If you’re like me, you probably still have questions about the Federal health-care reform bill. Through the media, many of us have heard that pre-existing conditions no longer prevent people from getting or keeping health insurance. Still others may be aware that their children under 26 are now eligible to be covered under their health insurance plan, and that it closes the Medicare Part D “donut hole” for seniors.
I’ve gotten calls and e-mails from many of you, and have talked with my neighbors and friends about health-care. These conversations led me to do some research about health-care reform that I hope helps you better understand the legislation.
What are the local benefits of health-care reform? How will I notice the changes in my area?
Health Insurance. First, health-care reform will result in insurance being available for all, and in fact mandated like automobile insurance. There are 153,000 adults that are uninsured in King County (12.5 percent) and most of them (excluding illegal immigrants) will have access to health insurance by 2014. This will be available either through Medicaid expansion, individual insurance plans or small business plans.
While our state has made great strides in insuring children, approximately 4 percent of our children are still uninsured. These children will all be insured by 2019.
Community Health Centers. One of SeaTac, Renton and Kent’s great assets is our HealthPoint community health centers, where anyone, regardless of income level or job status, can receive preventative care and dental services. The health care reform law recognizes the importance of these trusted community centers by including funding to help them nearly double the amount of patients they see. Because there will be so many more people accessing health care services, it is important to expand services at these cost-efficient community centers, rather than seeing many of the newly insured attempting to use expensive emergency room services for routine care.
Nutrition Labeling. Our local Board of Health passed menu-nutrition labeling legislation in 2007 for those of us who live in King County, but the rest of the nation does not have access to nutrition information. The health care reform law requires chains with 20-plus restaurants of the same name to provide nutrition information, which will lead the nation forward in our attempt to make better informed, healthier decisions when they are dining out.
What you will notice locally is the addition of nutrition labeling at grocery store delis, convenience stores, vending machines, and buffets. These changes won’t occur for 2-3 years, due to the time it takes to work with businesses in order to reach agreement on how and where to label food.
What does it cost and how will we pay for it?
Costs. Health-care reform will cost the government about $938 billion over a 10-year period according to the non-partisan Congressional Budget Office.
Expected Savings. The Congressional Budget Office anticipates that health care reform is anticipated to reduce the federal deficit by $143 billion over ten years. A large-amount of the savings are expected to come from a reduction in direct spending, including permanent reductions in what the federal government will pay service providers for most Medicare services and lower growth in Medicare costs.
How we will pay. We will pay for health care through a combination of savings from Medicaid and Medicare (as health-care costs go down) and new taxes and fees. For example, there will an excise tax on high-cost health plans, a tax on indoor tanning, fees on pharmaceutical companies, and an increased hospital tax on high-wage workers that will be phased in between now and 2018.
Will health care reform improve the quality of care, (i.e. eliminate unnecessary care, improve early disease detection, encourage doctors to be innovative)?
Research Institute. A new research institute will examine how effective different medical treatments are, and make recommendations to doctors. The establishment of these “best practice” protocols will result in better health care results for us all over time.
More Data. The new law requires doctors and hospitals to collect and report data (while keeping personal information anonymous) on race, ethnicity, sex, primary language, disability status, and for underserved rural and frontier populations. Doctors will use this information to identify what the major health issues are for different demographics, targeting prevention and disease screening to those that need it most.
Preventative Care. Preventative care for all will now be covered by insurance, with no co-pay or deductible required. That means your annual check-up at your primary care doctor is free for you. In addition, the health-care reform law includes $15 billion (over 10 years) for community prevention and wellness programs. As the old saying goes, an ounce of prevention is worth a pound of cure.
How does health care reform hold insurance companies accountable?
Appeals Process. If you think that your insurance company has wrongly denied a claim for reimbursement, you will now be able to appeal to a new, independent appeal board, resulting in less bureaucratic run-around for the consumer and your doctor.
Limits Profit. If your insurance company does not spend 85 percent of money they receive from us as a reimbursement for care, they must provide us with a rebate. What this means is that insurance companies have no incentive to maximize their profits on our backs, by denying reimbursement claims. They will be limited in what they can keep.
No Unreasonable Rate Hikes. Insurance companies must submit justification to our state Insurance Commissioner each time they request an increase in premiums. They can no longer willy-nilly impose rate hikes without a thorough review and approval.
No Lifetime or Annual Limit. Insurance companies can no longer limit the amount of care you can receive each year, or over the course of your life.
If you have additional questions, please call or e-mail my office. I’ve also included some helpful links on my Web site: www.kingcounty.gov/patterson.
Thank you for giving me the privilege of serving as your representative on the King County Council.
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