What Changes With Obama Health Reform?
March 25, 2010
Now that the bill has been signed, the medical world waits for the sound of a footfall - the other shoe dropping. How our industry is expected to figure out what has happened to it as the result of 2700 late night pages that even the legislators who passed it have not read is beyond us - we are children of a simpler era when government news was boring beyond belief, and the idea of crowding around a computer to learn what is happening next seems to us surreal. Still, after arm-twisting and deal making, the bill is the law. Now what?
Bills H.R. 3590 -- the Senate Health Care Reform Bill -- and H.R. 4872 -- the Reconciliation Act of 2010 -plow the road for final enactment of the most sweeping reform of the U.S. health care system since 1965, when Medicare was created.
Most of the really big stuff will not take effect until 2014, but many smaller changes will be upon us sooner. So far, what we have seen is not too painful. But we still have a lot to learn about the consequences, intended or otherwise, of such sweeping legislation.
Here are some of them:
Small Business Tax Credits
Chiropractors are business people, and as such they often have employees, and it is usually hard and costly to buy them health insurance (the shoemakers kids go barefoot). Beginning this year, the bill offers tax credits to help small businesses provide their employees with health insurance. Initial credits cover up to 35 percent of the total employee premium payments. In 2014, that jumps to 50 percent of premiums.
Medicare Preventive Care Without Co-Pays
January 1, 2011, co-payments for Medicare-covered preventative services will be eliminated. Preventative services will be also exempted from deductibles. This may mean more Medicare money is available for chiropractic care-if it can be determined what precisely is "preventive care", and whether or not chiropractors can provide it..
Early Retirees Re-Insurance
Many patients are employees that have been offered early retirement. They are too young to slow down, too old to start over, and they are often stuck without affordable insurance. Effective 90 days after bill enactment, a temporary re-insurance program helps offset the costs related to health benefits for this segment of the population. (Of course, we have to educate the patients to this option, and then court this group to our offices.)
Help for the Un-Insurable
If an employee goes without insurance for too long a time, then insurance plans can slap on a whole panel of exclusions due to pre-existing conditions. Previously, the way around this has been to carefully capture "open enrollments", which occur immediately upon hiring and then disappear until the next open enrollment period. No more. Ninety days after the bill passes, a special pool of high-risk insurance will be available from which no one can be excluded. Premiums, TBD, of course, but there are times when any insurance is better than none. Same for kids who are un-insurable, only the plan takes six months to take effect.
Also within six months after the bill fires up, no one can be dropped from an insurance plan when or because they get sick-and need it the most. Also, no more need to marry off a daughter just because she is too old for coverage under your own insurance. From six months after the bill starts, kids can stay on the rolls until they are 26. Finally, insurance plans can no longer cap their plan pay-outs with a lifetime limit.
Funding, Funding, Funding
All of the above merely prolong the love-hate relationship most chiropractors have with insurers. However, the new bill also authorizes major funding for "community health centers". Some predict that they will be able to double patient volume over the next five years. Also, there is a lot of money available to train the next generation of doctors and nurses.. Please stand by for how this will all work.
Appeals Are No Longer A Choice, But Mandates and Compliance For All. We will go into this in more depth in future articles.
So, is there good news after all in the Obama Health Reform bills, or have we all been put out to pasture? We will keep you updated as we continue to keep you informed as soon as facts become available and as facts and reality continue to morph this year. In the meantime, keep listening for that other shoe to drop.
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