In one of its most detailed defenses of the healthcare reform law, the Obama administration listed at least 15 benefits for consumers, without mentioning the law's controversial mandate to buy health insurance or provider-oriented changes such as accountable care organizations.
The list, in a release by HHS and two other federal departments, is framed as a letter to Rep. John Boehner (R-Ohio), the new speaker of the House, who plans to hold a vote next week to repeal the reform law. It includes the following benefits:
1. Protections for pre-existing conditions. New and group health plans are now banned from denying coverage to children up to age 19 due to a pre-existing condition. Adults with pre-existing conditions can now enroll in new Pre-Existing Condition Insurance Plans available in all 50 states. In 2014, insurers will be prohibited from discriminating against individuals of any age because of a pre-existing condition.
2. Coverage for young adults. More than 2 million young adults up to age 26 are able to stay on a parent’s health insurance policy when they cannot get coverage of their own.
3. Making insurance affordable. In 2014, all Americans will have access to affordable coverage in competitive state-based exchanges that offer private insurance options. The Congressional Budget Office estimates the exchanges will reduce the premiums for individuals by 14 to 20 percent.
4. Small Business Health Care Tax Credits. These tax credits began last year, providing up to 35 percent of an employer’s insurance costs, and they will rise to as much as 50 percent of such costs in 2014.
5. Early Retiree Reinsurance Program. This program helps employers to continue offering healthcare benefits to early retirees who are not yet eligible for Medicare.
6. Help for state reviews of rate hikes. The law makes $250 million available to states to enhance reviews of insurer's rate hikes so they can better protect consumers and stop unreasonable premium hikes from taking effect.
7. Required justification for rate hikes. Under proposed rules, insurance companies proposing rate hikes of 10 percent or more would have to post and justify those hikes to state or federal regulators. If the increases were found to be unreasonable, the insurer would have to publicly disclose this on its own website and the federal website, www.HealthCare.gov.
8. Defined medical loss ratios. New rules on medical loss ratio rules require insurers to spend at least 80-85 percent of premium dollars on healthcare or quality improvement efforts, instead of items such as marketing and CEO bonuses.
9. Patient’s Bill of Rights. The bill of rights, which took effect in September, bars insurers form rescinding coverage when the policyholder gets sick or makes an unintentional error in paperwork. In addition, insurers may no longer impose lifetime dollar limits on benefits. Women no longer need a referral to see an ob/gyn. The newly insured now have a choice of any available primary care physician in their network and can go to the closest ED even if it is out of their network. They will now receive preventive services like mammograms, colonoscopies, immunizations, and pre-natal and newborn care without an out-of-pocket charge. Consumers also have the right to appeal decisions made by their insurer to an independent third party.
10. Reining in Medicare costs. The government is controlling Medicare costs in several ways including stopping "unfair and irresponsible subsidies to insurance companies" and cracking down on waste, fraud and abuse.
11. Covering Medicare donut hole. Nearly three million seniors and people with disabilities who reached the prescription drug coverage “donut hole” in 2010 have received a tax-free $250 rebate. In 2011, beneficiaries who reach the donut hole will get a 50 percent discount on all covered name-brand prescription drugs and in 2020, the donut hole will be closed completely.
12. Medicare preventive services. Starting this month, Medicare beneficiaries will receive preventive services such as mammograms with no out-of-pocket costs and a new annual wellness visit and have their blood pressure, blood sugar, and cognitive abilities checked regularly by their doctor.
13. Reduction in Medicare Advantage payments. Payment will be reduced for Medicare Advantage plans, which receive $1,000 more per beneficiary on average than traditional Medicare pays. But 2011 Medicare Advantage premiums will be slightly lower on average even as seniors enjoy new benefits like the annual wellness visit.
14. Medicare anti-fraud activities. Since Jan. 2009, the federal government has recovered more than $2.8 billion for the Medicare Trust Funds and reached an all-time high in indictments.
15. Funds for health centers and primary care. The government has invested almost $3 billion in community health centers and $250 million beyond Recovery Act funding to help train 16,000 new primary care providers by 2015.
Read the HHS release on healthcare reform.
Read more coverage on defending healthcare reform against repeal efforts:
- HHS to List Negative Consequences of Repealing Reform
- House Sets Jan. 12 for Vote to Repeal Reform Law
- 5 Ways Democrats Hope to Stave Off Reform Repeal Efforts
The list, in a release by HHS and two other federal departments, is framed as a letter to Rep. John Boehner (R-Ohio), the new speaker of the House, who plans to hold a vote next week to repeal the reform law. It includes the following benefits:
1. Protections for pre-existing conditions. New and group health plans are now banned from denying coverage to children up to age 19 due to a pre-existing condition. Adults with pre-existing conditions can now enroll in new Pre-Existing Condition Insurance Plans available in all 50 states. In 2014, insurers will be prohibited from discriminating against individuals of any age because of a pre-existing condition.
2. Coverage for young adults. More than 2 million young adults up to age 26 are able to stay on a parent’s health insurance policy when they cannot get coverage of their own.
3. Making insurance affordable. In 2014, all Americans will have access to affordable coverage in competitive state-based exchanges that offer private insurance options. The Congressional Budget Office estimates the exchanges will reduce the premiums for individuals by 14 to 20 percent.
4. Small Business Health Care Tax Credits. These tax credits began last year, providing up to 35 percent of an employer’s insurance costs, and they will rise to as much as 50 percent of such costs in 2014.
5. Early Retiree Reinsurance Program. This program helps employers to continue offering healthcare benefits to early retirees who are not yet eligible for Medicare.
6. Help for state reviews of rate hikes. The law makes $250 million available to states to enhance reviews of insurer's rate hikes so they can better protect consumers and stop unreasonable premium hikes from taking effect.
7. Required justification for rate hikes. Under proposed rules, insurance companies proposing rate hikes of 10 percent or more would have to post and justify those hikes to state or federal regulators. If the increases were found to be unreasonable, the insurer would have to publicly disclose this on its own website and the federal website, www.HealthCare.gov.
8. Defined medical loss ratios. New rules on medical loss ratio rules require insurers to spend at least 80-85 percent of premium dollars on healthcare or quality improvement efforts, instead of items such as marketing and CEO bonuses.
9. Patient’s Bill of Rights. The bill of rights, which took effect in September, bars insurers form rescinding coverage when the policyholder gets sick or makes an unintentional error in paperwork. In addition, insurers may no longer impose lifetime dollar limits on benefits. Women no longer need a referral to see an ob/gyn. The newly insured now have a choice of any available primary care physician in their network and can go to the closest ED even if it is out of their network. They will now receive preventive services like mammograms, colonoscopies, immunizations, and pre-natal and newborn care without an out-of-pocket charge. Consumers also have the right to appeal decisions made by their insurer to an independent third party.
10. Reining in Medicare costs. The government is controlling Medicare costs in several ways including stopping "unfair and irresponsible subsidies to insurance companies" and cracking down on waste, fraud and abuse.
11. Covering Medicare donut hole. Nearly three million seniors and people with disabilities who reached the prescription drug coverage “donut hole” in 2010 have received a tax-free $250 rebate. In 2011, beneficiaries who reach the donut hole will get a 50 percent discount on all covered name-brand prescription drugs and in 2020, the donut hole will be closed completely.
12. Medicare preventive services. Starting this month, Medicare beneficiaries will receive preventive services such as mammograms with no out-of-pocket costs and a new annual wellness visit and have their blood pressure, blood sugar, and cognitive abilities checked regularly by their doctor.
13. Reduction in Medicare Advantage payments. Payment will be reduced for Medicare Advantage plans, which receive $1,000 more per beneficiary on average than traditional Medicare pays. But 2011 Medicare Advantage premiums will be slightly lower on average even as seniors enjoy new benefits like the annual wellness visit.
14. Medicare anti-fraud activities. Since Jan. 2009, the federal government has recovered more than $2.8 billion for the Medicare Trust Funds and reached an all-time high in indictments.
15. Funds for health centers and primary care. The government has invested almost $3 billion in community health centers and $250 million beyond Recovery Act funding to help train 16,000 new primary care providers by 2015.
Read the HHS release on healthcare reform.
Read more coverage on defending healthcare reform against repeal efforts:
- HHS to List Negative Consequences of Repealing Reform
- House Sets Jan. 12 for Vote to Repeal Reform Law
- 5 Ways Democrats Hope to Stave Off Reform Repeal Efforts