Major Health Care Reform Kicks in Today

[one...two...tree 2,762]

When the Affordable Care Act was signed into law last March, there were legitimate concerned that many of its key provisions wouldn't take effect for years. That said, it's wrong to assume major advances aren't already happening. Almost immediately after the legislation received President Obama's signature, new consumer protections and benefits kicked in -- young adults have been able to stay on their family health care plan through their 26th birthday; children with pre-existing conditions were no longer facing discrimination; and "rescission" practices were curtailed.

But as 2011 gets underway, even more worthwhile changes are taking effect, starting today.

The new year will bring important changes to U.S. health-insurance rules, as new provisions related to last year's massive health-care overhaul take effect.

The new rules are designed to help those caught in Medicare's "doughnut hole," offer seniors more preventative care, and limit how much of their customers' money health-insurance companies can keep for overhead and profit.

They all go into effect on Saturday.

These reforms may not appear especially sexy or high profile, but we're talking about some pretty important provisions. Seniors who've been stuck in prescription-drug "doughnut hole," will, for example, receive a 50% discount on the price of brand-name prescription drugs starting today. On a related note, seniors will also be eligible, starting today, for free "preventive services" screenings, including cancer tests like mammograms, and annual check-ups.

Of particular interest, on a systemic level, is the introduction of the new "medical loss ratio," which sounds more complicated than it is. This new rule forces private insurers to spend 80% to 85% of the money we pay them in premiums on paying for* actual medical care to its customers, rather than everything else (profit, marketing, executive salaries, overhead, etc.). In recent years, some insurance companies were spending as little as 50% of their premium dollars on their customers.

Americans almost certainly won't notice the shift resulting from the new medical loss ratio, but it's expected to make a pretty big difference, and it's one of the provisions that drew the loudest howls from the insurance companies and their congressional lackeys.

Taken together -- the reforms that took effect in 2010, coupled with the measures that kick in today -- we're talking about some major positive changes to the system. All of these reforms, by the way, tend to be pretty popular -- the larger concerns about the ACA notwithstanding -- but are nevertheless being targeted by congressional Republicans, who want to eliminate the benefits entirely.

http://www.washingtonmonthly.com/

[Rebecca Jo 1,962]

I have seen a change in this already at my place of work, where in my division we care for the developmentally disabled (formerly called mentally retarded persons).

These individuals are provided Medicare and Medicaid, but the doughnut hole caused them to have to pay a Part D premium and of course bear the cost of drugs that Medicaid does not pay.

Our company is "representative payee" for 30 of these individuals, meaning their Social Security check comes to us and we pay all their bills. Their checks are small - most around $700 to $800 per month. Our company provides group housing for these individuals, lowering their cost to keep a roof over their head but utility bills and grocery expense eats up a large portion of their income. (As an aside, these persons receive almost non-existent food stamp benefits of around $20 per month or less).

I am the person in our company who pays these expenses. I see the bills and I manage these funds. Beginning January 1, the premium for Part D coverage dropped to zero. I shall be curious as the drug bills come in over the next few months to see how those costs decline for our clients. These are the truly needy in our society who have had to bear a large portion of medication cost out of their meager incomes. I hope the new plan works.

[spookyturtle 9,465]

I hope this new plan works too. The seniors have been getting a raw deal. No increase in SS again this year. We have people on welfare milking the system while large numbers of seniors barely survive.

[^_^ 5,021]

I hope this new plan works too. The seniors have been getting a raw deal. No increase in SS again this year. We have people on welfare milking the system while large numbers of seniors barely survive.

Social security retirement benefits were designed to replace no more than 40% of pre-retirement income. Retirees have always been expected to provide the majority of their own retirement funding; that boomers, for the most part, have been too irresponsible to do so is a separate issue entirely.

[spookyturtle 9,465]

Social security retirement benefits were designed to replace no more than 40% of pre-retirement income. Retirees have always been expected to provide the majority of their own retirement funding; that boomers, for the most part, have been too irresponsible to do so is a separate issue entirely.

I'm more or less referring to those 80+. There are a lot of widows/widowers out there that are in tough shape.

[one...two...tree 2,762]

I have seen a change in this already at my place of work, where in my division we care for the developmentally disabled (formerly called mentally retarded persons).

These individuals are provided Medicare and Medicaid, but the doughnut hole caused them to have to pay a Part D premium and of course bear the cost of drugs that Medicaid does not pay.

Our company is "representative payee" for 30 of these individuals, meaning their Social Security check comes to us and we pay all their bills. Their checks are small - most around $700 to $800 per month. Our company provides group housing for these individuals, lowering their cost to keep a roof over their head but utility bills and grocery expense eats up a large portion of their income. (As an aside, these persons receive almost non-existent food stamp benefits of around $20 per month or less).

I am the person in our company who pays these expenses. I see the bills and I manage these funds. Beginning January 1, the premium for Part D coverage dropped to zero. I shall be curious as the drug bills come in over the next few months to see how those costs decline for our clients. These are the truly needy in our society who have had to bear a large portion of medication cost out of their meager incomes. I hope the new plan works.

My Mom told me awhile back, maybe in July, that they had already reached their maximum for prescriptions this year. She said the out of pocket for the remaining year was going to be around $2,000. She has diabetes and my father has Parkinson's.

[Rebecca Jo 1,962]

Social security retirement benefits were designed to replace no more than 40% of pre-retirement income. Retirees have always been expected to provide the majority of their own retirement funding; that boomers, for the most part, have been too irresponsible to do so is a separate issue entirely.

That may be, but when SS was implemented, no one knew that drug costs and hospital care (necessary costs of the process of aging) could eat up an elderly persons budget.

[^_^ 5,021]

... when SS was implemented, no one knew that drug costs and hospital care (necessary costs of the process of aging) could eat up an elderly persons budget.

I assume we're talking about the 65+. Medicare A covers hospital care, doesn't it? As for drug costs, that should be addressed too with Medicare D and the recent efforts to close to doughnut hole.

[Rebecca Jo 1,962]

My Mom told me awhile back, maybe in July, that they had already reached their maximum for prescriptions this year. She said the out of pocket for the remaining year was going to be around $2,000. She has diabetes and my father has Parkinson's.

Imagine the costs for a severely disabled person.

Some of our clients not only have mental limitations, but extreme physical disabilities. They cannot get themselves up and down or turn over. They cannot feed themselves or dress themselves.

Some can get around, but can't see or hear.

I assume we're talking about the 65+. Medicare A covers hospital care, doesn't it? As for drug costs, that should be addressed too with Medicare D and the recent efforts to close to doughnut hole.

Yes Part A is hospitalization, Part B is physician care.

And my post was about the fact that, hopefully, the new legislation closes the Part D gap, leaving more disposable income for those in need.

Edited to add that there is a deductible for Part B costs. Some physicians waive that deductible, some do not.

Edited January 1, 2011 by Rebecca Jo

[LaL 418]

I assume we're talking about the 65+. Medicare A covers hospital care, doesn't it? As for drug costs, that should be addressed too with Medicare D and the recent efforts to close to doughnut hole.

inpatient

[Rebecca Jo 1,962]

inpatient

Good catch.

[one...two...tree 2,762]

Imagine the costs for a severely disabled person.

Some of our clients not only have mental limitations, but extreme physical disabilities. They cannot get themselves up and down or turn over. They cannot feed themselves or dress themselves.

Some can get around, but can't see or hear.

It's heartbreaking.

[Rebecca Jo 1,962]

It's heartbreaking.

Awwwwwww.........

They are people, just like you or I. They just didn't ask to be born that way.

We just try at all times to be mindful of their human rights. Some are really in a bad way; some are more like the type of "sweetly" disabled they make TV shows about. Most are somewhere in the middle. Some of our clients were born "normal" but have had a head injury.

All of them have basic needs, and most have a way of expressing fondness towards those who care for them. If you are able to get past how sad it can be and see them as just someone who needs you, then it takes on a whole different perspective.

[SuperDuper! 230]

It's heartbreaking.

Man, such a cheery topic for a new year's morning. Now excuse me while I double down on some Prozac, and trundle off to the local 99 cent store where I can be with the happy, uplifting crowd there.

[spookyturtle 9,465]

Man, such a cheery topic for a new year's morning. Now excuse me while I double down on some Prozac, and trundle off to the local 99 cent store where I can be with the happy, uplifting crowd there.

Bye.