(Tom Wrote:) One of the things that I find especially troubling about the acerbic exchange that has been taking place during the debate of the healthcare reform legislation is how vocal the opposition is about a law they know nothing about. I think I can speak for Rob when I say that we think this is a good law, not without its flaws of course, and not because we're flaming liberals, but because we know what the law says. Here are some of the new law's provisions:
1. If you are currently a Medicare recipient, this law will close the "doughnut hole" in the prescription drug benefit - by 2020, it goes away. The current "doughnut hole" means that Medicare STOPS paying anything for drugs after $2700, and doesn't start again until your costs reach $6,154. Now with this legislation, In 2010, if you exceed the $2700 threshold, but don't make it to the $6154 threshold (known as the "doughnut hole" or coverage gap), you will at least receive a $250 rebate. It gets better in 2011, as the cost of drugs in the coverage gap will go down by 50 percent. AND, the law will begin phasing down the coinsurance amount in the coverage gap so that by 2020, it will reach the standard 25 percent beneficiary coinsurance.
2. Copayments and deductibles for certain preventive care screenings will be eliminated. Under this new law, seniors will receive FREE preventive services.
3. The law includes a provision to improve care coordination for individuals with multiple physicians.
4. Americans 65 and older will continue to receive comprehensive health insurance. Doctors and hospitals will continue to be paid per procedure under the new law.
5. Effective immediately, insurance companies cannot deny coverage to children with pre-existing conditions. AND, beginning in six months, insurance companies must extend coverage to adult children (up to the age of 26) if they are a full-time student.
6. Insurance companies will no longer be allowed to deny a person's coverage when they get sick, and insurance companies cannot impose a lifetime cap on coverage. Insurance companies will not be allowed to rescind a person's coverage except in the case of fraud.
7. Companies with 50 or more employees will have to provide health insurance for their employees, or be subject to a penalty.
So how will we pay for all these new provisions? The bottom line is being offset with the elimination of waste and fraud that has been endemic in the system, and from small reductions in reimbursements to hospitals and doctors. This is where I have some doubt - but we won't know if it works until we try something. Also, in the beginning there will be no significant cuts in service to Medicare beneficiaries. However, beginning in 2019, Medicare beneficiaries earning OVER $85,000 will have to pay higher premiums. But what's the big deal with this? Every year for the last 5 years, I have watched my insurance premiums, albeit subsidized by my employer, go up consistently between 17 and 25 percent each year. Do you get those kinds of raises?
Probably the biggest opposition that we're hearing about is this: by 2014, all citizens and legal residents will be required to carry health insurance. The concept is simple: spread the risk over a larger number of people. If we don't all participate, then we all end up paying a greater amount for an individual with no insurance that needs healthcare - think gunshot victim, or a individual that suffers a heart attack that had no insurance. So, if an individual refuses to buy health insurance, under this new law, you will have to pay a penalty of $695. In the beginning, there will be subsidies to help individuals pay this "fine," and there are provisions for individuals that are living below the poverty line.
So far, we're not hearing anything that's all that bad.
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