April 2010 Archives
Do this year's health care reform provisions justify higher insurance premiums?
Insurers say there's no question about it, that rates will rise due to the new costs. The White House's Nancy-Ann DeParle, though, counters that any additional costs will be "pennies or almost nothing," because the administration was careful to delay the changes with the greatest impact on insurers until 2014, so that the requirement that most people purchase insurance would offset any higher costs. Also, she said, some of the provisions only apply to new health plans (story here for National Journal subscribers).
By the end of September, insurers will no longer be allowed to impose cost-sharing on patients for preventive medical services identified by a new task force. In addition, insurers will have to cover young adults up to age 26 on their parents' policies, and they won't be allowed to exclude kids from coverage because of pre-existing medical conditions, to cancel policies unless the initial application was fraudulent, or impose lifetime benefit limits.
Does these changes justify premium increases? How much? And how tough should the administration and states be in fighting back?
What happens when the money runs out?
The new health reform law provides $5 billion to states to create temporary high-risk pools until broader reforms take place in 2014. But health care experts warn that $5 billion should last one year at most.
HHS Secretary Kathleen Sebelius at the beginning of April asked governors and state insurance commissioners whether they wanted to form their own high-risk pools, or whether the federal government would need to do it in their state. One state already has indicated that it won't do it. Currently, more than 30 states have high-risk pools, although they are often underfunded and have long waiting lists and high premiums.
In theory, both Democrats and Republicans have supported the concept of high-risk pools. Will these pools, as they are envisioned in the health reform law, help? Is it better for states or the federal government to run them? And should Congress appropriate more money?
While many big health reform changes won't happen until 2014, when most people must purchase insurance and many will qualify for subsidies, the law requires insurers to make some changes within a year. How much can these changes help individuals? Will they place too great a burden on insurers?
Within 90 days of enactment, there will be a new high-risk pool to get coverage to those with pre-existing medical conditions.
Adult children will be able to stay on parents' policies up to age 26.
Insurers won't be able to exclude kids from coverage because of pre-existing conditions, rescind coverage except in cases of fraud, or place lifetime limits on coverage.
Insurers will have to provide coverage without cost-sharing for certain preventive services determined by the U.S. Preventive Services Task Force.
Moreover, health plans will have to report how much of their premium dollars go to clinical services, quality and other costs. And they'll have to give consumers rebates if they spend less than 80-85 percent on clinical services. The government will create a process to review health plan premium increases, and plans will have to justify those increases. Currently states monitor premium increases. States will report on premium trend increases and recommend whether certain health plans should be excluded from the health insurance exchange because of unjustified premium increases.
4 responses: John Sheils, Bruce Lesley, John C. Goodman, David B. Kendall
What will be the effect of health care reform on Medicare -- for all stakeholders, including seniors, the federal government and medical providers? Has Congress put Medicare on a path to financial stability?
The law cuts some payments to medical providers, lowers payments to Medicare Advantage health plans, helps seniors more with prescription drug costs, and creates a Medicare Independent Payment Advisory Board to try to keep spending growth under control. The law creates pilot projects to test different ways to pay medical providers through such methods as bundled payments and accountable care organizations.
Are the nation's Medicare problems solved?
8 responses: John Sheils, Stuart Butler, J. James Rohack, Sally C. Pipes, Stuart Butler, Karen Davis, Sec. Mike Leavitt, John C. Goodman
