The Health Care Reform Debate Ends, A New Chapter Begins

President Barack Obama signed into law the Patient Protection and Affordable Care Act on March 23rd, 2010.

This legislation—which comes after a tumultuous year stemming from political disparity between the two parties—carries the lofty goal of extending coverage to around 30 million Americans who are currently without health insurance.

It will also add 16 million people to Medicaid as well as regulate private insurers very closely. The law is intended to constrain the soaring cost of medical care, cover the uninsured and enhance individual access to care, but much debate remains around the cost of the bill and the tax structure designed to help pay for or meet these goals.

“For millions of people with COPD, the Patient Protection and Affordable Care Act The Health Care Reform Debate Ends, A New Chapter Begins provides an opportunity to have coverage and access to health care,” John W. Walsh, president and founder of the COPD Foundation says. “It’s critically important for us to focus on enhancing the benefits for individuals with COPD and other chronic diseases.”

The new law will cost the government about $938 billion over 10 years, according to the Congressional Budget Office [CBO]. The CBO also estimated that it would reduce the federal deficit by $143 billion over a decade. The new law will have some immediate benefits and others that will be implemented over time. These changes to insurance practices should be beneficial to those living with chronic diseases such as COPD. However, once legislation passes the federal agencies with authority, it needs to go through regulatory rule-making which impacts implementation.

Many Americans remain concerned about the impact of the law on the insurance industry as increases in insurance premiums will reverberate and influence the business world. It is hard to predict at this time what will happen to private insurance premiums but patients may acquire lower premiums than prior to the passage of this legislation, and healthier individuals will probably pay more.

The goal of the legislation is to cover more individuals and enhance access to health insurance; the added customers should help the industry amortize the costs across all policies. But many questions will not be fully answered until the new insurance exchanges are established and enrolling individuals. Under the new law, most Americans will have to have insurance by 2014 or pay a penalty that begins at $95.00 or up to 1% of their income, whichever is greater. The penalties rise to $695.00 or 2.5% of income by 2016. The fee structure for penalties will be different for families than individuals. There are exemptions available from the insurance mandates based on financial hardships, religious beliefs or being an American Indian.

The law may make it easier for uninsured COPDers to get coverage by 2014 because they cannot be rejected based on health status. Prior to the insurance exchanges being established (in 2014), the law creates a temporary highrisk insurance pool for people who have been refused insurance in the past six months. New policies in the insurance exchanges will have to meet minimum requirements and will include a range of benefits including hospitalizations, doctors visits, prescription drugs, maternity care and preventative tests.

The “donut hole” coverage gap that Medicare beneficiaries of the Part D Prescription Drug Plan ages 65 and over currently face will close, and drug companies will be forced to offer name brand drugs at a discount for Medicare beneficiaries in the donut hole.

Here is a re-cap of some of the legislation’s provisions:

• Eliminating lifetime caps on benefits for all insurance plans six months after enactment of the bill
• Eliminating annual caps on benefits for individual and group plans in 2014
• Closing the Medicare Part D “donut hole” by 2020, and provide a $250 rebate for all those enrolled in Medicare Part D who enter the donut hole in 2010
• Prohibiting insurers from establishing eligibility rules based on genetic information, health status, medical condition (mental or physical illness), claims experience, receipt of healthcare, medical history, disability or evidence of insurability

Walsh emphasizes that under the new health care legislation, COPDers should remember the importance for their community to get involved with the management of their disease.

“The COPD Foundation remains committed to advocating for expanded access to appropriate therapies, and encourages all individuals with COPD to take responsibility and become involved in improving their level of care and quality of life,” Walsh says.

The COPD Foundation recommends that all individuals concerned about the new legislation find a reliable source of information to figure out how the law will affect you.

To that end we offer some of the following as resources:

• The Kaiser Family Foundation is a non-profit private operating foundation, dedicated to producing and communicating the best possible analysis and information on health issues. Their website includes overviews of health care reform and tools to evaluate the impact on your own insurance policy: www.kff.org
• The Democratic Policy Committee offers section by section review of the new law in plain English: http://dpc.senate.gov/ dpcdoc-sen_health_care_bill.cfm
• The House of Representatives Committee on Energy and Commerce offers a detailed timeline of implementation: http://docs.house.gov/energycommerce/ TIMELINE.pdf