Weird question ... Eh?



Well ... Ducks are weird . . .


If in the event that the ongoing battle of Health Care reform is finally settled with a signature by President Barack Obama, can anyone imagine what the next 45 years will bring what with the fine tuning and political manuevering that will no doubt transpire in the future?

What's the point of me bringing this up? Things won't stay stagnant. They'll change.

Imagine what can happen over time once a Public Law is established such as what is on the horizon with Health Reform. And I bring it up because that's exactly what has transpired with Medicare over the past 45 years.

Many many changes and additions have been legislated over the years that were and/or are still positives to the benefit of those who are covered by Medicare.  In addition, there have been many changes and subtractions of those sections of Medicare that were shown to be not so positive to the benefit of those who are covered by Medicare.

A Public Law such as what we are currently witnessing being formulated doesn't just all of sudden stop being updated and fine tuned over time. It's constantly being look at and evaluated decade after decade.

To show what I mean, I've found a very good site that exhibits the time line of Medicare since it's inception.

kff.org/medicare/timeline/

Keep scrolling down til your eyes bug out of your skull . . .

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1965-2009
		1965: President Johnson signed H.R. 6675 to establish Medicare for the elderly in Missouri. President Truman was the first to enroll in Medicare.

January 1965: President Johnson's first legislative message to the 89th Congress, Advancing the Nation's Health, detailed a program including hospital insurance for the aged under Social Security and health care for needy children.

March-July 1965: The House of Representatives (307-116) and the Senate (70-24) passed "the Mills Bill" (H.R. 6675), a package of health benefits and Social Security improvements.

July 30, 1965: President Johnson signed H.R. 6675 (Public Law 89-97) to establish Medicare for the elderly and Medicaid for the indigent in Independence, Missouri, in the presence of Harry S. Truman who advocated for such legislation in a message to Congress in 1945. Presidential remarks during signing ceremony

1965: President Truman was the first to enroll in Medicare.

1965: • Medicare Part A deductible: $40/year • Medicare Part B premium: $3/month

1966: The Social Security Administration announced the selection of private insurance companies to perform the major administrative functions of bill processing and benefit payment functions for Part A (Hospital Insurance) and Part B (Supplementary Medical Insurance) of the Medicare program.

July 1, 1966: Medicare coverage began. All persons age 65 and over were automatically covered under Part A. Coverage began for seniors who signed up for the voluntary medical insurance program (Part B). More than 19 million individuals ages 65 and older were enrolled in Medicare.

1969: The Task Force on Prescription Drugs, chaired by Dr. Philip Lee, released its final report on the costs and feasibility of adding prescription drug coverage to Medicare.

1970: • Medicare Part A deductible: $52/year • Medicare Part B premium: $4/month • Total Medicare population: 20.4 million beneficiaries

1972: October 30, 1972 President Nixon signed the Social Security Amendments of 1972 (PL 92-603), the first major adjustment to Medicare after its enactment. Medicare eligibility was extended to individuals under age 65 with long-term disabilities (who were receiving SSDI payments for two years) and to individuals with end-stage renal disease (ESRD). The amendments also established professional standards review organizations (PSROs) to review patient care, encouraged the use of health maintenance organizations (HMOs), and gave Medicare the authority to conduct demonstration programs.

1972: Medicare benefits were expanded to include some chiropractic services, speech therapy, and physical therapy.

1973: Medicare coverage began for individuals receiving Social Security Disability Insurance (SSDI) cash payments for two or more years. Nearly 2 million people under age 65 with long-term disabilities or ESRD were covered.

1975: • Medicare Part A deductible: $92/year • Medicare Part B premium: $6.70/month • Total Medicare population: 24.9 million beneficiaries

1977: Joe Califano, Secretary of the Department of Health, Education and Welfare, created the Health Care Financing Administration (HCFA) to administer both the Medicare and Medicaid programs. About 1,500 employees were transferred to HCFA from the Social Security Administration. Interview with Joe Califano on the establishment of HCFA

1980: The Omnibus Reconciliation Act of 1980 expanded home health services by eliminating the limit on the number of home health visits, the prior hospitalization requirement, and the deductible for any Part B benefits. It also required the Secretary to develop a list of surgical procedures that could be done on an outpatient basis in an ambulatory surgical center and would be reimbursed on a prospective payment system. The "Baucus Amendments" brought Medicare supplemental insurance, also called "Medigap," under federal oversight and established a voluntary certification program for Medigap policies.

1980: • Medicare Part A deductible: $180/year • Medicare Part B premium: $8.70/month • Total Medicare population: 28.4 million beneficiaries

1981: The Omnibus Budget Reconciliation Act of 1981 (OBRA 1981) included provisions to slow the growth in Medicare spending, including a change that resulted in an increase in the inpatient hospital deductible.

1982: The Tax Equity and Fiscal Responsibility Act (TEFRA) increased the Part B premium to cover 25% of program costs as part of policies designed to slow the growth of Medicare spending. Hospice services for the terminally ill were added to Medicare's covered benefits. TEFRA facilitated HMOs' participation in the Medicare program and established a risk-based prospective payment system for these plans. The Act also expanded HCFA's quality oversight efforts by replacing Professional Standards Review Organizations (PSROs) with Peer Review Organizations (PROs). TEFRA imposed a ceiling on the amount Medicare would pay for a hospital discharge and required HHS to submit a plan for prospective payments to hospitals and nursing homes. TEFRA required federal employees to begin paying the HI payroll tax.

1983: The Social Security amendments of 1983 established an inpatient hospital prospective payment system (PPS) for the Medicare program. The PPS is based on diagnosis-related groups, or DRGs, a pre-determined payment for treating a specific condition. The system was adopted to replace cost-based payments.

1984: The Deficit Reduction Act of 1984 (DEFRA) froze physician fees, established the Participating Physicians' Program, and established fee schedules for laboratory services, all of which were intended to slow the growth of Medicare's spending and constrain the federal deficit.

1985: The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) made Medicare coverage mandatory for newly hired state and local government employees. In addition, COBRA established the Emergency Medical Treatment and Labor Act (EMTALA), which required hospitals participating in Medicare operating active emergency rooms to provide appropriate medical screenings and stabilizing treatments.

1985: The Emergency Extension Act of 1985 froze PPS payment rates for inpatient hospital care and continued physician payment freezes to slow the growth of Medicare spending.

1985: • Medicare Part A deductible: $400/year • Medicare Part B premium: $15.50/month • Total Medicare population: 31.1 million beneficiaries

1986: The Omnibus Budget Reconciliation Act of 1986 (OBRA 1986) revised several of the payment procedures for various Medicare services in order to help slow the growth in Medicare spending.

1987: The Omnibus Budget Reconciliation Act of 1987 (OBRA 1987) imposed quality standards for Medicare- and Medicaid-certified nursing homes - in response to well-documented quality problems facing seniors in nursing homes. OBRA 87 also modified payments to providers under Medicare as part of the deficit reduction legislation.

1987: The Medicare and Medicaid Patient and Program Protection Act of 1987 was enacted to improve antifraud efforts and strengthen beneficiary protection programs.

1987: The Balanced Budget and Emergency Deficit Control Reaffirmation Act of 1987 froze Medicare payment rates in an attempt to slow Medicare spending.

1988: The Medicare Catastrophic Coverage Act of 1988, the largest expansion of the program since the enactment of Medicare, included an outpatient prescription drug benefit and a cap on beneficiaries' out-of-pocket expenses, and expanded hospital and skilled nursing facility benefits. Medicaid began coverage of Medicare premiums and cost-sharing for Medicare beneficiaries with incomes below 100% of the federal poverty level, known as Qualified Medicare Beneficiaries (QMB). The U.S. Bipartisan Commission on Comprehensive Health Care (which became known as "Pepper" Commission after the late Congressman Claude Pepper of Florida) was established to assess the feasibility of a long-term care benefit under Medicare. Detailed summary of the Medicare Catastrophic Coverage Act of 1988

1988: Clinical Laboratory Improvement Amendments were enacted to strengthen quality performance requirements for clinical laboratories to provide more accurate and reliable laboratory tests.

1989: The Medicare Catastrophic Coverage Repeal Act of 1989 retracted the major provisions of the 1988 Medicare Catastrophic Coverage Act, including both the outpatient drug benefit and the out-of-pocket limit. QMB benefits were retained.

1989: The Omnibus Budget Reconciliation Act of 1989 (OBRA 1989) established the Resource-Based Relative Value Scale (RBRVS) for physicians, replacing charge-based payments. Limits were placed on physician balance billing. Physicians were prohibited from referring Medicare patients to clinical laboratories in which they have a financial interest. OBRA 1989 also included a number of other provisions designed to slow the growth in Medicare spending.

1990: The Omnibus Budget Reconciliation Act of 1990 (OBRA 1990) established the Specified Low-Income Medicare Beneficiary (SLMB) eligibility group requiring state Medicaid programs to cover premiums for beneficiaries with incomes between 100% and 120% of the federal poverty level. Medicare was expanded to cover screening mammography and partial hospitalization services in community mental health centers. Federal standards were established for Medigap policies, including standardized benefit packages and minimum loss ratios, replacing the voluntary certification system.

1990: The U.S. Bipartisan Commission on Comprehensive Health Care (the "Pepper Commission") recommended the creation of a new Medicare long-term care program that would provide nursing home and home- and community-based services. These recommendations were not enacted.

1990: • Medicare Part A deductible: $592/year • Medicare Part B premium: $28.60/month • Total Medicare population: 34.3 million beneficiaries

1993: The Omnibus Budget Reconciliation Act of 1993 modified payments to Medicare providers, as part of overall deficit reduction legislation, and lifted the cap on wages subject to the HI payroll tax.

1993: States started to cover Medicare Part B premiums for SLMBs.

1995: • Medicare Part A deductible: $716/year • Medicare Part B premium: $46.10/month • Total Medicare population: 37.6 million beneficiaries

1996: The Health Insurance Portability and Accountability Act of 1996 (HIPAA) established the Medicare Integrity Program, which dedicated funds for program integrity activities.

1997: The Balanced Budget Act of 1997 (BBA) included a broad range of changes in provider payments to slow the growth in Medicare spending as part of the legislation to balance the federal budget. It also established the Medicare+Choice program, a new structure for Medicare HMOs and other private health plans offered to beneficiaries. The BBA also required HCFA to develop and implement five new Medicare prospective payment systems: inpatient rehabilitation hospital or unit services; skilled nursing facility services; home health services; hospital outpatient services; and outpatient rehabilitation services. The law also provided additional assistance with Medicare Part B premiums for beneficiaries with incomes between 120% and 135% of poverty (QI-1s) through a first-come first-serve block grant program administered by state Medicaid programs. The law provided for partial assistance with premiums for beneficiaries with incomes between 135% and 175% of poverty (QI-2s). The BBA also established the National Advisory Commission on the Future of Medicare and the Medicare Payment Advisory Commission (which replaced both the Prospective Payment Assessment Commission and the Physician Payment Review Commission).

1998: The internet site www.Medicare.gov was launched to provide updated information about Medicare. View Medicare.gov

1999: The toll-free number, 1-800-MEDICARE (1-800-633-4227), was made available nationwide. The first annual Medicare & You handbook was mailed to all Medicare beneficiary households.

1999: The Ticket to Work and Work Incentives Improvements Act of 1999 (TWWIIA) expanded the availability of Medicare and Medicaid for certain disabled beneficiaries who return to work.

1999: The Balanced Budget Refinement Act of 1999 (BBRA) increased payments for some Medicare providers and reduced or froze payment rates for other Medicare services. BBRA also increased payments to Medicare+Choice plans.

1999: The National Advisory Commission on the Future of Medicare completed its work on Medicare reform, but lacked sufficient votes to report out a formal recommendation.

2000: The Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act (BIPA) of 2000 further increased Medicare payments to providers and Medicare+Choice plans, reduced certain Medicare beneficiary copayments, and added covered preventive services. BIPA also enabled people with amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease) to enroll in Medicare upon diagnosis instead of having to satisfy the 24-month waiting period.

2000: • Medicare Part A deductible: $776/year • Medicare Part B premium: $54.40/month • Total Medicare population: 39.7 million beneficiaries

2001: Secretary of Health and Human Services, Tommy Thompson, renamed HCFA, which became the Centers for Medicare and Medicaid Services (CMS).

2001: Medicare began covering people with ALS.

2002: The Public Health Security and Bioterrorism Preparedness and Response Act of 2002, along with other public health measures, temporarily moved deadlines for submitting Medicare+Choice plan information. The law stated that in 2005, individuals enrolled in M+C plans would only be able to make and change elections to an M+C plan on a more limited basis, which was later changed by the Medicare Modernization Act of 2003.

2003: The Consolidated Appropriations Resolution (CAR) of 2003 increased payments for some hospitals, updated the physician fee schedule, and extended payment of the Part B premium for QI-1.

2003: QI-2 beneficiaries no longer received assistance from Medicaid in paying their Part B premiums.

2003: December 8, 2003 The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) was passed by the House (220-215) and the Senate (54-44) in November and signed into law (Public Law 108-173) by President Bush on December 8, 2003, providing a new outpatient prescription drug benefit under Medicare beginning in 2006. In the interim, it created a temporary prescription drug discount card and transitional assistance program. The MMA also established a new income-related Part B premium for beneficiaries with higher incomes (beginning in 2007), indexed the Part B deductible, created regional PPOs under the Medicare Advantage program (previously named Medicare+Choice), along with financial and other incentives for private health plans to contract with Medicare. The MMA also established a new way of assessing Medicare's financial status by looking at general revenues as a share of total Medicare spending. Presidential remarks during the signing ceremony

2004: A temporary Medicare-Approved Drug Discount Card Program began along with a transitional assistance program to provide a $600 annual credit to low-income Medicare beneficiaries without prescription drug coverage in 2004 and 2005.

2005: Medicare begins covering a "Welcome to Medicare" physical, along with other preventive services, such as cardiovascular screening blood tests and diabetes screening tests. Medicare begins education and outreach activities to implement the 2006 prescription drug benefit. Learn more facts about Medicare

2005: • Medicare Part A deductible: $912/year • Medicare Part B premium: $78.20/month • Total Medicare population: 42.3 million beneficiaries Learn more facts about Medicare

And ya' know ... There are a few of us old farts around here that watched this all transpire in slow-motion 3-D and living color . . .

 

~OGD~


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   I felt this article is timely in light of this week's top news. . .


Things will most likely get worse... before they get worse . . .

The portion of the article below that really struck me was, "A third of all staff positions in the behavioral-health unit at the post's medical center, Evans Army Community Hospital, were left unfilled in 2007."

?!?!?!

I wonder if this is par for the course throughout the Army? If it is it sure would make life tough if not downright unbearably stressful for behavioral-health unit staff working under those extreme conditions.

PTSD is not exclusively reserved to those who have been subjected to the tremendous trauma associated with combat. If you think I'm wrong, you don't have a clue what PTSD is.

I also note that Paul Rieckhoff, a frequent visitor here at the Cafe also chimes in below.


Snippet from Rolling Stone, November 6, 2009, page 2 of 6 . . .

In the six years since combat operations began in Iraq, Fort Carson -- the country's third-largest Army base, with 22,000 active soldiers on duty -- has become its own kind of killing field. Before Kevin Shields was gunned down, at least three other Iraq War veterans from the base had been arrested for murder, and a fourth had committed suicide after killing his wife. Since then, at least five more GIs at Fort Carson have been arrested in connection with murders, attempted murders or manslaughter. All told, the military acknowledged this summer, 14 soldiers from the base have been charged or convicted in at least 11 slayings since 2005 -- the largest killing spree involving soldiers at a single U.S. military installation in modern history.

Spurred by public outrage, the Army conducted a six-month study into the Fort Carson killings, examining the medical and combat histories of the 14 accused soldiers. Like Bressler, nine of the vets served in the 4th Brigade Combat Team, which suffered a casualty rate in Iraq eight times higher than other Fort Carson units. The Army's 126-page report, released in July, marked the first time the military has ever acknowledged the significance of combat in the behavior of returning veterans. There is, according to the report, a "possible association between increasing levels of combat exposure and risk for negative behavioral outcomes." But in classic bureaucratic language, the study fell short of calling for any real specific action beyond a need for more studies.

"We don't have enough data yet to determine any cause-and-effect relationships," Maj. Gen. Mark Graham told me before stepping down as commander of Fort Carson in August. "And even if you could identify high-risk soldiers, what are you going to do? Lock them up? What you have to do is watch their behavior."

In fact, that's exactly what Fort Carson failed to do. The story of how a once-promising infantryman like Louis Bressler wound up in prison for taking part in two murders reveals as much about the Army's negligence as it does about Bressler's mental decline. Despite the heavy fighting seen by their troops, the base's commanders were completely unprepared to treat and monitor soldiers suffering from severe combat trauma. A third of all staff positions in the behavioral-health unit at the post's medical center, Evans Army Community Hospital, were left unfilled in 2007, at a time when the base was experiencing an all-time high in PTSD cases. Soldiers suffering from serious delusions were often sent off with a handful of pills and never returned for additional treatment. In one case, a mentally disturbed vet who imagined himself to be an "alien dinosaur-like creature" allegedly raped and killed a teenager after reportedly being declared fit for duty by a Fort Carson psychiatrist.

"It's no surprise that these murders happened at Fort Carson, as opposed to another Army base," says Paul Rieckhoff, an Iraq War veteran and executive director of Iraq and Afghanistan Veterans of America. "The failures of leadership we've seen there border on dereliction of duty."

And for you who have not taken the time to introduce yourselves fully to combat-related PTSD, I behoove you to start at this blog and work your way through it:

Wednesday, November 04, 2009

Afghanistan, Iraq Veteran Army Suicide Rate Continues to Climb; PTSD Timeline Update

And for a broader understanding of the clinical nature of PTSD, outside of the combat military, and it's various forms, you may wish to go to the Mayo Clinic site and work you way through it:

Post-traumatic stress disorder (PTSD)

What lurks out there across America. and the associated acts will is only going to get worse if folks don't understand the true nature of the condition of PTSD and assist those who may not even realize they are in it's grip...

~OGD~

   For Your General Info . . .



Yesterday in his TPM Editor's blog Josh posted this quote attributed to some reader by the initials of BK  . . .

Actually, its greatest point of vulnerability will be the 2012 election, since much of it doesn't take effect until 2013. The mandates that will drive up costs will take effect before then--young people will pay much more since premiums will be equalized for all age groups and private companies will have to cover even sick people. Since there will be no opt-out or no competition, they will be able to charge whatever they want.

By 2012, the exchanges that will get small business owners and employees insured are not supposed to be set up. So basically, all the politically and economically costly things go into effect first, and the beneficial things (insuring people and taking burdens off small business) will not have materialized. It's perfect for demonization.

What stood out to me was what reader BK stated in the above:

The mandates that will drive up costs will take effect before then--young people will pay much more since premiums will be equalized for all age groups and private companies will have to cover even sick people. Since there will be no opt-out or no competition, they will be able to charge whatever they want.

If reader BK comes by and reads this blog I'd advise the individual to specifically read the section on "Individual mandate" -- specifically in H.R. 3962 below dealing with mandates and the date of implementation.

Plus, BK should not overlook "Expansion of public programs" and the section dealing with "Establish a temporary national high-risk pool to provide health coverage to individuals (and spouses and dependents) with pre-existing medical conditions. Individuals who have been denied coverage, offered unaffordable coverage, have an eligible medical condition or who have been uninsured for at least six months will be eligible to enroll in the national high-risk pool" and it's effective date of implementation.

In addition the individual should take a real close read of the section below dealing with "Changes to Private Insurance" -- specifically in H.R. 3962 dealing with "Require review of increases in health insurance premiums prior to implementation of the increases." and the associated date that requirement will take effect. (Hint: when the bill is signed and becomes Public Law as in effective upon enactment)

Another section that may be of interest to BK in "Changes to Private Insurance" -- specifically in H.R. 3962 is;  "Remove the anti-trust exemption for health insurers and medical malpractice insurers." (Effective upon enactment)

So ...

Here is the latest rundown from the Kaiser Foundation interactive side-by-side comparison tool on what and when key provisions are purportedly set to go into effect.


Expansion of public programs

H.R. 3962

• Expand Medicaid to all individuals under age 65 (children, pregnant women, parents, and adults without dependent children) with incomes up to 150% FPL. Provide Medicaid coverage for all newborns who lack acceptable coverage and provide optional Medicaid coverage to low-income HIV-infected individuals (with enhanced matching funds) until 2013 and for family planning services to certain low-income women. In addition, increase Medicaid payment rates for primary care providers to 100% of Medicare rates by 2012. Require states to submit a state plan amendment specifying the payment rates to be paid under the state's Medicaid program. The coverage expansions (except the optional expansions) and the enhanced provider payments will be financed with 100% federal financing through 2014 and 91% federal financing beginning in year 2015. (Effective January 1, 2013)
• Repeal the Children's Health Insurance Program (CHIP) and require CHIP enrollees with incomes above 150% FPL to obtain coverage through the Health Insurance Exchange beginning in 2014. CHIP enrollees with incomes between 100% and 150% FPL would be transitioned to Medicaid and states would receive the CHIP enhanced match rate for children above current levels and up to 150% FPL. Require a report to Congress with recommendations to ensure that coverage in the Health Insurance Exchange is comparable to coverage under an average CHIP plan and that there are procedures to transfer CHIP enrollees into the exchange without interrupting coverage or with a written plan of treatment. (Report due by December 31, 2011)

Baucus Bill:

• Expand Medicaid to all individuals (children, pregnant women, parents, and adults without dependent children) with incomes up to 133% FPL (to be implemented in 2014). Adults with incomes between 100-133% FPL will have the option of obtaining coverage through Medicaid or with federal subsidies through the exchange. All newly eligible adults will be guaranteed a benchmark benefit package that at least meets the minimum creditable coverage standards. Require states to provide premium assistance to any Medicaid beneficiary with access to employer-sponsored insurance if it is cost-effective for the state. To finance the coverage for the newly eligible (those who were not previously eligible for a full benchmark benefit package or who were eligible for a capped program but were not enrolled), states will receive an increase in the federal medical assistance percentage (FMAP). Initially, the percentage point increase in the FMAP will be 27.3 for states that already cover adults with incomes above 100% FPL and 37.3 for other states. These percentage point increases will be adjusted over time so that by 2019, all states will receive an FMAP increase of 32.3 percentage points for the newly eligible. High need states--those with total Medicaid enrollment that is below the national average for enrollment as a percentage of the state population and unemployment rates of 12% or higher for August 2009--will receive full federal funding for the newly eligible for five years.
• Require states to maintain current income eligibility levels for children in Medicaid and the Children's Health Insurance Program (CHIP) until 2019. CHIP benefit package and cost-sharing rules will continue as under current law. Beginning in 2014, states will receive a 23 percentage point increase in the CHIP match rate up to a cap of 100% and a .15 percentage point increase in the Medicaid match rate. CHIP-eligible children who are unable to enroll in the program due to enrollment caps will be eligible for tax credits in the state exchanges.

Changes to Private Insurance

H.R. 3962

• Establish a temporary national high-risk pool to provide health coverage to individuals (and spouses and dependents) with pre-existing medical conditions. Individuals who have been denied coverage, offered unaffordable coverage, have an eligible medical condition or who have been uninsured for at least six months will be eligible to enroll in the national high-risk pool. Premiums for the high-risk pool will be set at not higher than 125% of the prevailing rate for comparable coverage in the state and could vary by no more than 2:1 due to age; annual deductibles will be limited to $1,500 for an individual; and maximum cost-sharing will be limited to $5,000 for individuals. (Effective January 1, 2010 and until the Health Insurance Exchange is established)
• Individuals eligible for COBRA continuation coverage may retain COBRA coverage until the Exchange is established or they obtain acceptable coverage. (Effective upon enactment)
• Limit health plans' medical loss ratio to not less than 85% to be enforced through a rebate back to consumers and prohibit plans from imposing aggregate dollar lifetime limits on coverage. (Effective January 1, 2010) Prohibit insurers from rescinding coverage except in cases of fraud. (Effective July 1, 2010)
• Adopt standards for financial and administrative transactions to promote administrative simplification. (Effective upon enactment)
• Require review of increases in health insurance premiums prior to implementation of the increases. (Effective upon enactment)
• Provide dependent coverage for children up to age 27 for all individual and group policies. (Effective January 1, 2010)
• Limit pre-existing condition exclusions for group policies prior to implementation of the insurance market reforms by shortening the period plans can look back for pre-existing conditions from six months to 30 days and shortening the period plans can exclude coverage of certain benefits from 12 months to three months. (Effective January 1, 2010)
• Prohibit reductions to retiree benefits unless reductions also apply to current employees. (Effective upon enactment)
• Prohibit coverage purchased through the individual market from qualifying as acceptable coverage for purposes of the individual mandate unless it is grandfathered coverage. Individuals can purchase a qualifying health benefit plan through the Health Insurance Exchange. (Effective January 1, 2013)
• Impose the same insurance market regulations relating to guarantee issue, premium rating, and prohibitions on pre-existing condition exclusions in the insured group market and in the Exchange. (See creation of insurance pooling mechanisms). (Effective January 1, 2013)
• Improve consumer protections by establishing uniform marketing standards, requiring fair grievance and appeals mechanisms and accurate and timely disclosure of plan information. (Effective January 1, 2013)
• Create the Health Choices Administration to establish the qualifying health benefits standards, establish the Exchange, administer the affordability credits, and enforce the requirements for qualified health benefit plan offering entities, including those participating in the Exchange or outside the Exchange.
• Permit states to form Health Care Choice Compacts to facilitate the purchase of individual insurance across state lines. (Effective January 1, 2015)
• Remove the anti-trust exemption for health insurers and medical malpractice insurers. (Effective upon enactment)

Baucus Bill (No dates set for implemetation):

• Impose the same insurance market regulations relating to guarantee issue, premium rating, prohibitions on pre-existing condition exclusions, risk adjustment, and rescissions in the individual market, in the exchange, and in the small group market, phasing in the new rules for small group market over five years. (See new rating and market rules in Creation of insurance pooling mechanism.)
• Require health plans to report the proportion of premium dollars spent on items other than medical care and require plans to compile information on coverage in a standard format.
• Require all new policies (except stand-alone dental, vision, and long-term care insurance plans) to comply with one of the four benefit categories, including those offered through the exchanges and those offered outside of the exchanges. Require health plans in the individual and small group markets to at least offer coverage in the silver and gold categories. Existing individual and employer-sponsored plans do not have to meet the new benefit standards. (See description of benefit categories in Creation of insurance pooling mechanism.)
• Require small employers to provide a plan with a deductible that does not exceed $2,000 for individuals and $4,000 for families unless contributions are offered that offset deductible amounts above these limits. This deductible limit will not affect the actuarial value of bronze plans and does not apply to "young invincible" plans. (See description of benefit categories in Creation of insurance pooling mechanism.)
• Allow states the option of merging the individual and small group markets.
• Create a temporary reinsurance program to help stabilize premiums during the first three years of operation of the exchanges when the risk of adverse selection due to enforcement of the new rating rules and market changes is greatest. Finance the reinsurance program through mandatory contributions by health insurers.
• Allow insurers to offer a national health plan with a uniform benefits package in the states in which they are licensed.  National plans would be required to offer plans with silver and gold benefit packages and would be exempt from state benefit requirements. Allow states to opt out of the national plan.
• Permit states to form health care choice compacts and allow insurers to sell policies in any state participating in the compact. Insurers selling policies through a compact would only be subject to the laws and regulations of the state where the policy is written or issued.

Benefit design:

H.R. 3962

• Create an essential benefits package that provides a comprehensive set of services, covers 70% of the actuarial value of the covered benefits, limits annual cost-sharing to $5,000/individual and $10,000/family, does not require cost-sharing for preventive services, and does not impose annual or lifetime limits on coverage. The Health Benefits Advisory Council, chaired by the Surgeon General, will make recommendations on specific services to be covered by the essential benefits package as well as cost-sharing levels. Prohibit abortion coverage from being required as part of the essential benefits package; require segregation of public subsidy funds from private premiums payments for plans that choose to cover abortion services beyond those for which public funding is permitted (public funding of abortions is permitted to save the life of the woman and in cases of rape or incest); and require there be no effect on state or federal laws on abortions. (Health Benefits Advisory Council report due one year following enactment; essential benefits package becomes effective January 1, 2013)
• All qualified health benefits plans, including those offered through the Exchange and those offered outside of the Exchange (except certain grandfathered individual and employer-sponsored plans) must provide at least the essential benefits package. (Effective January 1, 2013)
• Require a report on including oral health benefits in the essential benefits package. (Report due one year following enactment)

Baucus Bill (No dates set for implementation):

• Create minimum creditable coverage that provides a comprehensive set of services, covers 65% of the actuarial value of the covered benefits, limits annual cost-sharing to $5,950/individual and $11,900/family, does not impose annual or lifetime limits on coverage, and is not more extensive than the typical employer plan. Require the Secretary to define and annually update the benefit package through a transparent and public process. (See description of benefit categories in Creation of insurance pooling mechanism.)
• Prohibit abortion coverage from being required as part of the minimum benefits package; require segregation of public subsidy funds from private premium payments for plans that choose to cover abortion services beyond Hyde--which allows coverage for abortion services to save the life of the woman and in cases of rape or incest; and require there be no effect on state or federal laws on abortions.

Individual mandate:     

H.R. 3962

• Require all individuals to have "acceptable health coverage". Those without coverage pay a penalty of 2.5% of their adjusted income above the filing threshold up to the cost of the average national premium for self-only or family coverage under a basic plan in the Health Insurance Exchange. Exceptions granted for those with incomes below the filing threshold (in 2009 the threshold for taxpayers under age 65 is $9,350 for singles and $18,700 for couples), religious objections and financial hardship. (Effective January 1, 2013)

Baucus Bill:

• Require U.S. citizens and legal residents to have qualifying health coverage. Enforced through a tax penalty of $750 per adult per year. The penalty will be phased-in according to the following schedule: $0 in 2013; $200 in 2014; $400 in 2015; $600 in 2016; and $750 in 2017. Exemptions will be granted for financial hardship, religious objections, American Indians, and if the lowest cost plan option exceeds 8% of an individual's income or if the individual has income below 133% of the poverty level.

Premium subsidies to employers

H.R. 3962

• Provide small employers with fewer than 25 employees and average wages of less than $40,000 with a health coverage tax credit for up to two years. The full credit of 50% of premium costs paid by employers is available to employers with 10 or fewer employees and average annual wages of $20,000 or less. The credit phases-out as firm size and average wage increases and is not permitted for employees earning more than $80,000 per year. (Effective January 1, 2013)
• Create a temporary reinsurance program for employers providing health insurance coverage to retirees over age 55 who are not eligible for Medicare. Program will reimburse employers for 80% of retiree claims between $15,000 and $90,000. Payments from the reinsurance program will be used to lower the costs for enrollees in the employer plan. Appropriate $10 billion over ten years for the reinsurance program. (Effective 90 days after enactment)

Baucus Bill:

• Provide small employers with fewer than 25 employees and average annual wages of less than $40,000 that purchase health insurance for employees with a tax credit.
• Phase I : For tax years 2011 and 2012, provide a tax credit of up to 35% of the employer's contribution toward the employee's health insurance premium if the employer contributes at least 50% of the total premium cost or 50% of a benchmark premium. The full credit will be available to employers with 10 or fewer employees and average annual wages of less than $20,000. Tax-exempt small businesses meeting these requirements are eligible for tax credits of up to 25% of the employer's contribution toward the employee's health insurance premium.
• Phase II : For tax years 2013 and later, for eligible small businesses that purchase coverage through the state exchange, provide a tax credit of up to 50% of the employer's contribution toward the employee's health insurance premium if the employer contributes at least 50% of the total premium cost or 50% of a benchmark premium. The credit will be available for two years. The full credit will be available to employers with 10 or fewer employees and average annual wages of less than $20,000. Tax-exempt small businesses meeting these requirements are eligible for tax credits of up to 35% of the employer's contribution toward the employee's health insurance premium.
• Create a temporary reinsurance program for employers providing health insurance coverage to retirees ages 55 to 64. Program will reimburse employers or insurers for 80% of retiree claims between $15,000 and $90,000. Appropriate $5 billion to finance the program.

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Again: Here is the link to the interactive tool

kff.org/healthreform/sidebyside.cfm


And I truly hope for BK and Josh (and anyone else who bothers to read this) that this helps clarify the effective dates of implementation in relationship to the various sections of this bill.


~OGD~
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