What the health care ruling means to you

What the health care ruling means to you
By Josh Levs, CNN
updated 11:06 AM EDT, Thu June 28, 2012

CNN -- The Supreme Court's decision Thursday to uphold the Affordable Care Act means that the predictions about how it will affect all Americans remain in place.

Read the court ruling (.PDF)

STORY HIGHLIGHTS

• The Supreme Court's decision upholds the health care law
• The requirement to have health insurance by 2014 remains in place
• Insurance companies must cover people with pre-existing conditions
• Small business owners and medical groups disagree over the impacts of the law

Here are some highlights:

The uninsured

The decision leaves in place the so-called individual mandate -- the requirement on Americans to have or buy health insurance beginning in 2014 or face a penalty -- although many are exempt from that provision.

In 2014, the penalty will be $285 per family or 1% of income, whichever is greater. By 2016, it goes up to $2,085 per family or 2.5% of income.Health care exchanges, which are designed to offer cheaper health care plans, remain in place as well.

The insured

Because the requirement remains for people to have or buy insurance, the revenue stream designed to help pay for the law remains in place. So insured Americans may be avoiding a spike in premiums that could have resulted if the high court had tossed out the individual mandate but left other requirements on insurers in place.

Young adults

Millions of young adults up to age 26 who have gained health insurance due to the law will be able to keep it. The law requires insurers to cover the children of those they insure up to age 26. About 2.5 million young adults from age 19 to 25 obtained health coverage as a result of the Affordable Care Act, according to the U.S. Department of Health and Human Services.

Two of the nation's largest insurers, United Healthcare and Humana, recently announced they would voluntarily maintain some aspects of health care reform, including coverage of adult dependents up to age 26, even if the law was scrapped.

People with pre-existing conditions

Since the law remains in place, the requirement that insurers cover people with pre-existing medical conditions remains active.

The law also established that children under the age of 19 could no longer have limited benefits or be denied benefits because they had a pre-existing condition.

Starting in 2014, the law makes it illegal for any health insurance plan to use pre-existing conditions to exclude, limit or set unrealistic rates on coverage.

It also established national high-risk pools that people with such conditions could join sooner to get health insurance. As of April, a total of only about 67,000 people were enrolled in federally-funded pools established by the health care law, according to the National Conference of State Legislatures.

More than 13 million American non-elderly adults have been denied insurance specifically because of their medical conditions, according to the Commonwealth Fund. The Kaiser Family Foundation says 21% of people who apply for health insurance on their own get turned down, are charged a higher price, or offered a plan that excludes coverage for their pre-existing condition.

All taxpayers

No matter what the Supreme Court had decided, it would have been a mixed bag for all Americans when it comes to federal spending. There is heated dispute over what impact the health care law will have on the country over the long term.

The federal government is set to spend more than $1 trillion over the next decade to subsidize coverage and expand eligibility for Medicaid. The nonpartisan Congressional Budget Office estimated that the law could reduce deficits modestly in the first 10 years and then much more significantly in the second decade.

The CBO said a repeal of the mandate could reduce deficits by $282 billion over 10 years, because the government would be subsidizing insurance for fewer people. But the nation faces costs in various ways for having people who are uninsured. The Urban Institute's Health Policy Center estimated that without a mandate, 40 million Americans would remain uninsured.

Meanwhile, the Flexible Spending Accounts that millions of Americans use to save money tax-free for medical expenses will be sliced under the law. FSAs often allow people to put aside up to $5,000 pre-tax; as of 2013, they were to face an annual limit of $2,500.

Small business owners

The rules and benefits small business owners face as a result of the health care law remain in place.

As CNN has chronicled, the law brought a mix of both. The director of the National Federation of Independent Business is one of the plaintiffs who pushed the court to strike down the law. Meanwhile, a group called Small Business Majority fought to protect the law, saying its loss could be a nightmare.

As of 2014, under the law, small firms with more than 50 full-time employees would have to provide coverage or face expensive fines.

All Americans, in lesser known ways

The massive health care law requires doctors to report goodies they get from medical supply companies; demands more breastfeeding rooms; requires all chain restaurants to list calories under every menu item, and includes numerous other provisions, which now remain in place.

Doctors and other health care providers

Health care providers have already begun making changes based on the 2010 law, and in preparation for what will go into effect in 2014. Those plans continue.

In the short term, doctors avoid "chaos" that may have resulted from the law suddenly being dropped or changed, according to Bob Doherty, senior vice president of governmental affairs at the American College of Physicians, who wrote a blog post on the website kevinmd.com this spring.

Medical groups have disagreed over the law.

How the Supreme Court Justices voted

http://www.cnn.com/2012/06/28/politics/supreme-court-health-effects/index.html

Supreme Court Upholds Entire Affordable Care Act

From Medscape Medical News
Supreme Court Upholds Entire Affordable Care Act

Robert Lowes

Posted: 06/28/2012

June 28, 2012 — The Supreme Court today declared in a 5-4 vote that the Affordable Care Act (ACA) — the most significant healthcare legislation since the creation of Medicare — is also a constitutional act.

The ruling comes as a shock to many observers, who predicted the court would strike down the individual mandate to obtain insurance coverage, if not the entire law, after its 5-member conservative wing voiced misgivings about the controversial provision during oral arguments in March. The court decision also represents an early Christmas present for President Barack Obama, who seeks reelection this fall against a Republican opponent committed to rolling back "Obamacare."

The individual mandate was at the core of a lawsuit filed against the ACA by officials from 26 states, all but 1 of whom were Republican, as well as a business association. Similar to their Republican allies in Congress, the plaintiffs claimed that the mandate violated the Constitution's Commerce clause, which empowers Congress to regulate interstate commerce. They argued that although healthcare is a form of interstate commerce, Congress cannot compel "inactive" individuals to engage in commerce; that is, to buy or sell something. To allow the mandate to stand, they said, would open the door to further encroachments on personal liberty.

A federal district court in Florida and a federal appeals court in Georgia sided with the plaintiffs and invalidated the individual mandate. However, the Supreme Court had other precedents to follow.
The majority of lower federal courts that ruled on similar challenges to the ACA gave the mandate a clean bill of health, agreeing with the Obama administration's argument that contrary to the law's critics, individuals foregoing insurance coverage actively participate in the healthcare marketplace because they will eventually require medical attention. Their decision not to get coverage is bad for everyone else because the cost of their free or subsidized care is passed on to others in the form of higher provider costs and higher premiums, according to the administration. In addition, the decision by healthy Americans to go uninsured leaves the existing risk pool of insured Americans smaller and sicker, driving up premiums even more.

The mandate helps cure all these problems, the administration contended, by forcing "free riders" to finance their healthcare now as opposed to later, if at all.
During the oral arguments in March, several conservative Supreme Court justices did not appear to buy into the administration's point of view.

"Here the government is saying that the federal government has a duty to tell the individual citizen that it must act," said Justice Anthony Kennedy, "and that is different from what we have in previous cases, and that changes the relationship of the federal government to the individual in a very fundamental way."

The court's ruling on the ACA addressed more than the mandate. The justices also upheld the constitutionality of the law's dramatic expansion of the Medicaid program, which the plaintiffs had portrayed as a usurpation of states' rights. The court also declared that a penalty levied on individuals who fail to obtain health insurance coverage beginning in 2014 does not bar consideration of the case beforehand. At issue was a law called the Anti-Injunction Act (AIA), which prohibits anyone from challenging a tax in court until it has been paid. A federal district judge in Richmond, Virginia, last year ruled that the ACA penalty amounted to a tax, and thus triggered the AIA.


http://www.medscape.com/viewarticle/765416?sssdmh=dm1.797961

Affordable Care Act Delivers Cheaper Prescription Drugs to Nearly 500,000 People

Law Has Already Saved $260 Million, Averaging $545 for People in Donut Hole

Thanks to the Affordable Care Act, nearly 500,000 people with Medicare Part D who reached the gap in coverage know as the “donut hole” have received an automatic 50 percent discount on their covered brand name prescription drugs. The Centers for Medicare & Medicaid Services (CMS) posted data today that shows 478,272 Medicare beneficiaries have benefitted from the 50 percent discount in the first five months of 2011. These beneficiaries saved a total of $260,534,102, or an average savings of $545 per beneficiary.

The number of seniors benefiting from this discount continues to grow. In the month of May alone, the total number of beneficiaries who received the discount rose by over 76 percent, while the dollar amount of savings rose by over 56 percent. Based on data from past years, CMS expects that as many as 4 million additional beneficiaries will fall into the coverage gap later this year and benefit from these discounts.

Most of these discounts are helping Americans with serious medical conditions – nearly 14 percent of the benefits provided to date – more than $36 million – are for cancer drugs, more than 8 percent or $21 million for drugs to help control high blood pressure and cholesterol, and another more than 7 percent – about $20 million – are for drugs provides to diabetic patients.

For more information on how the prescription drug discount and other provisions of the Affordable Care Act benefits seniors and people with disabilities, visit www.HealthCare.gov.

People with Medicare can learn more about these new benefits, including new free preventive benefits and other helpful information by contacting customer service representatives at 1-800-MEDICARE (1-800-633-4227 toll free) or by visiting http://www.medicare.gov/

A blog and state-by-state numbers are up on healthcare.gov now at: http://www.healthcare.gov/news/blog/Seniors06282011a.html

To read the entire CMS press release issued today (6/28) click here: http://www.cms.gov/apps/media/press/release.asp?Counter=3996

Pre-Existing Condition Insurance Plan-No longer need to wait for insurance denial letter

The Pre-Existing Condition Insurance Plan (PCIP) was created under the Affordable Care Act to ensure more Americans with pre-existing conditions have access to affordable health insurance and serves as a bridge to 2014 when insurers will no longer be allowed to deny coverage to people with any pre-existing condition, like cancer, diabetes, and asthma.  In 23 states and the District of Columbia, the PCIP program is federally-administered.  The remaining states operate their own PCIP programs using federal funds provided by the Affordable Care Act.

Reducing Premiums and Easing Eligibility
On May 31, 2011, the U.S. Department of Health and Human Services (HHS) announced new steps to reduce premiums and make it easier for Americans to enroll in federally-administrated PCIP programs:

• Premiums will drop as much as 40 percent in 17 states and the District of Columbia.  These premium decreases help bring PCIP premiums closer to the rates in each state’s individual insurance market; in the six states where PCIP premiums were already well-aligned with state premiums, premiums will remain the same.
• Eligibility standards will be eased in all 23 states and the District of Columbia where PCIP is federally-administered to ensure more Americans with pre-existing conditions have access to affordable health insurance. Starting July 1, 2011, people applying for coverage can simply provide a letter from a doctor, physician assistant, or nurse practitioner dated within the past 12 months stating that they have or, at any time in the past, had a medical condition, disability, or illness.  Applicants will no longer have to wait on an insurance company to send them a denial letter.  Applicants will still need to meet other eligibility criteria, including that they are U.S. citizens or residing in the U.S. legally and that they have been without health coverage for six months.

In the chart below, you can find how PCIP premiums will be changing in states with federally-administered PCIP programs.

State	PCIP Premium Reduction
Alabama	-40.0%
Arizona	-40.0%
Delaware	-40.0%
District of Columbia	-18.3%
Florida	-40.0%
Georgia	-15.5%
Hawaii	No Change
Idaho	No Change
Indiana	-26.2%
Kentucky	-40.0%
Louisiana	-24.8%
Massachusetts	No Change
Minnesota	-38.3%
Mississippi	-2.1%
Nebraska	-20.5%
Nevada	-37.5%
North Dakota	No Change
South Carolina	-14.7%
Tennessee	-18.4%
Texas	-23.6%
Vermont	No Change
Virginia	-40.3%
West Virginia	-15.8%
Wyoming	No Change

HHS also sent letters today to the 27 states running their own programs to inform them of the opportunity to modify their current PCIP premiums.

Increasing Outreach with Partners
Beginning this fall, HHS will begin paying agents and brokers for successfully connecting eligible people with the PCIP program.  This step will help reach those who are eligible but un-enrolled.  Several States have experimented with such payments with good success.  This is a part of continuing HHS outreach efforts with states, insurers, providers, and agents and brokers to reach more eligible people and let them know that coverage is available.  HHS is working with insurers to notify people about the PCIP option in their state when their application for health insurance is denied.

HHS is also reaching out to a coalition of providers and consumer advocates in each state.  Through meetings conducted by CMS and HHS regional offices and materials such as drop-in articles, fact sheets and brochures, many more consumers will be able to learn about the benefits of the PCIP program and more partners can learn how to help residents in their state sign up for this coverage.

Similar outreach efforts this spring helped raise PCIP enrollment by nearly 50% since February 2011.  Currently, 18,313 individuals receive coverage through PCIP.  For state-level enrollment data as of March 31, visit HealthCare.gov/news/factsheets/pcip05062011a.html.

About the Pre-Existing Condition Insurance Plan
PCIP provides comprehensive health coverage, including primary and specialty care, hospital care, prescription drugs, home health and hospice care, skilled nursing care and preventive health and maternity care.  It limits annual out-of-pocket spending and does not carve out benefits the people need.

Premiums will vary depending on the state you live in, and what plan you choose.  But as an example, if you live in a state where the U.S. Department of Health and Human Services provides coverage, the premium for an age 50 year old enrollee may range between $214 and $559, depending on State of residence and plan option.  Medical and drug deductibles vary by plan option.  For an estimated premium range for your state, go to www.HealthCare.gov/law/provisions/preexisting.

For more information, including eligibility, plan benefits and rates, as well as information on how to apply, visit http://www.pcip.gov/ and click on “Find Your State.” Then select your state from a map of the United States or from the drop-down menu. The PCIP Call Center is open from 8 a.m. to 11 p.m. Eastern Time. Call toll-free 1-866-717-5826 (TTY 1-866-561-1604).

http://www.healthcare.gov/news/factsheets/pcip05312011a.html