In a previous post we touched on the subject of health insurance coverage in the newly signed Patient Protection and Affordable Healthcare Act, otherwise commonly known as the Healthcare Reform Bill. What people are hearing and what the bill really contains seems to be a severe disconnect.
If anyone believes that the coverage for the uninsured will cover everything, think again. That is known as a Cadiallac plan that will be taxed. Will the policies have a deductible of $5,000.00, $10,000.00, what will it be? Will it cover prescription medications? What exactly is the government promising to the citizenry when it states it has passed healthcare reform? Let's take a look
• Create four benefit categories of plans plus a separate catastrophic plan to be offered through the Exchange, and in the individual and small group markets:
– Bronze plan represents minimum creditable coverage and provides the essential health benefits, cover 60% of the benefit costs of the
plan, with an out-of-pocket limit equal to the Health Savings Account (HSA) current law limit ($5,950 for individuals and $11,900 for
families in 2010); So who has that kind of money laying around to pay for healthcare.If you can't afford the premium how can you afford the out of pocket expense?
– Silver plan provides the essential health benefits, covers 70% of the benefit costs of the plan, with the HSA out-of-pocket limits;
– Gold plan provides the essential health benefits, covers 80% of the benefit costs of the plan, with the HSA out-of-pocket limits;
- Platinum plan provides the essential health benefits, covers 90% of the benefit costs of the plan, with the HSA out-of-pocket limits;
– Catastrophic plan available to those up to age 30 or to those who are exempt from the mandate to purchase coverage and provides catastrophic coverage only with the coverage level set at the HSA current law levels except that prevention benefits and coverage for three primary care visits would be exempt from the deductible. This plan is only available in the individual market.
Hold onto your pocket book if you are a low-income individual or family.
– • Reduce the out-of-pocket limits for those with incomes up to 400% FPL to the following levels:
– 100-200% FPL: one-third of the HSA limits
($1,983/individual and $3,967/family);
– 200-300% FPL: one-half of the HSA limits
($2,975/individual and $5,950/family);
– 300-400% FPL: two-thirds of the HSA limits
($3,987/individual and $7,973/family).
These out-of-pocket reductions are applied within the actuarial limits of the plan and will not increase the actuarial value of the plan.
FPL stands for the Federal Poverty Level. Here is a chart of the federal poverty levels for 2009-2010. $10,830 for an individual and $22,050 for a family of four. If you are at those levels you will be expected to pay $1,983/individual and $3,967/family. Folks, are they kidding us??? If they call that a reduction what a scam.
In an effort to educate the masses here is some other highlights of the bill from the Kaiser Family Foundation that are worth mentioning.
• Impose new annual fees on the pharmaceutical manufacturing sector, according to the following schedule:
– $2.8 billion in 2012-2013;
– $3.0 billion in 2014-2016;
– $4.0 billion in 2017;
– $4.1 billion in 2018; and
– $2.8 billion in 2019 and later.
• Impose an annual fee on the health insurance sector, according to the following schedule:
– $8 billion in 2014;
– $11.3 billion in 2015-2016;
– $13.9 billion in 2017;
– $14.3 billion in 2018
– For subsequent years, the fee shall be the amount from the previous year increased by the rate of premium growth.
If anyone believes that those entities won't in turn pass on those costs to the consumers there are a few bridges for sale. Basically consumers will have to pay premiums then higher premiums because these costs will be passed on.
• Create state-based American Health Benefit Exchanges and Small Business Health Options Program (SHOP) Exchanges, administered by a governmental agency or non-profit organization, through which individuals and small businesses with up to 100 employees can purchase qualified coverage. Permit states to allow businesses with more than 100 employees to purchase coverage in the SHOP Exchange beginning in 2017. States may form regional Exchanges or allow more than one Exchange to operate in a state as long as each Exchange serves a distinct geographic area. (Funding available to states to establish Exchanges within one year of enactment and until January 1, 2015) Individuals and small businesses will not receive any ability to purchase qualified coverage until 2017. Exchanges will allow businesses to pool their purchase lowering costs. Evidently that wasn't important enough to happen now.
Some sobering analysis. That is why they want to tell you that the Republicans are obstructionists. It keeps your eye off the real problems in this legislation.
Let's go on to Medicaid.
Expand Medicaid to all individuals under age 65 (children, pregnant women, parents, and adults without dependent children) with incomes up to 133% FPL based on modified adjusted gross income (as under current law and in the House and Senate-passed bills undocumented immigrants are not eligible for Medicaid). All newly eligible adults will be guaranteed a benchmark benefit package that at least provides the essential health benefits. 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 100% federal funding for 2014 through 2016, 95% federal financing in 2017, 94% federal financing in 2018, 93% federal financing in 2019, and 90% federal financing for 2020 and subsequent years. States that have already expanded eligibility to adults with incomes up to 100% FPL will receive a phased-in increase in the federal medical assistance percentage (FMAP) for non-pregnant childless adults sothat by 2020 they receive the same federal financing (90%) as other states. In addition, increase Medicaid payments in fee-forservice and managed care for primary care services provided by primary care doctors (family medicine, general internal medicine or pediatric medicine) to 100% of the Medicare payment rates for 2013 and 2014. States will receive 100% federal financing for the increased payment rates. (Effective January 1,2014)
So taxpayers of individual states will have to share the burden and costs of this expansion starting in 2017 and beyond- A federal mandate but a state problem. No wonder the 14 Attorney Generals are suing the government.
Obama, Kanjorski, and Carney are taking the ability to use your FSA/HSA to pay for over the counter purchases.
Exclude the costs for over-the-counter drugs not prescribed by a doctor from being reimbursed through an HRA or health FSA and from being reimbursed on a tax-free basisthrough an HSA or Archer Medical Savings Account. (Effective January 1, 2011)
To the abortion foes
• Require plans that choose to offer coverage for abortions beyond those for which federal funds are permitted (to save the life of the woman and in cases of rape or incest) in states that allow such coverage to create allocation accounts for segregating premium payments for coverage of abortion services from premium payments for coverage for all other services to ensure that no federal premium or cost-sharing subsidies are used to pay for the abortion coverage. Plans must also estimate the actuarial value of covering abortions by
taking into account the cost of the abortion benefit (valued at no less than $1 per enrollee per month) and cannot take into account any
savings that might be reaped as a result of the abortions.
Prohibit abortion coverage from being required as part of the essential health benefits package. (Effective January 1, 2014)
Can an Executive Order really supercede the law of the land? Why not prohibit it now? Why wait until 2014?
Paul Kanjorski and Chris Carney had a choice. The information above represents their choice.
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