NN&I - May 2010
Health Care Beat 16 Nephrology News & Issues May 2010www.nephronline.comHow health care reform plans on reforming health careBy Thomas Keating and Mark E. Neumann[ HEALTH CARE BEAT , continued on page 22 ]When the ink started to dry on the Patient Protection and Affordable Care Actthe official name of the health care reform bill Congress passed in March and President Obama signed into lawit was clear that implemen-tation was not going to be an easy task. Attorney generals in 15 states have filed suit against the federal government, saying the law's requirement that U.S. residents must buy insurance is un-constitutional. Most of the provisions in the law don't take effect until 2014 (see box). mandating that people with pre-existing conditions are not turned down, and closing the Medicare prescription "doughnut hole," will reduce the deficit and slow the ever-escalating rise in overall health care costs. The law uses tax increas-es on upper-income households, a tax on high-cost insurance, insurance exchanges, and efficiencies in Medicare to cover the tab. Congressional Republicans who vot-ed unanimously against the bill claim the legislation means federal takeover age reforms rely on existing govern -ment programs and private insurance, and its payment reforms are varia-tions on themes tried before without much success. The bill doesn't create a new federal bureaucracy or create a publicly-owned insurer to compete in the private marketplace, which was demanded by many progressive advo-cacy groups and supported by liberals in Congress.Half of the estimated 32 million peo-ple who will get insurance under the bill will be enrolled in state-based Medicaid programs. While the federal government will pick up most of the cost, Medicaid chronically underpays physicians and hospitals in most states (renal provid-ers in some states have already begun reporting lower payments through their state Medicaid programs as more indi-viduals get added).With millions of new enrollees, states could come under increasing pressure to raise rates or not have doc-tors willing to participate in the pro-gram. The Mayo Clinichighly touted as a beacon of cost containment as well as outstanding medical carestopped accepting Medicaid patients at the beginning of the year at its Glendale, Ariz. clinic. They said they could no longer continue to operate the facility at a loss. Similarly, Walgreens and two other pharmacies in Washington state Change will come over the next decade as the reforms in the law gradu -ally go into effect. The White House and the Demo-crats in Congress who voted for the bill are betting that providing health care to 32 million uninsured Americans, of one-sixth of the economy. They say it will increase insurance premiums, cut Medicare benefits and add a massive tax increase. Their leaders vowed to push for repeal of the legislation should they win control of Congress in the fall.The Obama-era health care cover -Main changes under the new lawMore adults will get Medicaid coverage. \037 Low-income families will get federal subsidies to buy insurance. \037 Small businesses will get tax credits to help cover the cost of insurance for \037 their employees. Children will be able to stay on parents' health insurance policies until they \037 turn 26, starting in September. \037 The wealthy will pay higher taxes to help finance the 10-year, roughly \037 $940 billion cost. Businesses with 50 or more workers will have to insure them or pay a penalty. \037 Seniors will gain additional prescription-drug coverage; those in the \037 Medicare drug program's doughnut hole will receive rebates this year. The most controversial taxes will not go into effect until 2013or even 2018. \037 A mandate that most Americans obtain health insurance starts in 2014. \037 A prohibition against insurers turning down adults for coverage because \037 of pre-existing conditions will also start in 2014. The law creates a marketplace or purchasing pool to make it more affordable \037 for people to buy insurance. HCB_NNI0510_4.indd 16 4/19/10 4:19:30 PM
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