Pit & Quarry, August 2012

S o the United States Supreme Court has upheld the health care law To this day many people still dont know what the law is or what it does to them or for them Without getting into the finer details and qualifications the new law reforms the insurance system so everyone can have health care It requires everyone with financial means to have insurance and allows for the use of tax credits to financially assist those with limited means Insurance companies will experience a number of immediate effects Companies may not rescind health insurance policies nor may they deny coverage for preexisting conditions Companies must allow dependents to be covered up to age 26 and they may not impose lifetime limits on what they will pay Additionally insurance companies must cover preventive services like immunizations limit administrative overhead to keep down policy costs and use uniform provisions for easy comparison of available policies What happens in 2014 Two years from now raising insurance rates based on health status predisposition or past claims will be barred Insurers may take into account family structure place of residence and age Premiums may be decreased for health promotion programs or increased for tobacco use States will have insurance exchanges in 2014 to help employers and individuals get coverage Individuals will be mandated to have at least minimum coverage or pay a penalty of 95 in 2014 350 in 2015 750 in 2016 and as indexed thereafter Employers may continue to offer BY MICHAEL T HEENAN existing insurance coverage at existing levels in 2014 and beyond and those with 50 or more employees must offer affordable insurance or pay a penalty of 750 for every full time employee Another development is that employers with more than 200 employees will have to enroll all new full time employees Also tax credits will assist small businesses with fewer than 25 employees for up to 50 percent of premium Further developments are that exchange plans will have no out of pocket charges exceeding health savings accounts and deductibles will be capped at 2000 for individuals and 4000 for families In 2014 policies will be available at four levels based on how much insurance companies will pay platinum 90 percent gold 80 percent silver 70 percent and bronze 60 percent Also individuals under 30 will be able to acquire policies limited to catastrophic coverage If a state opts not to have an exchange a public health insurance option will be available Non profit insurance cooperatives may also be established with federal support States will be able to establish health plans for non Medicaid lower income individuals And all insurance companies participating in exchanges will have the same simple enrollment Medicaid eligibility for lowerincome people will be expanded with federal expenditures Medicaid enrollment will be simplified and its services and quality will be improved There will also be enhanced federal support for childrens health insurance and the Childrens Health Insurance Program enrollment will be simplified Medicare Medicare will endure changes as well Coinsurance and deductibles will be waived for most preventative services Medicare prescription drug benefits will be enhanced and drug companies will be required to provide a 50 percent discount for name brand drugs Medicare payments will now be linked to quality performance on common high cost procedures A new Center for Medicare Innovation will be established to improve payments and delivery as will pilot programs to improve care and manage delivery costs Other Medicare changes to note Hospitals will be paid less based on percentages of potentially preventable readmissions provider fees in rural areas will be increased and bonus payments will be made for ground and air ambulance services in rural areas Public health improvements Beyond Medicare some general public health improvements are being sought For example a fund will be established for expanded national investment in prevention and public health Access to clinical preventive services will be improved and studies will be funded to examine best prevention practices Grants will be made for studies of Health care upheld Employers must now report the value of health insurance benefits on W 2 forms High dollar employersponsored health benefits will be taxed on premiums higher than 8500 for individuals and higher than 23000 for families Continued on page 55 50 PIT QUARRY August 2012 www pitandquarry com