Obama Administration Allows States to Define Health Benefits in 2014

The Obama administration said Friday that it would not define a single uniform set of “essential health benefits” that must be provided by insurers for tens of millions of Americans.

Instead, it will allow each state to specify the benefits within broad categories. The new law lists 10 categories of “essential health benefits” that must be provided by insurance offered in the individual and small-group markets, starting in January 2014. These include preventive care, emergency services, maternity care, hospital and doctors’ services, and prescription drugs.

NY Times article, December 16, 2011

The Latest Health Care Reform Update, April 15, 2011

Obama Signs Repeal of Health Reform 1099 Reporting Rule 

On April 14, President Barack Obama signed legislation that repeals a much-criticized health care reform law provision requiring employers doing more than $600 in business with a corporate vendor to furnish Form 1099 statements. Small employers, in particular, complained that the burden imposed by the reporting provision, which had been scheduled to go into effect in 2012, was too great.

Obama’s Medicare Proposal: How Would It Work?

President Obama’s debt-relief plan differs profoundly with Republicans’ on the fate of Medicare.  As outlined on Wednesday, a central aspect of the president’s plan would be to double down on one of the most controversial aspects of his health care reform law: an independent board with the power to slow costs in the Medicare system if the program’s spending rises faster than set limits.

Under the health care law, this Independent Payment Advisory Board (IPAB) would start to work if Medicare spending rises faster than the annual growth of the U.S. gross domestic product, plus 1 percent.  Under the plan outlined by President Obama on Wednesday, the board would act if Medicare spending rises faster than GDP plus 0.5 percent.

As it is now structured, the IPAB is supposed to be an organization of 15 members appointed by the president and confirmed by the Senate.  The health care reform law calls for the board to have varied geographic and professional representation, with experts in health care finance, hospital management and health insurance, as well as physicians.

If Medicare spending surpasses its targets, these people are supposed to put their heads together and come up with ways to cut the program so the costs remain under the set threshold.  Their recommendations are then submitted to Congress.

  • If lawmakers vote to approve them, and they are signed by the president, they become law. 
  • If Congress does not vote on the recommendations, they become law.
  • If Congress votes the recommendations down, but the president vetoes what Congress did, and Congress cannot override the veto, they become law.

One thing that makes it controversial is that it takes away some of Congress’s power to deal with Medicare issues.  Former Obama budget director Peter Orszag has said the board might be “the largest yielding of sovereignty from the Congress since the creation of the Federal Reserve.”

According to an analysis of the current law by the Kaiser Family Foundation, the board is prohibited from making recommendations that would:

  • Ration health care procedures,
  • Increase taxes,
  • Change Medicare benefits, or
  • Make the program more expensive for beneficiaries.

What would the board be able to change?  

  • Things Medicare pays for,
  • What it pays to providers, and
  • The program’s structure, among other things.

Since a big target of spending reductions probably would be things that supply income to doctors, hospitals, and other providers, the IPAB is intensely unpopular in the medical establishment.  Changing or repealing it is one of the American Medical Association and the American Hospital Association’s highest priorities.

A Site Helping Consumers Understand Health Care Reform

This new site was established to help comsumers understand what the reform means for them.  This isn’t a goverment website!

The Health Care and You Coalition is made up of some of our country’s leading organizations that represent consumers, patients, physicians, nurses, hospitals and pharmacists. The goal is to provide the public with easy-to-understand information about the health care law. HealthCareandYou.org is a place where individuals, families, small business owners and health care professionals can turn for help in understanding the specific law and how it impacts them.

A New York Times article by Anahad O’Connor states, One poll released by the Kaiser Family Foundation last week found that about 20 percent of people believe — wrongly — that the law was killed when House Republicans voted to repeal it earlier this year, and 26 percent said they didn’t know enough to say whether it was still the law or not. While a bill to repeal the act was approved by House Republicans in January, it was seen as largely symbolic since a similar measure would be unlikely to clear the Democratic-controlled Senate. President Obama has also said he would veto the bill if it reached his desk.

This is a valuable resource for every American.  Please share with someone you love.

New York and New Jersey Establish “High Risk Health Insurance Pools”

The federal Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act, which together comprise the new federal health care reform law, were signed into law by President Obama on March 23, 2010, and March 30, 2010, respectively. The health care reform law contains a provision for the establishment of a temporary statewide insurance pool for high risk individuals.  Coverage through this program will be available until January 2014 when more health insurance coverage options become available through a Health Insurance Exchange.

New York

This new program is called the Pre-Existing Condition Insurance Plan (PCIP) and will be available throughout the country. In New York State, the PCIP plan is called the NY Bridge Plan, and is administered by Group Health Incorporated (GHI), an EmblemHealth company.

The NY Bridge Plan provides health coverage to individuals who have a pre-existing medical condition, have not had insurance for six months, and who are legal residents.

The NY Bridge Plan covers a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs.  Eligibility is not based on income and the Plan does not charge a higher premium because of a pre-existing condition.  Coverage for a pre-existing condition begins right away, with no waiting period.

Applications are available now with coverage effective October 1, 2010. for more information go to NY Bridge Plan

New Jersey

NJ Protect is a new health insurance option for uninsured New Jerseyans with pre-existing medical conditions. Coverage through NJ Protect will generally cost less than comparable individual health insurance and offer superior benefits. Because the program is federally subsidized, treatment for pre-existing medical conditions will be covered as of the day a policy goes into effect, and preventive care will be covered at no out-of-pocket cost to the policyholder.

Applications for NJ Protect are now available.  Contact Horizon Blue Cross and Blue Shield of NJ to request the application.  Please be sure to explain you are asking about NJ Protect so the customer service representative can quickly provide information for the NJ Protect options.  More more information go to www.HorizonBlue.com/NJProtect

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