Coming soon to a health care plan near you: The Health-Care Law Provisions Taking Effect in 2011

Change is scary but knowing what to expect helps. Check out the changes to our nation’s healthcare that will be in effect starting in 2011. Please note that most of the big stuff is happening in 2014. -SP

By Katherine Hobson
Parts of the uncatchily named Patient Protection and Affordable Care Act, aka the health-care overhaul law, began to kick in earlier this year. But in 2011, other provisions will roll out — some as soon as January 1.

The Kaiser Family Foundation counts 21 provisions taking effect next year. Among them:

-The requirement that the proportion of premium dollars spent on medical care must amount to at least 80% for small business plans and 85% for large group plans will kick in. The so-called medical loss ratio was the subject of discussion and lobbying this year as insurers jockeyed to meet the requirements — and to avoid paying consumers rebates if they don’t.
It’s the beginning of the end for the Medicare prescription-drug “doughnut hole.” Next year drug makers will provide a 50% discount on brand-name medications that fall into that coverage gap. Federal subsidies for generics will also begin.

-For Medicare beneficiaries, there will be no cost-sharing for certain preventive health services that receive an A or B rating from the U.S. Preventive Services Task Force.

-You won’t be able to pay for OTC drugs out of your flexible spending account, unless those drugs have been prescribed by a physician. (There are some exceptions.) We wrote recently about the change and how to figure out what’s eligible. The same applies to health reimbursement accounts.

-Calorie counts and other nutritional information will be posted on chain-restaurant menus and on food sold via vending machines.
The health-care overhaul law’s major provisions — such as the mandate that almost everyone purchase insurance, the requirement that insurers accept all comers and the establishment of state-based insurance exchanges — don’t take effect until 2014.

Click here to read the full article and the many helpful links at the Wall Street Journal online.

US News and World Report: Report Finds Baby Boomers to Gain Most From Health Care Reform

By Amanda Gardner
HealthDay Reporter

TUESDAY, Dec. 14 (HealthDay News) — America’s Baby Boomers may be poised to benefit the most from health-care reform, a new report shows.

Some of those gains will come right away, such as the elimination of restrictions on people with preexisting conditions, while others — no more lifetime limits on health insurance and subsidized coverage through health insurance exchanges — are slated for 2014, as more provisions of the Affordable Care Act are rolled out.

On Monday, a federal district judge in Virginia ruled that a key provision of the law, which mandates coverage for most Americans, was unconstitutional. Most analysts expect the case to eventually reach the U.S. Supreme Court.

The new report, from the Commonwealth Fund, is the sixth in a series examining how the new reform package, signed into law in March by President Barack Obama, will change health-care coverage in the United States.

“This report paints a picture of the Baby Boomer generation whose health and financial security are in jeopardy because of rising health-care costs and declining coverage,” Cathy Schoen, senior vice president at Commonwealth Fundm, said during a Monday news conference. “The good news is that the Affordable Care Act is already making a difference and things will continue to improve. We will enter a new era in health care with an end to turning people down for health insurance because of age and health.”

But Devon Herrick, a senior fellow with the National Center for Policy Analysis, is worried that these forthcoming changes could skew the system for the worse.

Read more at US News and World Report’s website.

FREE Event: Health Insurance Options for Seniors

Learn more about the health insurance options for seniors including recent
changes in the law from a panel of experts.

Panelists include:
Norma Almanza, HICAP Coordinator, Texas Department of Insurance
Patricia Longoria, Director of Community Relations, Physicians Health Choice

Join us in the AGE Building Dining Room
3710 Cedar Street, Austin, 78705
Saturday, November 13
10am-Noon

For more information or to pre-register, please call Bruce Kravitz at (512) 451-4611 or email bkravitz@ageofaustin.org. Respite is available on-site at Elderhaven by reservation only.

To RSVP for respite, contact Katy Rouse at (512) 458-6305 by November 10. Elderhaven is an Adult Day Center that provides care daily (M-F) for the elderly with nurse oversight in Travis and Williamson Counties. Call 458-6305 for more information.

NYT: Palliative Care Extends Life, Study Finds

From the New York Times.com

In a study that sheds new light on the effects of end-of-life care, doctors have found that patients with terminal lung cancer who began receiving palliative care immediately upon diagnosis not only were happier, more mobile and in less pain as the end neared — but they also lived nearly three months longer.

The findings, published online Wednesday by The New England Journal of Medicine, confirmed what palliative care specialists had long suspected. The study also, experts said, cast doubt on the decision to strike end-of-life provisions from the health care overhaul passed last year.

“It shows that palliative care is the opposite of all that rhetoric about ‘death panels,’ ” said Dr. Diane E. Meier, director of the Center to Advance Palliative Care at Mount Sinai School of Medicine and co-author of an editorial in the journal accompanying the study. “It’s not about killing Granny; it’s about keeping Granny alive as long as possible — with the best quality of life.”

In the three-year study, 151 patients with fast-growing lung cancer at Massachusetts General, one of the nation’s top hospitals, were randomly assigned to get either oncology treatment alone or oncology treatment with palliative care — pain relief and other measures intended to improve a patient’s quality of life. They were followed until the end of 2009, by which time about 70 percent were dead.

Read the full article here at the New York Times.com

The Affordable Care Act —What it Means for Those with Pre-Existing Conditions

The new healthcare reform recently passed was pretty confusing for the general public. Check out this helpful guide from healthcare.gov breaks down information if you have a loved one with pre-exisiting conditions

If your loved one has been denied health insurance coverage by a private insurance company due to a pre-existing condition, there may be hope. The Pre-Existing Condition Insurance Plan (PCIP) is a new program created by the Affordable Care Act to provide coverage for uninsured people with pre-existing conditions until the new insurance market rules take effect in 2014. Eligible individuals include those who have been uninsured for at least six months, have a pre-existing condition or have been denied health coverage because of a health condition, and are a U.S. citizen or are residing here legally. To learn more about the Pre-Existing Condition Insurance Plan, click here.

NPR: Long-Term Care Program Debuts In New Health Law

From NPR News
April 2, 2010
By Julie Rovner

The Community Living Assistance Services and Supports Act will help Americans save money to meet the cost of long-term care as they age. The program will especially benefit senior citizens.
The Community Living Assistance Services and Supports Act will help Americans save money to meet the cost of long-term care as they age. The program will especially benefit senior citizens.
It got precious little debate in either the House or Senate, and President Obama didn’t even mention it when he signed the huge health bill into law. But buried within the new health care overhaul is the first-ever federal insurance program to help Americans meet the often crushing costs of long-term care.

The Community Living Assistance Services and Supports Act, better known as the CLASS Act, was one of the last legislative efforts of the late Sen. Edward Kennedy (D-MA). He added it to the health bill last summer as it was moving through the committee he chaired in the Senate. While some lawmakers questioned whether the program would, as promised, actually pay for itself, it remained in the measure to the end.

“Long-term care supports and services have been the forgotten element of people’s health care needs,” said Judy Feder, a senior fellow at the Center for American Progress and professor of public policy at Georgetown University. “People who need help with the daily tasks of living need medical care, and they need these daily supports. They don’t distinguish between the two.”

Read more here at NPR News