar Inc., Deere & Co. and Valero Energy have also said they would take smaller charges

·         Premiums for Medicare Advantage plans will increase, benefits decreased or plans terminated due to cuts made to these plans by the new bill. Participants will face a higher total healthcare cost.

·         Insurance carriers are challenging the inclusion of children with pre-existing conditions. The carriers say that if they do not now cover children, then they should not be required to cover children with pre-existing conditions.

Final Comment

Now that the bill has been signed into law, the President and the majority party in Congress is out to "sell" it to the public. Why was it passed if it has to be "sold" to the people it will cover?

Outbreak Notice
Update: Dengue, Tropical and Subtropical Regions

Situation Information

Dengue fever is the most common cause of fever in travelers returning from the Caribbean, Central America, and South Central Asia. This disease is caused by four similar viruses (DENV-1, -2, -3, and -4) and is spread through the bites of infected mosquitoes.

Dengue infections are frequently reported from most tropical countries of the South Pacific, Asia, the Caribbean, the Americas, and Africa. Although dengue transmission often occurs in both rural and urban areas, dengue infections are most frequently reported from urban settings.

Since early 2009, an increased number of dengue cases have been reported from countries throughout several regions of the world. 

Africa

Cape Verde: In 2009, more than 21,000 suspected cases and 6 deaths (as of December 6, 2009) were reported. Approximately 60 cases were reported in nearby Senegal, according to the UN Office for the Coordination of Humanitarian Affairs.

South Pacific

Dengue activity continues to circulate throughout this region. Examples of outbreaks include the following:

• Malaysia: In the first 6 weeks of 2010, more than 6200 cases and 23 deaths were reported throughout the country, especially in Selangor and Sarawak.
• Indonesia: Dengue activity is ongoing. From January-October 2009, more than 100 deaths were attributed to dengue hemorrhagic fever. In December 2009, the Ministry of Health issued an alert about heightened dengue hemorrhagic fever transmission during this rainy season.
• Sri Lanka: As of February 23, 2010, 7500 cases have been reported throughout the country, including in the Colombo capital district.

Central and South America and the Caribbean

Certain countries in Central and South America as well as in the Caribbean, are reporting dengue activity. These areas include Brazil, Colombia, Guatemala, Honduras, Nicaragua, Puerto Rico, St. Barthelemy, and Saint Martin.

Middle East

Dengue activity has been reported in recent months in this region, including areas popular among travelers such as Jeddah and Mecca in Saudi Arabia.

Advice for Travelers

Travelers can reduce their risk of getting dengue fever by protecting themselves from mosquito bites. The mosquitoes that spread dengue usually bite at dusk and dawn but may bite at any time during the day, especially indoors, in shady areas, or when the weather is cloudy.

Travelers should follow the steps below to protect themselves from mosquito bites:

• Where possible, stay in hotels or resorts that are well screened or air conditioned and that take measures to reduce the mosquito population. If the hotel is not well screened, sleep under bed nets to prevent mosquito bites.
• When outdoors or in a building that is not well screened, use insect repellent on uncovered skin. If sunscreen is needed, apply before insect repellent.
• Look for a repellent that contains one of the following active ingredients: DEET, picaridin (KBR 3023), Oil of Lemon Eucalyptus/PMD, or IR3535. Always follow the instructions on the label when you use the repellent.
• In general, repellents protect longer against mosquito bites when they have a higher concentration (percentage) of any of these active ingredients. However, concentrations above 50% do not offer a marked increase in protection time. Products with less than 10% of an active ingredient may offer only limited protection, often no longer than 1-2 hours.
• The American Academy of Pediatrics approves the use of repellents with up to 30% DEET on children over 2 months old.
• Protect babies less than 2 months old by using a carrier draped with mosquito netting with an elastic edge for a tight fit. Wear loose, long-sleeved shirts and long pants when outdoors.
   

Symptoms and Treatment

Symptoms of dengue include:

• fever
• severe headache
• pain behind the eyes
• joint and muscle pain
• rash
• nausea/vomiting
• hemorrhagic (bleeding) manifestations

Usually dengue fever causes a mild illness, but it can be severe and lead to dengue hemorrhagic fever (DHF), which can be fatal if not treated. People who have had dengue fever before are more at risk of getting DHF.

No vaccine is available to prevent dengue, and there is no specific medicine to cure illness caused by dengue. Those who become ill with dengue fever can be given medicine to reduce fever, such as acetaminophen, and may need oral rehydration or intravenous fluids and, in severe cases, treatment to support their blood pressure. Aspirin (acetylsalicylic acid), aspirin-containing drugs, and other nonsteroidal anti-inflammatory drugs (e.g., ibuprofen) should be avoided because of the possibility of bleeding. Early recognition and treatment of severe dengue (e.g., signs and symptoms consistent with impending blood pressure failure) can reduce the risk of death.

If you return from a trip abroad and get sick with a fever, you should seek medical care. Be sure to tell the doctor or other health-care provider about your recent travel.

 

 

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