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June 2010 Archives
Is two-tier health care inevitable as a result of the federal overhaul, with some doctors catering to the rich with concierge practices that don't accept Medicare and Medicaid patients while overwhelmed clinics are struggling to serve the less-well-off with government insurance? Is there still a role for physicians who serve all segments of the public?
How big a deal are the grandfather rules that the Obama administration released last week? Democrats claim they keep Obama's word that those who like their health plans can hold on to them, although Republicans argue they prove him wrong.
The new law exempts existing (or grandfathered) health plans from some new and upcoming requirements that are meant to protect consumers -- such as adding certain preventive benefits without charging consumers -- as long as they don't significantly raise premiums, make modest increases in co-payments or significantly cut benefits.
Health plans and employers would lose their exempt -- or grandfathered -- status if they raised co-payments by the greater of $5 or a medical inflation rate plus 15 percent. Deductibles couldn't go up more than medical inflation plus 15 percent. In addition, employers couldn't cut the amount of the premium that they contribute by more than 5 percent.
The administration estimates that the majority of people who get employer-sponsored health insurance through businesses with 100 or more workers (133 million Americans) won't see any changes as a result of the regulation. For small businesses, though, the prediction is that 70 percent will be grandfathered the first year, but only one-third over several years.
6 responses: Karen Davis, Larry C. McNeely II, James P. Gelfand, Dan Danner, John C. Goodman, Sen. Max Baucus, D-Mont.
How will small businesses fare under the new health care reform law and upcoming regulations? Is the small-business tax credit enough of an incentive to entice them to begin offering insurance to their workers? Will the 2016 sunset of the credit keep small businesses from jumping in?
Small businesses worry that their costs will increase because of the law's insurance tax and because there will be new requirements for what benefits must be included in health plans. Small businesses will also be prohibited from offering health plans with deductibles higher than $2,000.
Are small-business concerns valid? Are the incentives enough -- and the disincentives small enough -- to get many of them to begin offering coverage to workers?
6 responses: Stuart Butler, Uwe Reinhardt, Stuart Butler, John C. Goodman, James P. Gelfand, Dan Danner
In the new House jobs bill, there is no extension of COBRA subsidies for newly laid-off workers, nor is there a continuation of extra federal funding to help states pay for Medicaid, which can experience increased enrollment years after the end of a recession.
The Senate may take up similar legislation this week.
Is this a big deal? How much longer should states get extra Medicaid funding, or is it time for the federal government to pull back?
If states don't get the extra Medicaid money, will there be a big hit to Medicaid benefits?
4 responses: Stuart Butler, Jennifer Luray, James P. Gelfand, Rep. Pete Stark, D-Calif.
With or without Medicare demonstrations, physicians, hospitals and insurers are quickly positioning themselves to move toward accountable care organizations.
In considering what ACOs should look like, which of these groups should lead the way? Should ACOs be organized and operated by hospitals?
Can physicians come together successfully through independent physician associations? Can physicians be a part of ACOs without losing their autonomy?
What should be the involvement of insurers, who should carry the financial risk, and are we looking at a return to the old-style form of HMO capitation, which is more or less a bad word in today's health care policy environment?
7 responses: Karen Ignagni, Darrell G. Kirch, Jack Lewin, Larry C. McNeely II, Karen Davis, John C. Goodman, J. James Rohack
