Insurance for people with pre-existing conditions. Consistent benefits for seniors. An ability for children to stay on their parents’ insurance plans until their 27th birthday. The controversial health care reform bill signed into law Tuesday by President Barack Obama brings about a number of changes to various population groups in Arizona.
Insurance for people with pre-existing conditions. Consistent benefits for seniors. An ability for children to stay on their parents’ insurance plans until their 27th birthday.
The controversial health care reform bill signed into law Tuesday by President Barack Obama brings about a number of changes to various population groups in Arizona.
Health-care economics and law experts from Arizona State University outlined a few of the changes just hours after the bill became law.
Arizona, however, may be challenging the plan. Already, Gov. Jan Brewer has said she may file a suit because the law requires Arizona to fund health care programs that it can’t afford.
Almost immediately, the gap known as the “donut hole” in Medicare prescription drug coverage will be eliminated, said James Hodge Jr., Lincoln professor of health law and ethics and director of the public health law and policy program at ASU.
All seniors are required to sign up for Medicare when they turn 65. That coverage becomes their primary health insurance if they don’t have another plan or their secondary insurance if they do, Hodge said.
When the prescription coverage was changed under the previous administration, there was a gap that left seniors obligated to pay between $2,500 and $5,000, Hodge said.
“In that area, seniors are required to pay virtually 100 percent. This will fill the hole,” he said.
In addition, there will be a reduction in co-payments for some preventive care.
“This means we’ll see them access preventive care before they need it for catastrophic claims,” he said.
But the bill also reduces the reimbursements Medicare provides to physicians, which may result in some doctors not seeing Medicare patients, said Marjorie Baldwin, director of the School of Health Management and Policy.
“It may mean some seniors may have difficulty finding a provider,” she said.
The biggest change here, Hodge said, is the fact that insurance companies won’t be able to deny coverage for children and it eliminates the lifetime caps based on a person’s specific condition.
“Insurance will cover you for the duration of treatment,” Hodge said.
With federal subsidies, low-income families will also be able to get insurance.
Families currently with insurance may also see an increase in their deductible or co-payments when plans are renegotiated by their employers, Baldwin said.
“As coverage is expanded, there will be more demand, but also insurers are mandated to cover everyone, even those with pre-existing conditions. That’s going to bring in a less healthy group into the insurance pool. They will cost more and these costs will have to be spread around the entire insurance pool. They cannot charge higher premiums for someone who has a pre-existing condition,” Baldwin said.
With the individual mandate in the bill, everyone will soon be required to carry insurance. The tax penalty ranges from $95 to $700 annually, Baldwin said.
She fears healthy people — like her students — may choose to pay the penalty rather than pay for health insurance because it may be cheaper, negating the benefits of having everyone insured.
There are as many as 30 million uninsured Americans, Hodge said. The law opens the door for them to receive insurance, regardless of income or pre-existing conditions.
The law also expands eligibility for Medicaid.
“They should find health insurance much more accessible,” Baldwin said. “That should allow them to see primary care providers rather than going to the emergency room, for example. This would allow more preventive care rather than waiting for acute care.”
It also requires states to continue or expand existing health care programs to receive federal matching funds — which, for Arizona, may be a fight in the given fiscal situation.
Hospitals and providers
There will be a mixed response from this group, the ASU experts said. On one hand, the law opens up a new group of clients who have previously not had insurance or sought out preventive care.
“They recognize they’ll have access to a whole new market they have not been able to tap into because they’ve been uninsured. Providers can provide preventive services to a whole new class of people presently booted out of the market,” Hodge said.
But it also lowers some of the Medicare reimbursements, which means the hospitals may pass the higher costs on to patients who have insurance, Baldwin said.
The bill also creates community health centers, which will be operated privately and help fill the needs created by the newly insured, Hodge said. In essence, the centers will be funded through Medicaid because its patients will likely have their insurance subsidized by the federal government.
Hospitals and the American Medical Association have supported reform for the most part, Hodge said.