By: Neal Tepel
After a year debate and stalling, a deeply divided Congress has passed landmark health care legislation known as H.R. 3590, the Patient Protection and Affordable Care Act on March 23, 2010. Every American will now be provided with health care coverage including the 32 million uninsured Americans. This ground-breaking legislation will finally tackle the many abuses by the insurance industry. With the country is a deep recession, HR 3590 also addresses a growing budget shortfall. According to the Congressional Budget Office this legislation would reduce the deficit by $143 billion over 10 years. The $938 billion cost would be offset by penalties, new taxes and fees.
This bill addresses the disparity in heath services between poor Americans and the rich, between those receiving the finest health services on the planet and those uninsured. The new law will allow for the expansion of the community health centers in local neighborhoods. This will have a substantial savings to hospitals since many in underprivileged neighborhoods use emergency rooms for their primary care. The increase of screening and prevention programs created by funding under this legislation will save thousand from sickness or death.
The expected changes in regulations will cut down on unjustified rate increases and denials of coverage. No longer can an insurance company deny care based on a pre-existing condition. Nor can they cancel insurance coverage retroactively or put lifetime limits on the dollar value of benefits. Insurers must eliminate the gap between what they charge those most likely to get sick and those least likely to need a doctor. In the event of a catastrophic accident or illness, employees no longer have to worry that their benefits will run out.
The new law phases-out Medicare Part D’s “donut hole” coverage gap on prescription medications for seniors. The doughnut hole refers to the period when Medicare patients must pay out-of-pocket for prescriptions after spending $2,830. Presently when total spending by a patient exceeds this ceiling, the coverage discontinues. Beginning this year, any Medicare beneficiary who crosses into the doughnut hole will receive a $250 check to help pay for the drugs. By 2020, the hole is closed altogether. The new law also allows the Secretary of Health & Human Services (HHS) the authority to negotiate drug prices with manufacturers. Even the threat of implementing this provision will save taxpayers and consumers billions of dollars.
Under this legislation a new innovative insurance program will cover at-home care for the aged and disabled. This initiative is titled Community Living Assistance Services and Supports. Those not able to perform daily living activities or having functional deficits will receive in-home care instead of costly institutional placement. The savings could be monumental. The goal is to allow persons with functional deficits or the inability to perform various daily living activities to receive care in their homes rather than hospitals. The legislative change will also allow young adults up to 26 continued coverage on their parents’ insurance.
Since this legislation requires individuals to obtain coverage, more workers will join their employer-sponsored plans. Small businesses with fewer than 50 workers are exempt from many of the legal requirements and will benefit from generous tax credits. The law, however, allows for the continuation of existing employer-sponsored programs without the consumer protections that apply to new plans.
The issue of how to improve heath care for Americans has been debated for many years. Several presidents tried unsuccessfully to broach the subject with Congress. President Teddy Roosevelt’s Progressive Party platform in 1912 had a public health care plank. Presidents Franklin D. Roosevelt, Harry Truman, Lyndon Johnson, Richard Nixon and Bill Clinton all had ambitions of creating legislation to improve heath care. It’s ironic that the present heath care initiative looks much like the market-based proposals the Republicans sponsored to counter Clinton’s plan in 1993. Politics prevented every attempt to pass critical health care legislation until now. The baton has been passed on the Yes We Can President and Barack Obama has crossed the finished line creating quality health care for every American.
Neal Tepel is the former president of the Civil Service Merit Council and writes on labor issues.