Health Care Reform – Iniatives to Expect in 2011

The Health Reform Law was passed with hopes of making quality healthcare more affordable and accessible. The plan was to implement iniatives over a four-year process. With 2010 and the first phase of Health Reform behind us, it’s a great time to revisit the subject to see if more Americans are able to get health insurance. For information on getting Kaiser Permanente now, click Affordable Medical Insurance.

2010 Health Reform Highlights
In 2010, the President Obama Health Reform mandated that children could no longer be denied health insurance due to pre-existing medical conditions; however, many insurers opted to discontinue offering private coverage to children, due to the high costs typically associated with treating children. In effect, children could not get private health insurance year-round, though in some states open enrollment periods were instituted.



On the upside: The Health Reform Bill allowed young adults to stay on their parents’ insurance until their 26th birthday. Additionally, preventive care services on new private plans became free, lifetime limits on insurance coverage were eliminated, and Americans with pre-existing conditions who had been uninsured for at least 6 months were afforded an option to enroll in a temporary high-risk pool until year 2014 when Health Benefit Exchanges are scheduled to be in effect.

2011 Health Reform Initiatives
21 More features of Health Care Reform have been or will be instituted during the course of this year. Effective January 1, 2011, insurance companies are required to spend at least 85 percent of all premiums for large employer plans, and 80 percent of premiums for individual and small employer plans, on medical services and quality improvement. The Health Reform Bill requires insurers to publicly report their medical loss ratio. Insurance companies who do not meet the thresholds are required to provide rebates to customers. In addition, the Health Reform Law calls for insurance companies to submit justification for premium increases. Insurers with excessive or unreasonable rate increases may not be able to participate in the Health Insurance Exchanges in 2014.

Also in January 2011, over-the-counter drugs not prescribed by a doctor will no longer be qualified reimbursements under a Health Savings Account (“HSA”), Archer Medical Savings Account (“MSA”), Health Reimbursement Account (“HRA”), and a Health Flexible Spending Account. Also, the tax penalty on non-qualified HSA or Archer MSA expenses is increased from 10 percent to 20 percent.

A number of the 2011 Health Reform iniatives are Medicare/Medicaid related. Starting January 1, 2011, some preventive services, like annual wellness visits and personalized prevention plans will be free for seniors who are on Medicare. Also, seniors on Medicare will receive a 50 percent discount on brand-name drugs while in the Medicare Part D “Donut Hole” coverage gap. Moreover in January 2011, the Health Care Reform will assist high-risk Medicare beneficiaries improve care after they leave the hospital to avoid unnecessary readmissions.

Starting March 23, 2011, States will be awarded grants to begin planning for the Health Insurance Exchanges. Enrollment in Exchanges begins in 2014.

In October 2011, the Health Reform Bill calls for the Independent Payment Advisory Board to evaluate the Medicare Trust Fund to look for ways to reduce wasteful costs while improving the health of patients and increasing access to quality care. Also the new Community First Choice Option will provide States the alternative of offering disabled citizens home and community based services through Medicaid instead of nursing homes.

Things to Come in 2014
This is when the big ticket items are scheduled to be established. In 2014, the Health Reform Bill requires Americans and legal residents to have basic health insurance. An exemption may be available to individuals who are unable to obtain affordable insurance. Uninsured individuals who do not qualify for the exemption will pay a fee.

Insurance companies can no longer deny coverage to any age bracket due to pre-existing medical conditions. The Health Reform Law mandates that insurers can no longer charge higher rates based on health status or gender. The Health Reform Bill allows healthcare costs to be balanced out so that individuals without pre-existing conditions will help carry the cost for those with pre-existing conditions.

In 2014, Health Insurance Exchanges will be set in place giving Americans tons of options. These are state-based programs administered by either a governmental agency or non-profit organization. Individuals and small businesses with no more than 100 employees can buy health coverage directly through these Exchanges.

For more information, visit www.healthcare.gov and for the Kaiser Permanente response to health care reform visit http://xnet.kp.org/reform/index.htm.

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